Phantom Limb

The novel’s conclusion is built upon a structure that embodies The Importance of Confronting the Truth. By withholding the protagonist’s true identity until the final pages, the author constructs an immersive experience of a dissociative fugue state. The entire narrative preceding the climax in Chapter 23 is revealed to be a product of the narrator’s imagination, revealing that the epiphany in Chapter 19—when she admits to herself and others that Emily has been dead for two years and that the Emily who lived with her during this time was a hallucination—is a partial truth at best. The text of the headstone, “Emily Rooth (1991-2009)” (230), functions as an external truth that collapses the narrator’s psychological defense. Seeing her own name printed on a headstone triggers the narrator to refute this falsehood, remembering for the first time since the car crash that she is Emily and Elizabeth is the one who died in the accident. This last-act plot twist—a common technique in the psychological thriller genre—forces a complete reinterpretation of every prior scene; every fight with the phantom “Emily” and every description of her self-harm is recast as a manifestation of a single, tormented consciousness. This illustrates that memory is not a passive record but an active force used to rewrite a history too traumatic to bear.

These final chapters deconstruct the initial binary of the “healthy” twin caring for the “sick” one, revealing this dynamic as a projection that serves to manage The Fragmentation of Identity After Trauma. Elizabeth, as a persona, represents the competent ego ideal, while the created memory of Emily embodies the repressed, guilt-ridden, and self-destructive aspects of the narrator’s psyche. The therapist Lisa provides the clinical framework for this fusion when she explains, “[I]n reality, you’ve been both Emily and Elizabeth for two years” (194). The narrator, Emily, externalizes her suicidality and trauma onto a phantom version of her sister, which allows the “Elizabeth” persona to function in the world. The suicide attempt that lands her in the hospital is the ultimate manifestation of this internal war. The Epilogue presents the culmination of this fragmentation. Rather than integrating these disparate parts into a whole self, Emily makes a conscious decision to permanently suppress her original identity, denying herself the chance for true healing.

The motif of cutting and scars highlights Self-Harm as a Manifestation of Psychic Pain. Initially presented as a symptom of her sister’s depression, the self-harm is recontextualized as the narrator’s own ritual of penance for causing Elizabeth’s death. The moment the narrator truly sees the scars on her own legs—a revelation prompted by observing her friend Rose’s body dysmorphia in a mirror—marks the beginning of her constructed reality’s collapse. After the full memory of the car accident returns, every cut is recontextualized as an act of self-punishment by Emily, who cannot otherwise atone for having killed her sister and taken her identity, since she is not consciously aware of having done these things. The Epilogue’s final scene solidifies this connection. Alone in her new room, Emily unwraps a new razor. The act is framed as a necessary release, a feeling of “undeniable pleasure of my soul being set free” (242). This demonstrates that her underlying guilt remains unaddressed. By choosing to live as Elizabeth, she avoids public accountability, but her body becomes the private site where justice is endlessly enacted.

The figures of Lisa and Dr. Larson represent systems of therapeutic intervention that are ultimately subverted by the protagonist’s will to deceive. Both therapists correctly identify key elements of her condition: the dissociative disorder, the underlying childhood sexual abuse, and the need to process grief. Dr. Larson’s session successfully triggers a breakthrough, forcing a confrontation with repressed memories. Yet, the novel suggests that therapeutic language can be manipulated to avoid The Importance of Facing the Truth. Once Emily understands the mechanics of her own psychology, she learns to perform the role of a healing patient. She consciously uses the therapeutic framework to construct a convincing narrative of “integration” for Dr. Larson, all while cementing her decision to permanently dissociate from her true self. Her avoidance of Lisa in the Epilogue is a tacit admission that her deception could not withstand the scrutiny of someone who has deep, personal history with both twins. The hospital system discharges her based on her performance of recovery, highlighting a disconnect between observable behavioral change and true recovery.

The friendship between the narrator and Rose functions as a critical catalyst, built on a shared foundation of mental health crises. Rose’s anorexia is a parallel disorder to the narrator’s dissociative identity; both involve a schism between internal perception and external reality. It is by witnessing Rose’s delusion in a mirror—seeing her point to non-existent fat on her emaciated frame—that the narrator is forced to question her own perceptual reality, leading to the recognition of the scars on her legs. Their bond offers genuine comfort and a vision of a post-hospital future, culminating in the plan to become roommates. However, the Epilogue reveals the limitations of this connection. Emily watches Rose relapse into her eating disorder and says nothing, recognizing a shared, unspoken pact to maintain their respective fictions. Her new identity requires a degree of emotional compartmentalization that precludes genuine intervention. Their friendship, born from a moment of shared truth, ultimately settles into a quiet coexistence of separate, protected delusions.