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‘You’re Not You’: Beautiful acting by Hilary Swank, Emmy Rossum

Sometimes formulaic works.

“You’re Not You” has the classic ingredients of a made-for-TV weeper, but thanks to a fine screenplay, sure-handed direction and two beautiful performances, it becomes something more, something better.

Something that earns your heart.

Hilary Swank has never become a giant movie star, but there’s a reason she has two Academy Awards. When given the right material, she soars.

Swank plays Kate, a gifted classical pianist with a seemingly idyllic life. Her dashing husband (Josh Duhamel) dotes on her, she has marvelous friends, and she lives in a house suitable for the cover of Architectural Digest.

But after playing piano one night at a dinner party, Kate experiences a slight tremor in her hands — and unless you’ve never seen any movie, ever, you know when a character notices a minor affliction, it’s just the beginning of her troubles.

She is diagnosed with ALS aka Lou Gehrig’s Disease. Within a year, she’s unable to use the bathroom or take a shower without the help of a caregiver or her husband, who is fiercely protective of her and seems nearly obsessive about taking care of Kate.

In a plot development that stretches credibility but we need it to set the table for the rest of the story, Kate hires a new caregiver: the utterly inexperienced Bec (Emmy Rossum), a human train wreck who bounces in and out of college, hops in and out of the beds of strangers (“I’m not girlfriend material” she blithely tells one conquest), drinks a lot and has a half-assed dream of becoming a singer-songwriter, if only she could get over her stage fright.

They invented the term “hot mess” for this girl. Bec isn’t much different from Rossum’s Fiona Gallagher character on “Shameless” — a smart, beautiful, screwed-up chick who is often her own worst enemy. For such an elegant actress (she once played the young Audrey Hepburn in a TV movie), Rossum has a real affinity for playing hardscrabble types.

As Kate and Bec begin to bond, the wheels come off elsewhere. The shining knight husband develops some serious chinks in his armor, Kate’s girlfriends are incapable of dealing with her rapidly deteriorating condition, and then there’s Kate’s mother (Frances Fisher), a real piece of work. (Both Kate and Bec have serious mom issues.)

Working from a screenplay by Jordan Roberts and Shana Feste (based on the novel by Michelle Wildgen), director George C. Wolfe nimbly peppers in some much-needed comic relief. Stephanie Beatriz plays Bec’s wisecracking best friend. Loretta Devine is an ALS patient with a wonderful, adoring husband (Ernie Hudson). Although they’re in just a handful of scenes, Devine and Hudson create a lovely, authentic romance worthy of an entire movie of their own.

“You’re Not You” becomes a love story of sorts. Not a romance, but Kate comes to depend on Bec, and Bec feels a sense of self-worth for perhaps the first time in her life. They cling to each other in the storm.

Swank is amazing. Kate’s condition worsens to the point it’s almost impossible to understand what she’s saying, and Bec has to act as her interpreter. Kate is unable to walk, she can’t take care of herself, her physical moments are extremely limited — and yet she’s still Kate. Her mind is intact, but she’s trapped inside her own body. It’s a heartbreakingly effective performance.

Rossum’s Bec, on the other hand, is a whirlwind — constantly in motion (unless she’s battling a hangover), as if she’s afraid to sit still and be alone with her life. She’s funny but also a little bit tragic. It’s perhaps Rossum’s best work to date.

There’s no cure for ALS. Kate knows this, and she explodes in anger whenever anyone tries to sugarcoat her situation or talks about “experimental” treatments. She has been handed a death sentence and she won’t pretend otherwise. A movie about this subject matter is a tough sell, but Swank and Rossum are brilliant, and in its own unique way, “You’re Not You” is one of the best buddy movies of the year.