The central twist of "Vertigo" is revealed in a flashback from Judy's perspective about two-thirds into the film: the woman Scottie knew as Madeleine never died. Judy was hired by Gavin Elster to impersonate his wife, Madeleine, as part of an elaborate plot to murder the real Mrs. Elster. Elster knew of Scottie's acrophobia and used him as the perfect witness. When Judy, as Madeleine, ran up the bell tower, Scottie was unable to follow. At the top, Elster was waiting with the body of his real wife, which he threw from the tower. The inquest ruled it a suicide, and Scottie's testimony, colored by the story of Madeleine's 'possession,' sealed the case.
This early reveal completely changes the film's dynamic. The suspense is no longer about what happened to Madeleine, but about Scottie's psychological state and Judy's agonizing predicament. We watch with dread as Scottie, unaware of the truth, forces the woman he once loved (and who loves him back) to erase her own identity and become a ghost. His obsession is revealed not just as romantic longing, but as a form of necrophilia—he is trying to bring a dead woman back to life. Every moment of Judy's transformation is fraught with tension and pathos. The Carlotta Valdes necklace becomes the crucial clue. When Scottie sees Judy wearing it, he finally understands the deception. His decision to take her back to the scene of the crime is an act of cruel psychological retribution. The ending is crushingly ironic: Judy, startled by the sudden appearance of a nun, falls to her death from the tower, tragically and accidentally recreating the fake suicide she was paid to perform. Scottie is left standing at the precipice, cured of his vertigo but having lost everything, a man completely broken by his obsession.