A shooter has opened fire at Westfield High. Kevin Gedman, student who survived the initial onslaught, flees to the library and informs his fellow students in the library that there is a gunman in the halls. The students barricade the door and hide in various places around the library. The door handles rattle, but the barricade holds. The students don't move and listen to the gunmen's footsteps. Their accompanying teacher realizes that the gunmen is approaching a second entrance. He darts up and slams himself against the unlocked door, barricading the closed door with his body weight. There is a moment of silence before the gunmen shoots a hole through the door, crippling the teacher. Tate pushes the door open, then walks around the library executing the students one by one. After his massacre, Tate returns home.
The Los Angeles SWAT team arrive and Constance answers the door. An officer asks her if Tate Langdon lives there, and she confirms that he is her son. The SWAT team enter the Langdon home and head upstairs, where Tate is waiting on his bed. They train their scopes on him, and he mimes putting a gun to his head, and quickly reaches for a gun, but is shot down immediately.
Violet searches online for information about the Westfield High Massacre and finds the list of victims and Tate's picture as the shooter. Frantically searching for her mother, she finds Constance waiting in the kitchen, who has deduced Violet has discovered the truth about Tate and the ghosts and introduces medium Billie Dean Howard who is there to help Tate move on, as he isn't aware he's dead. Constance explains that that is why she wanted Tate to see Ben. Constance and Billie Dean want Violet to help them get Tate to move on to the beyond and in order to convince Violet, who is still skeptical of ghosts in general and Billie Dean's abilities, Billie Dean passes on a recollection from Mary, Violet's dead grandmother.
Dreaming, Vivien rubs her pregnant belly while a cello plays and strange handprints appear from her womb, giving her pain, waking her up and causing her to press the panic button. Luke comes to check out the house, and deems it safe but mentions that Hayden didn't make it back to the police station. Ben has moved out and is back now for a therapy session in his office, despite Vivien wanting him gone but they come to a working arrangement.
Violet begins to self harm again and imagines herself cutting her throat in order to kill herself. She sees a vision of Tate, who asks whether she is scared now, and then disappears.
Ben's new patient, Derrick, is terrified of urban legends --particularly "Piggy Man", a pig butcher from Chicago in 1893, who wore a pig mask while slaughtering them. The pigs tore him apart after an accident and his former customers were dismembered. He can be conjured by anyone saying, "Here piggy pig, here piggy pig pig," into a mirror.
Violet enters to talk to Ben, and is beside herself, saying that the darkness is eating her up. Ben believes she is talking about the breakup of her parents but in reality, she is struggling to cope with her newfound knowledge of Tate's actions, his death, and the realities of ghosts. As he comforts her, Ben unknowingly calls Violet by Vivien's name.
Vivien is looking for Nurse Angie, who quit, while Moira cleans. Constance enters with a gift of sweetbreads (raw organs) for Vivien to eat for her pregnancy. Moira, as she prepares the food, tells Vivien that Ben will cheat again.
Ben works with Derrick again, using successive approximation in the Harmon's bathroom. Derrick tries the "pig call", and a bloody Gladys appears in the tub, believing she is meant, since she is overweight.
Vivien gets an amniocentesis.
Violet sees Leah, who has become her friend at the deserted swimming pool-turned-unofficial-skate park. Leah warns Violet that the devil is real and talks to her about the book of Revelation and the Red Dragon. As neither of them are sleeping; Leah offers Violet some of her sleeping pills.
Violet goes to the school library and sees the plaque commemerating the massacre victims. A teacher in a powered wheelchair discusses the incident with Violet, who wants to know why Tate did it, and the teacher thinks Tate just wasn't a good person.
Vivien tries to fire Moira because there's no money to pay her but Moira agrees to work for free. Vivien cautiously eats a whole brain raw sent by Constance, and discovers she enjoys it.
Violet comes home and catches a glimpse of Tate. Following him to the basement, she encounters the ghosts of Troy and Bryan, Gladys, Fiona, Dallas, and Charles Montgomery. Terrified, she runs upstairs to her room and finds that Tate has put her iPod on for her and written "I LOVE YOU" on her chalkboard. Scared and confused about her feelings, Violet attempts to commit suicide by overdosing on the sleeping pills Leah gave her. Tate finds her and drags her to the bath tub, trying to revive her whilst crying, successfully making her throw up some pills.
Ben is in session with Derrick who has met a woman but is too scared to pursue her. Ben challenges him to confront his issues in order to be able to start a relationship.
Vivien finds Angie in a church who has turned to Catholicism after claiming she saw the Antichrist in her womb. Vivien believes the woman is insane.
Derrick calls the Piggy Man in his own bathroom, and ironically dies when an overweight robber hiding behind the shower curtain believes that Derrick is aware of his presence and shoots him in the head.
Constance parlays with Billie Dean, who thinks Addy is mad at Constance. Constance says she has one last thing to say to Addy. Addy says through Billie that Constance should have treated her better. Constance apologizes to Addy, and tells her how proud she was of her and her beauty. Addy says she knows and is grateful that Constance "didn't get her to the lawn at the old house" but is now afraid of Tate. Back in 1994, Constance wants to talk to Tate, but Tate goes for a hidden gun under his pillow and is riddled with bullets by the SWAT team in response. An officer asks the dying Tate why he did it. Tate tries to say something, but dies before he can.
Violet had borrowed a book on birds from the school library that Tate took out previously in order to understand him as the school teacher who got shot had told her that Tate used to read books on birds. As she finds Tate's name on the register, Tate appears and asks her if she's going to tell her parents about the overdose. He confronts her on how distant she is to him now and wants to know if she wants him to leave her alone, admitting he is in love with her and will stand by her decision. Violet calls him to her, and they lie down in her bed -- in the same room in which Tate died -- both exhausted.
Derrick is a patient of Ben's who possesses an irrational fear of urban legends. As a result of these fears, he is largely meek, timid, scared, and defeated in disposition. He mentions to Ben that while growing up, he was constantly bullied by his brothers, who scared him for their own amusement. He doesn’t have the confidence and courage to look in mirrors due to his concerns of the Piggy Man legend. To help Derrick conquer his fears of Piggy Man, Ben urges him to carry out the Piggy Man ritual in front of a mirror. Derrick agrees to do so at his own home and successfully manages to utter the final "Piggy". Ironically, he dies in the bathroom when an overweight burglar hiding behind the shower curtain mistakes the chant as a deliberate insult to him, and shoots Derrick in the head. His partner chastises him for murdering Derrick, and the two flee.
Mary is Violet's late grandmother, appearing in a vision facilitated by the medium Billie Dean Howard.
Mr. Carmichael was shot in the Westfield high school library by Tate during his rampage in 1994. Violet finds him working at the library in 2011, but he is now disabled as a result of being shot.
Angela is a nurse who assists Vivien and Ben when the former begins to feel contractions. Angie questions the pregnancy timeline since the baby is much larger than it should be at eight weeks. Peering further at the ultrasound, she faints. Angela later converts to Catholicism, exclaiming to Vivien that she saw the Antichrist in her belly. Vivien, who believes the woman is crazy, leaves the church but Angela recites various Bible verses as she does so.
- Constance Langdon: "It's hard to keep good help."
- Leah: "The Devil is real and he's not some little red man with horns and a tail. He can be beautiful because he's a fallen angel and he used to be God's favorite. "
- Billie Dean Howard: "I see it all the time. The dead can hold a grudge better than most Scorpios."
- Denis O'Hare (Larry Harvey) is credited but does not appear.
- The SWAT team was provided by Sigloch, a company of mostly US Marine Corps and US Army vets that reenact fighting for movies.
- After Vivien eats a brain, Derrick gets shot in the head, an ironic twist on the Piggyman legend.
- Vivien’s consumption of raw meat is reminiscent of scenes in the film Rosemary's Baby , (directed by Roman Polanski, husband of Sharon Tate at the time of her murder) which actress Connie Britton says was “a big inspiration” for Ryan Murphy.
- Taissa Farmiga mentioned filming the bathtub scene in the November issue of Nylon magazine, saying that it was hard to film, but that it felt like an accomplishment afterwards.
- In Tate's fantasies about the school shooting he wears a black hoody, a Prussian blue American Civil War Union soldier coat and skull make up. His hair is slicked back. In reality, while he did wear the Civil War coat, he also wore a Black T-shirt and had his hair like he normally does, without any make up.
- To avoid paying licensing fees to Google, the search engine Violet uses is called RoundSearch.
- Similarly the LA Times is called LA Tribune on the show.
- The bird book that Tate took out and that Violet takes out to retrace his steps is a reprint of John James Audubon's "Birds of America" (1827), in the edition by Roger Tory Peterson (called the "Baby Elephant Folio"). This book currently costs $ 185.
- In the scene in which Tate is shot by the SWAT team, two books are visible: A copy of Henrik Ibsen's "A Doll's House", the play on the horrors of marriage. In Violet's room there is an actual doll house in its stead. The other book is "Water's Edge: Domestic Politics and the Making of American Foreign Policy" (1979) by Paula Stern. This book is a history and critique of the Jackson-Vanik amendment, further pushing Tate's intellectual/deep thinker credentials.
- In another ironic reference, similar to the "Don't get stuck in high school" monologue, Tate says to Violet "I don't know what I've done".
Theorized references are references that fans strongly suggest there is a connection there, but there is no proof/information/confirmation from an AHS cast member at this time it is a reference.
- The bird book is a reference to the 1988 film Beetlejuice in which the character Charles is obsessed with bird books as well.
- Jeff Jensen, a writer for Entertainment Weekly, suggests the title of the episode as well as the Pigman legend itself is a reference to the song "Piggy" by Nine Inch Nails, recorded in the home of Charles Manson victim Sharon Tate. ("Hey pig piggy pig pig pig/All of my fears came true.") Tate's name is a reference to Sharon Tate, as was his "Helter Skelter" and LaBianca's murder. The title score was recorded by a member of Nine Inch Nails. This theory also connects to Cult, as a fictionalized version of Sharon Tate actually appears, being reenacted along with other actors, portraying Charles Manson's followers.
- Stack, Tim, "'American Horror Story': Ryan Murphy on Vivien's blood-craving baby and next week's 'most sexual episode' yet -- EXCLUSIVE" | EW | 9 Nov. 2011. <http://insidetv.ew.com/2011/11/09/american-horror-story-ryan-murphy-piggy-piggy/>.
- Tim Stack (November 9, 2011). 'American Horror Story': Ryan Murphy on Vivien's blood-craving baby and next week's 'most sexual episode' yet -- EXCLUSIVE. Entertainment Weekly. “There’s a little bit of a homage to Rosemary’s Baby where she ate the liver.”
- Smith, Caitlin | "Something Wicked" | Nylon | Nov. 2011. | p. 119/120 <http://www.zinio.com/reader.jsp?issue=416196386&o=ext>.
- Jensen, Jeff, "'American Horror Story': Sympathy For The Devil. Or Not." | EW | 10 Nov. 2011. <http://tvrecaps.ew.com/recap/american-horror-story-piggy-piggy-episode-6/>.