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In Edgar Allan Poe's "Tell-Tale Heart," the burden of guilt and its psychological effects drive the narrative to insanity, leading him to truly believe he is hearing the beating heart of the old man.
The confined setting within the story serves to heighten the drama and emotion. We as an audience never see beyond the walls of the house, making the story much more eerie.
The narrator sneaks into the old mans room for seven consecutive nights. The thrill and excitment that overcomes him when he plots to kill the old man points to an extreme level of mental derangment.
Poe uses the passage of time to increase tension. As the audience we are on edge ondering when the old man will be murdered.
Poe builds on the anticipation of the narrators downfall with the sound of the old mans heart. It beats faster and louder, until he eventually breaks down.