On your turn, you take two actions. An action is almost always used to play a card from your hand. How that works depends on what kind of card you choose.
When the game ends, each player adds up the Self-Worth scores of all their dead Characters. If the Porcelain Throne is controlled, that player scores an additional −30 Self-Worth Points. The player with the lowest total wins!
When one entire family has succumbed to Untimely Deaths, the game ends. Self-Worth scores are then tallied, and the most miserable player wins the game.