Phantom Limb

The narrator’s first sensory experiences upon waking in the hospital—described as fragmented phrases like, “Beeping. Machines whirring. Footsteps” (55), mirror the narrator’s shattered consciousness. Her amnesia surrounding the suicide attempt is a foundational element of her dissociative state, illustrating The Importance of Confronting the Truth. In constructing an alternate reality after the death of her twin, the narrator has left herself vulnerable to a hidden truth that can harm her without her knowledge. This hidden truth is hidden from the reader as well as the narrator. By presenting the narrative directly from the narrator’s disoriented perspective, the novel compels an initial acceptance of her version of reality. The clinical environment of the hospital, with its locked doors and constant surveillance, serves as a physical manifestation of her psychological imprisonment. She is trapped not just by the mental health facility, but by a delusion designed to protect her from an unbearable truth. This section uses the conventions of first-person narration to turn the reader into a participant in the protagonist’s delusion, making the eventual dismantling of that reality a shared experience.

Within the psychiatric ward, the narrative explores The Fragmentation of Identity After Trauma by presenting characters whose conditions echo the narrator’s own hidden turmoil. The ward functions as a microcosm where the stability of the self is shown to be fragile. Rose, the patient with anorexia, serves as a critical foil. Her inability to perceive her own emaciated body accurately foreshadows the narrator’s own disconnect from her physical self and the scars she does not remember inflicting. Rose’s distorted perception provides a tangible example of the mind’s capacity to create a false reality. Similarly, Doris’s violent outburst, in which she screams, “I kill me mudder!” (86), is a raw, externalized manifestation of the kind of profound guilt that the narrator is systematically repressing. The narrator is an observer of these other individuals: She analyzes their behaviors from a vantage point of perceived sanity, reinforcing her constructed role as the stable sister, Elizabeth, while her own internal reality is as fractured as that of anyone around her.

The motif of enclosed spaces, previously associated with the twins’ abusive childhood, is reconfigured within the psychiatric unit to represent a different form of imprisonment. The descriptions of locked doors, security protocols, and escorted movements create a sense of physical and psychological confinement. This oppressive atmosphere externalizes the narrator’s internal state: She is trapped within a labyrinthine mental construct. The architectural layout of the ward, with its central nurses’ station, reinforces a feeling of constant observation, stripping away privacy and autonomy. This forced transparency stands in stark contrast to the insular world the narrator believes she shared with Emily. The hospital environment is therefore not just a setting but an antagonistic force where her fabricated self is subject to constant examination. This institutional pressure creates the narrative tension necessary to precipitate the eventual collapse of her delusion, demonstrating how external structures can challenge and break down internal defenses.

These chapters develop the theme of Self-Harm as a Manifestation of Psychic Pain by seeding the narrator’s monologue with language that operates on a dual level. Her declaration, “I remember that I’m the one who killed her” (61), is presented and interpreted by all characters as survivor’s guilt. However, in light of the later revelation that the narrator is Emily, it becomes a confession disguised as a figurative expression of grief. This unresolved culpability affects the narrator’s interactions. She rejects the comfort of her adoptive parents and Thomas not out of simple grief, but from a sense of unworthiness, believing she does not “deserve […] expressions of love” (61) because she failed as a protector. Her rage upon learning of Emily’s burial is a panicked reaction to the objective finality of the grave, a fact that threatens the foundation of her two-year delusion. The burial forces a piece of the real world into her controlled narrative, representing a loss of control over the memory of the person whose identity she has assumed to survive her guilt.

The treatment team meeting and group therapy session highlight the limitations of clinical psychology in the face of deceptive trauma. The narrator approaches these sessions as a performance, curating her answers to align with what she believes a grieving but recovering person should say. She leverages therapeutic language—referencing her “support network” (75)—to manipulate the system for a quick release. The clinical environment, with its diagnostic labels, is ill-equipped to penetrate a delusion so deeply integrated into the patient’s identity. The other patients, who readily announce their diagnoses, contrast sharply with the narrator, whose true illness is hidden. Mark Underwood’s correction, urging patients to see their illness as a part of them rather than their entire identity, is ironic. The narrator has done the opposite: She has completely subsumed her identity into a fabricated one. This section reveals how an intelligent individual can use the system’s own language to conceal a truth more complex than a textbook diagnosis can capture.