Phantom Limb

Phantom Limb (2016) is a psychological thriller by Lucinda Berry. Drawing on her professional background as a clinical psychologist specializing in childhood trauma, Berry crafts a narrative grounded in real-world psychological concepts. The novel follows a young woman caring for her identical twin who has depression, a relationship defined by a shared traumatic past; when a new romance threatens their codependency, the narrator’s reality begins to unravel, revealing that her memories and very identity may be a fiction constructed to survive an unbearable loss. The book explores themes of The Fragmentation of Identity After Trauma, Self-Harm as a Manifestation of Psychic Pain, and The Importance of Confronting the Truth.

This guide refers to the 2016 Rise Press edition.

Content Warning: The source material and guide feature depictions of child abuse, child sexual abuse, suicidal ideation and self-harm, death by suicide, mental illness, disordered eating, and sexual content.

Language Note: The source text uses offensive terms for mental illness, which are reproduced in this guide only in quotations.

Plot Summary

The narrative begins as the narrator and protagonist, who goes by the name Elizabeth Rooth, comes home from her telemarketing job to care for her identical twin sister, Emily, who is experiencing a severe depressive episode. Elizabeth finds that Emily has not left their apartment in days and has inflicted fresh cuts on her legs and stomach, a recurring behavior that Elizabeth has managed for years. A flashback reveals the origin of this self-harm. At their adoption party at age eight, their abusive biological mother made a surprise appearance, deeply upsetting Emily, who later used a thumbtack to scratch her leg for the first time, telling Elizabeth it “felt good.”

In the present, Elizabeth struggles to hide her year-long relationship with her boyfriend, Thomas, from the volatile and codependent Emily. After an argument with Thomas, Elizabeth resolves to tell her sister about him, reflecting on their traumatic childhood with a neglectful, abusive mother whose “special friends” sexually abused them. Their rescue at age seven led to their adoption by Bob and Dalila Rooth. Feeling overwhelmed by Emily’s worsening condition, Elizabeth secretly makes an appointment with their childhood therapist, Lisa.

After a reassuring session with Lisa, Elizabeth tells Emily about Thomas. Emily’s initial acceptance quickly turns to a violent outburst when Elizabeth suggests Thomas visit their apartment. Emily eventually calms down and agrees to meet him elsewhere. However, the situation escalates when Thomas reveals that Emily confronted him at his job, where Emily called Elizabeth “crazy” and “damaged.” Enraged by this betrayal, Elizabeth returns home and has a vicious fight with Emily. For the first time, Elizabeth refuses to comfort her sister afterward, instead falling asleep on the couch. When she wakes later that night, she finds Emily dead on the bathroom floor from an apparent suicide.

Elizabeth wakes up disoriented in a hospital. Thomas is there. A psychiatrist, Dr. Larson, informs her that she has been in the hospital for seven days and that she attempted to die by suicide after finding Emily. She is transferred to the hospital’s psychiatric unit, where she is placed on a 72-hour psychiatric hold with one-on-one supervision. She befriends Rose, a young woman with severe anorexia, who advises her on how to manipulate the system for a quick release. During a visit from Bob, Dalila, and Thomas, the narrator is consumed by guilt, believing she is responsible for Emily’s death. When Bob accidentally reveals that Emily’s funeral has already taken place, the narrator flies into a rage, feeling betrayed and excluded.

Dr. Larson begins to challenge the narrator’s reality, informing her that Emily’s funeral happened two years ago and that she was in attendance. He states plainly, “Emily has been dead for two years” (108). The narrator dismisses this as a psychological test. During a team meeting, another psychologist reiterates the fact, causing the narrator to have a violent episode. She lunges at the doctor before being sedated and placed in restraints. Dr. Larson later informs her that she is on an extended psychiatric hold after her therapist, Lisa, helped her adoptive mother secure power of attorney. He diagnoses her with “Dissociative Disorder Not Otherwise Specified,” which explains her memory gaps and fragmented psyche.

The narrator begins to question her own mind after Thomas visits and gives her printouts from an online support group for twins who have lost their other half. The stories resonate deeply, as other twins describe creating ways to keep their sibling “alive” (172) to cope. The true turning point occurs in the bathroom with Rose. As the narrator watches Rose point out non-existent fat on her emaciated body in a mirror, she realizes that Rose’s brain is tricking her. This prompts the narrator to look at her own legs with a new awareness, and she is horrified to see they are covered in self-harm scars she has no memory of inflicting.

Lisa visits and provides crucial context. She reveals that Emily died in a car accident two years ago, a week after their high school graduation. Lisa explains that the narrator, whom she believes to be Elizabeth, was so traumatized that her brain created a reality where Emily was still alive. She theorizes that the narrator has been living as both herself and a created version of Emily, and that she inflicted the wounds on herself while in the persona of the self-destructive Emily. Later, during a phone call, Thomas confirms the severity of her amnesia by revealing they attempted to have sex, an unsuccessful encounter that the narrator does not remember.

Believing it will aid the healing process, Lisa gets permission to take the narrator to visit Emily’s grave. At the cemetery, the narrator reads the headstone: Emily Rooth (1991-2009) (230). The sight triggers a complete memory recall, revealing the final truth. The narrator is not Elizabeth; she is Emily. A flashback shows the night of the accident. Jealous of Elizabeth’s new boyfriend, Emily impersonated her sister to kiss him, leading to a massive fight in the car. Emily, who was driving, crashed into a truck, and Elizabeth was thrown from the car and killed. Overcome with guilt at the scene, Emily identified herself to the police as Elizabeth, assuming her twin’s identity.

Three weeks later, Emily is discharged from the hospital, having decided to keep her true identity a secret. She successfully convinces her doctors and family that she, as Elizabeth, has grieved and “let go” (36) of Emily. She understands that her dissociative fugue allowed her to assume Elizabeth’s identity while battling her own self-destructive nature. She plans a future with Thomas, fully committed to living as Elizabeth. The narrative concludes with Emily alone in her room, taking out a new razor blade. She cuts herself, promising it will be the last time, revealing that her true, self-destructive identity persists beneath the surface of her new life.