Phantom Limb

“She shook her head. ‘It felt good.’ She smiled as if she’d just won an award.”

Self-harm in the form of cutting and scars serves as a motif throughout the book. Here, the simile comparing Emily’s smile to that of someone who has “won an award” juxtaposes physical injury with a sense of accomplishment. This establishes a psychological link between self-inflicted pain and relief, a coping mechanism born from trauma that becomes central to the narrator’s own suppressed identity and her performance of Self-Harm as a Manifestation of Psychic Pain.

“I had super powers and used them to float into the ceiling tiles to watch myself. I waited to come down from the tiles until the game was over.”

This passage describes dissociation as a childhood survival strategy during sexual abuse. The narrator’s framing of this mental escape as “super powers” illustrates how a child’s mind rationalizes a traumatic defense mechanism. This ability to psychologically detach from her own body and experience foreshadows the far more profound and long-term dissociative fugue she enters after her sister’s death, forming the basis for the novel’s unreliable narration.

“‘Elizabeth, it’s okay.’ […] ‘It’s okay to love someone other than Emily. You know that, don’t you? It’s okay to let go.’”

Spoken by the therapist Lisa, these words become ironic in light of the revelations at the end of the book. While Lisa intends to give “Elizabeth” permission to form a healthy, independent identity, she is actually speaking to Emily, who has taken on the identity of the deceased Elizabeth. In suggesting that the narrator “let go,” Lisa unwittingly gives her permission to let go of the memory of the real Elizabeth and fully inhabit her life, highlighting the theme of The Fragmentation of Identity After Trauma.

“No, I won’t. I’ve had the exact same life. We’ve been the same damn person. For the first time ever, I was doing something for myself. Just me.”

During a climactic fight with her sister “Emily,” the narrator “Elizabeth” unknowingly screams the literal truth of her psychological state. The lines, “I’ve had the exact same life,” and, “We’ve been the same damn person,” are intended as hyperbole but are in fact literal statements about her dissociative identity. This moment of irony captures the internal war between the narrator’s fractured psyche—the stable “Elizabeth” who wants a future and the wounded “Emily” who is fighting for survival.

“My twin was dead, which meant I was only half-alive, and the intensity of the loss screamed at me, shattering every wall I’d built over the years to keep myself strong. The space she occupied within me was immense and limitless, and the loss of her left an empty, aching void inside of me that could never be replaced with anyone else’s love.”

In this internal monologue, the narrator uses the metaphor of being “half-alive” to articulate her grief, suggesting that, as a twin, she is incomplete in herself. The personification of loss as something that “screamed” and the imagery of “shattering every wall” illustrate the violent, overwhelming nature of her psychological trauma. This passage establishes the foundation of her fragmented identity, portraying her sense of self as being entirely dependent on her twin’s existence.

“Emily and I were each other’s life support. My purpose in life was to take care of her and keep her safe. […] I kept Emily going when she didn’t have the strength to keep going on her own, but she kept me going too because she gave me a purpose for living. She defined me, gave me the role I had to play.”

This reflection on the twins’ past reveals the deep-seated codependency that blurred their individual identities long before the narrative’s central trauma. This characterization establishes the psychological groundwork for the dissociative fugue, suggesting her identity was already primed for fusion with her sister’s.

“I would like you all to try and remember that you are not your mental illness. Your mental illness is only a part of you. I want to encourage you all to say your name and then say ‘with a disorder.”

Delivered by a psychologist during group therapy, this line functions as situational irony, highlighting the gap between conventional therapeutic practice and the narrator’s unique psychological state. The advice to separate identity from diagnosis is impossible for the narrator, whose entire identity is a construct of her trauma and mental illness. This moment subtly underscores The Fragmentation of Identity After Trauma, showing how the narrator’s condition defies standard psychological frameworks.

“I was in the hospital for trying to kill myself but had no memory of what I’d done that night. I searched my brain for one, but there was nothing. […] I could trace my memory all the way back to opening up the bathroom door and discovering her crumpled body, but that was it. Her body and then darkness.”

This passage explicitly demonstrates The Importance of Confronting the Truth by highlighting the narrator’s amnesia surrounding her suicide attempt. The stark contrast between the vivid (though fabricated) memory of finding Emily and the complete “darkness” that follows is a key structural clue to her dissociative state. This memory gap builds suspense and characterizes the narrator’s fractured consciousness, showing how her mind has selectively erased an unbearable truth.

“‘Get out!’ I screamed at them, pointing at the door. ‘Leave. All of you. Now! You buried her. You put her in the ground without me even being there! How could you? Why would you do that?’”

This outburst marks the first major fracture in the narrator’s meticulously constructed delusion. Triggered by her adoptive father’s accidental mention of Emily’s grave, her violent reaction reveals the immense psychological energy required to maintain her alternate reality. The raw, accusatory dialogue demonstrates her complete belief in the false timeline she has created, where Emily’s death is a recent event, and foreshadows the violent internal conflict that will occur as reality continues to intrude.

“Emily and I were two parts that made a whole, and I was only half of a person without her. […] Now it was as if part of my body had been suddenly chopped off. I was an amputee, and like any amputee I was left with the excruciating phantom pain of being tortured by my lost limb.”

Following the news of Emily’s burial, the narrator uses the extended metaphor of phantom limb pain to convey an abstract psychological state, framing the twins’ identities as literally inseparable. This passage establishes the core argument of the theme The Fragmentation of Identity After Trauma by suggesting that the loss of one twin creates an unbearable void that feels like a physical amputation.

“Shelly turned to me. ‘What about you? Are you a cutter?’ I shook my head.”

In a conversation with other patients about self-harm, the narrator’s simple denial functions as a moment of irony, though this irony becomes clear only at the end of the novel. Unbeknownst to her, she is the one inflicting the cuts on her own body, a truth her dissociative state conceals by projecting the behavior onto her memory of Emily. This dialogue highlights the unreliability of her narration and directly engages with the cutting and scars motif as a physical manifestation of a guilt she cannot consciously access.

“‘Shut up!’ I lunged at Dr. Heimer. I couldn’t help it. I wanted to make her be quiet.”

During a team meeting, the narrator’s violent physical reaction to a doctor confirming Emily’s death illustrates the extreme measures her psyche employs to protect its delusion. Her loss of control is a defense mechanism, externalizing her internal struggle to preserve the reality her mind has constructed for survival. The attack is not merely an emotional outburst but a desperate, physical attempt to silence an objective truth that threatens to shatter her entire identity.

“I’d started swallowing my tears as a little girl when I figured out that the only way Mother knew she hurt me was if I cried and I was determined that no matter what Mother did to me, she would never know she’d hurt me. […] Something had shifted.”

After breaking down in front of her new friend Rose, the narrator reflects on the origin of her emotional suppression through a flashback to her childhood abuse. The act of “swallowing tears” is presented as a learned survival tactic, demonstrating the long-term psychological impact of her early trauma. Her admission that “[s]omething had shifted” marks a critical turning point, indicating that the defenses built in childhood are beginning to crumble, a necessary step for her repressed memories to eventually surface.

“When she died, it was more than your frail psyche was able to handle, so instead of dealing with the reality of her death, you continued to live as if she was alive.”

Dr. Larson provides the first clear, clinical explanation for the narrator’s psychological state, offering a framework for understanding her delusion. This piece of exposition explicitly defines her experience as a product of dissociation, linking her current condition directly to the trauma of her twin’s death. The quote serves as an authorial signpost, shifting the narrative’s central question from whether the narrator is grounded in reality to why her mind created such an elaborate and protective fantasy. As this fantasy becomes unsustainable, Dr. Larson emphasizes The Importance of Confronting the Truth.

“If Dr. Larson was right and I’d been creating Emily for the last two years, then why did I make her sick and give her such a miserable existence? If I imagined her because I couldn’t let go of her, then why did I invent a scenario that suffocated us both and left me feeling so alone?”

In this moment of introspection, the narrator grapples with the logic of her own delusion. The use of rhetorical questions demonstrates her internal conflict as she attempts to reconcile the protective impulse to “keep Emily alive” with the painful reality of the fiction she has constructed. These questions function ironically, as the narrator is unknowingly articulating the core of her trauma; she created a sick and suffering Emily as a manifestation of her own guilt and self-loathing, a key aspect of the theme of Self-Harm as a Manifestation of Psychic Pain.

“I’d heard it before. Every guy I dated said the same thing. ‘I think I’m numb from the waist down.’ I’d never felt a thing. Unlike me, Emily loved sex and couldn’t get enough of it.”

Though both “Emily” and “Elizabeth” are largely constructs of the narrator’s imagination, they are foils for each other. The narrator’s declared physical and emotional numbness contrasts sharply with the sexual appetite she projects onto her twin, a psychological split that foreshadows the final revelation of her fragmented identity. By assigning sexual trauma and subsequent aversion to her “Elizabeth” persona while attributing uninhibited sexuality to the “Emily” she has created, the narrator unknowingly compartmentalizes the conflicting aspects of her own self.

“I found an online support forum for people who’ve lost their twins. […] They talk about their experiences and tell personal stories and stuff. I thought you might like to read them, so I used up half my ink printing out a bunch of it.”

Here, Thomas’s well-intentioned gift ironically reinforces the narrator’s delusion. Believing he is helping “Elizabeth” grieve, he instead provides her with a framework and external validation for the elaborate fiction her mind has created to cope with trauma. This act highlights the theme of The Importance of Confronting the Truth, showing how even compassionate support can inadvertently strengthen a false reality when the true source of the trauma remains hidden.

“I was fascinated with their descriptions of the things they’d done to try to keep their twin alive. Some talked to their twin in the mirror. Others began dressing like them. […] There were those who kept a journal or a diary where they wrote letters to their lost twin and then pretended to be the other twin writing back.”

Reading stories from a support group, the narrator finds a false sense of belonging, which is used to underscore the severity of her dissociation. The passage employs a list of coping mechanisms—talking in mirrors, changing appearance, writing letters—that unknowingly catalogue the very behaviors the narrator has been exhibiting. This moment provides her with a logical, albeit incorrect, explanation for her actions, temporarily soothing her anxiety while delaying the inevitable confrontation with the truth.

“She was staring in the mirror and seeing things that weren’t there. […] Her brain had tricked her. Hypnotically, I began to undo my jeans […]. [T]hen I looked down at my legs. They were mutilated.”

This scene marks the narrative’s turning point, where the symbol of mirrors forces a confrontation with objective truth. The narrator’s sudden insight into Rose’s body dysmorphia—the realization that “[h]er brain had tricked her”—acts as a catalyst for her own anagnorisis, the moment of critical discovery. By juxtaposing Rose’s delusion with the narrator’s discovery of her own self-inflicted scars, the text shatters the protagonist’s constructed reality and visually confronts her with the physical evidence of her repressed guilt.

“Sometimes when people experience significant trauma, their brains will disconnect to protect them from the loss. […] Emily being dead was more than your brain could process, and for you to function at all, you had to act as if Emily was still alive. […] [I]n reality, you’ve been both Emily and Elizabeth for two years.”

In this passage, the narrator’s childhood therapist, Lisa, provides the psychological explanation for the narrator’s two-year-long delusion. Lisa’s professional authority is used to deliver direct exposition, grounding the novel’s central premise in the clinical concept of a dissociative fugue state. This dialogue functions as a critical turning point, reframing the narrative as an exploration of The Importance of Confronting the Truth. The statement that she has “been both Emily and Elizabeth” encapsulates the core conflict of her fractured self, directly addressing the theme of The Fragmentation of Identity After Trauma.

“Much like Rose looked into the mirror and saw fat that didn’t exist, I’d been looking into the mirror for two years and seeing smooth, unblemished skin that didn’t exist.”

After observing Rose, who has anorexia, perceive a distorted version of herself in a mirror, the narrator experiences a pivotal moment of realization about her own body. This quote employs a parallel structure to equate the narrator’s dissociative delusion with Rose’s body dysmorphia, framing both as failures of perception caused by a deceived mind. The symbol of mirrors is central here, as the mirror transforms from a tool of self-deception into a catalyst for confronting the objective, physical truth of her self-inflicted scars. This recognition shatters her constructed reality and initiates her conscious journey toward understanding her fragmented identity.

“I flashed back to the ceiling tiles in Mother’s bedroom, where I would hide and watch as the special friends played their games with my body. Each ceiling tile was filled with tiny holes and I would pick one to focus on and send my brain into it.”

During a session with Dr. Larson, the narrator recalls the origins of her dissociative coping mechanisms. This flashback reveals that her ability to detach from reality was developed as a survival strategy against childhood sexual abuse. The imagery of escaping into the “tiny holes” of a ceiling tile is used as a metaphor for psychological retreat, illustrating how the mind fractures to protect itself from unbearable physical and emotional pain. This moment establishes a direct causal link between her past trauma and her present inability to process the loss of her sister.

“I took a deep breath and looked up slowly. There it was: Emily Rooth (1991-2009) […] I reached down and rubbed the spot of the raised Emily carved on my inner thigh—the tattoo I’d put there with a razor on our fourteenth birthday. […] I did it to remind me I was alive and who I was. I’m Emily Rooth.”

At the cemetery, the sight of the headstone triggers the novel’s final plot twist. The text juxtaposes the external, objective truth of the grave marker with the internal, physical “truth” of the scar Emily carved on her own leg years prior. This climactic moment resolves the narrative’s central mystery, with the simple, italicized statement, “I’m Emily Rooth,” signifying the complete collapse of her assumed identity and the return of her repressed self. The gravestone acts as the final, undeniable piece of evidence that shatters her two-year-long dissociative fugue.