“The Fall of the House of Usher” is about the fine line that exists between reason and madness. The narrator represents the reasonable individual of sound mind and judgment who falls prey to the evil, otherworldly influences of a diseased place. The line between sanity and insanity is a popular theme in Gothic fiction, as is the story’s plot structure. Often, a protagonist in Gothic fiction receives a letter inviting them to visit a long-lost friend or relative. The location is remote, and there is often an ailing relative living deep within the house who remains unseen. The protagonist experiences progressively stranger feelings and events, and they must decide if these experiences are real or a figment of their imagination.

Gothic narratives that follow this plot structure force both the protagonist and the reader to confront the limits of their sanity when faced with unexplainable, terrifying events. The protagonist’s task is either to escape (often saving a young woman in the process) or to succumb to madness themselves.

Death is always a central theme in Gothic literature, and in this case, the story contains various kinds of death. At the beginning of the story, death is imminent: Madeline dies early in the story, and Usher’s worsening health imply that the family line, which has been dwindling for generations, is nearing its end.