49 pages • 1-hour read
Phantom Limb
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Chapters 10-14Chapter Summaries & Analyses
Content Warning: This section of the guide contains discussion of mental illness, self-harm, and death.
Chapter 10 Summary
The next morning, Elizabeth cannot eat. She thinks about Emily and a plan she once made to be buried with her. Though this plan is now impossible, she wishes to join Emily in death as soon as possible. This wish makes her feel guilty because of the pain it would cause Dalilah and Bob. She compares the shock of Emily’s absence to the pain of a phantom limb after an amputation. When Dr. Larson calls her in, she repeats her story of attempting to die by suicide after finding Emily dead.
Dr. Larson states that Emily’s funeral was two years ago and that Elizabeth attended it. The shock pushes Elizabeth into a dissociative state. She flashes back to a childhood court hearing where she climbed a tree to escape the chaos. When she returns to the present, she is in the family room with Rose. Elizabeth rejects Dr. Larson’s claim as a cruel test and tries to reason it away by recalling recent, vivid memories of Emily being alive.
Chapter 11 Summary
That afternoon, Elizabeth anxiously waits for the medical team meeting. The strain overwhelms her, and she has a panic attack and vomits. Rose and Polly help her to the bathroom. Polly lets her lie down in her room, and Elizabeth drifts into recurring nightmares. When she rejoins the group, she watches as other patients compare their self-inflicted scars.
In group therapy, a patient named Shelly confronts Elizabeth, demanding to know why she is there. Rose intervenes, explaining that Elizabeth is struggling to process events. Shelly backs off. Elizabeth observes the unit’s unspoken hierarchy and the ways patients protect themselves.
Chapter 12 Summary
Right after group, Dr. Larson escorts Elizabeth to the team meeting, where she tells the clinicians she thinks they are testing her sanity. Dr. Karen Heimer, a psychiatrist, restates that Emily died two years ago. Elizabeth lunges at the doctor in a rage. Staff restrain and sedate her. She wakes in four-point restraints, which Polly removes once she settles. Elizabeth refuses visitors and dinner. When she returns to the common room, Rose says, “[Y]ou’re one of us now” (128).
The next morning, Elizabeth expects to be discharged, as her 72-hour psychiatric hold, imposed because of her suicide attempt, is ending. Instead, Dr. Larson explains that her adoptive mother, Dalila, holds power of attorney and has extended the psychiatric hold. The session shifts toward Elizabeth’s history. Dr. Larson asks about her earlier therapy, and Elizabeth describes positive work with Lisa, the therapist who once helped her and Emily feel safe.
Chapter 13 Summary
On the third day, Elizabeth tells Rose her stay has been extended. Morning group derails when Shelly explodes again, and Elizabeth withdraws. She admits to Rose that her twin is dead. Rose responds with simple kindness. The release of pressure breaks Elizabeth, and she sobs—the first time she has cried in front of anyone but Emily. She remembers how their biological mother taught her to hide tears.
The exchange encourages Rose to share her own story: Her father left when she was an infant, her mother was a wealthy and successful attorney who neglected her emotionally, she developed an eating disorder in childhood, and a suicide attempt at 11 years old led to her first stay in a mental health facility. The exchange exhausts Elizabeth. She refuses visitors again and goes to bed early, feeling trapped.
Chapter 14 Summary
On the fourth day, Dr. Larson asks why Elizabeth keeps turning away visitors. She explains that she cannot return Dalila’s love and traces that numbness back to her biological mother. Dr. Larson uses attachment theory to explain her feelings. When she asks for a diagnosis, he tells her she has Dissociative Disorder Not Otherwise Specified, a fragmentation of the mind that follows severe trauma.
Elizabeth recalls talking with Emily about losing time and having similar memory gaps. Dr. Larson explains that Emily was Elizabeth’s protective factor and that her death led Elizabeth to break from reality. He repeats that Emily has been dead for two years and no one is testing her. He considers her ability to ask about what is real a sign of progress.
Chapters 10-14 Analysis
The narrative structure in this section places the reader within the protagonist’s reality, establishing a conflict between subjective experience and objective truth. Through the unreliable first-person narrator, the text fosters an identification with a consciousness that is actively fabricating its world to survive. The foundational crack in this reality appears when Dr. Larson states that Emily’s funeral occurred two years prior. This revelation is a structural assault on the narrative framework. The narrator’s immediate response is to retreat into a dissociative state, recalling a childhood memory of escaping a courtroom by mentally climbing a tree. This analepsis provides a historical precedent for her coping mechanism, rooting her delusion in a long-standing pattern of self-preservation. Her subsequent internal monologue, in which she refutes the doctor’s claim by citing detailed “memories” of Emily’s recent existence, illustrates her resistance to The Importance of Confronting the Truth. These are not faulty recollections but meticulously constructed artifacts of a mind defending itself against an annihilating truth.
Central to the protagonist’s psychological collapse is the novel’s title metaphor, the phantom limb, which represents a fractured self. The narrator articulates her loss: “Now it was as if part of my body had been suddenly chopped off. […] I was left with the excruciating phantom pain of being tortured by my lost limb” (105). This self-diagnosis suggests that without her twin, the narrator does not feel whole. The symbol supports the theme of The Fragmentation of Identity After Trauma by asserting that the twins’ codependency was so absolute that one’s death constitutes a dismemberment of the other’s being. The locked psychiatric ward, in which the patients’ movements are tightly controlled, functions as a physical symbol of the narrator’s mental imprisonment. This connection is reinforced by the motif of locked rooms; the secured unit is an externalization of her own mind. Her violent reaction to being confined—lunging at a doctor and being physically restrained—mirrors her psychological struggle against a reality she cannot accept. The ward becomes a crucible where her internal and external captivities merge, forcing a confrontation her fabricated world was designed to avoid.
Within the ward, a new social dynamic emerges that challenges the protagonist’s isolation and begins to reshape her fragmented identity. The psychiatric unit operates as a microcosm with its own hierarchy and rituals. The protagonist’s initial posture is that of an outsider, but her developing rapport with Rose signals a critical shift. This relationship offers a model of connection based not on the fused identity of twinship but on the shared experience of Self-Harm as a Manifestation of Psychic Pain. The other patients’ ritual of comparing self-inflicted wounds introduces the motif of cutting and scars as a communal language of pain. This scene foreshadows her own confrontation with the forgotten marks on her body, positioning self-harm as a legible record of emotional pain. The pivotal moment of her integration occurs after her violent outburst, when Rose welcomes her with the declaration, “You’re one of us now” (129). This acceptance marks a change in her self-perception; she is no longer merely an observer but an initiated member of a community defined by psychological wounds. This forced belonging erodes the boundaries of her exceptionalism and is a necessary step toward recognizing her own trauma.
The narrative grounds the protagonist’s surreal experience in genre conventions of the psychological thriller through the introduction of clinical language and diagnostic frameworks. Dr. Larson’s explanation of attachment theory contextualizes the narrator’s inability to reciprocate Dalila’s maternal affection, tracing it back to childhood neglect. This clinical lens reframes her emotional numbness not as a personal failing but as a predictable outcome of developmental trauma. His diagnosis of Dissociative Disorder Not Otherwise Specified further demystifies her condition, defining her memory loss and fragmented self as symptoms of a recognized psychological response to stress. The medical team’s approach mirrors a therapeutic process: They first introduce a destabilizing fact, endure the patient’s violent rejection of it, and only then provide a theoretical framework for processing it. Dr. Larson’s explanation that Emily served as her “protective factor” (154) and that her death caused a split from reality provides the core thesis for her psychological state: “[I]nstead of dealing with the reality of her death, you continued to live as if she was alive” (154). By embedding these clinical concepts within the narrative, the text validates the extremity of the protagonist’s mental break while charting a potential path toward comprehension.
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