Study Guide

I Know This Much is True Madness

By Wally Lamb


"Your brother was always neat and clean. […] You can't say that about all of them. But you have to be firm with these people." (1.8)

In this case, "These people" = black people, Native American people, mentally ill people… basically anyone who isn't white, heterosexual, male, and (comparatively) sane.

It's tempting to delude yourself when your screwed-up brother becomes gainfully employed and starts acting less screwed up for a while. You begin to take sanity for granted—convince yourself that optimism's in order. (3.21)

Mental illness almost always comes back, and the quiet periods are really just the calm before the inevitable storm.

There's a pattern with Thomas when he's starting to spiral down—he latches on to one thing and won't let go. Won't give it a rest. Perseveration, the doctors call it. (7.73)

Perseveration is also a term used with people on the autism spectrum.

"It wasn't that simple. I mean, hey, it's not like Ray ever helped the situation much. But he didn't cause Thomas's illness. His brain caused it. It's biological. Chemical." (7.103)

Could it be possible that Thomas's illness is a combination of nature and nurture (or lack of)? Perhaps he's born with the potential for mental illness, and Ray's abuse triggers it. This could explain why Thomas gets sick but not Dominick, a question that comes up for Dominick.

"Why? So you can sell my secrets to the Iraqis? Hand my head on a platter to the CIA?" (15.182)

One of the most disturbing aspects of Thomas's illness is his extreme paranoia, part of which probably evolves from the fact that, as a child, everyone was out to get him, from Ray, to his boss, to his classmates. As he gets older, Thomas needs to invent more enemies.

"Progress in that he was much more verbal than he had been. Much more trusting and communicative. Which is good." (15.282)

Because of Thomas's paranoia, he has trouble trusting anyone—for all he knows, Dr. Patel could be working for the Ayatollah or something. His simply talking to her doesn't seem like a huge step, but it is.

"I mean, we're twins, right? It's going to happen eventually, isn't it?" (17.177)

Some mental illness runs in the family, so Dominick, as a twin, has reason to be afraid. Or is this just part of Thomas's paranoia manifesting itself in Dominick? There's no way to know for sure.

He's nuts, I told myself. Told it to the mirror in front of me. He's f***ing nuts. (20.193)

Yes, Thomas is nuts, but Dominick is the one talking to himself in the mirror, so…

What if it wasn't a game? And if it wasn't, what the f*** was it? What was happening? (21.97)

It's easy to write off mental illness as something else, especially when the mentally ill person is still a teenager. They could just be acting out for attention. But it's dangerous to let it go on unchecked.

"Schizophrenia," I said. "The gift that keeps on giving." (42.296)

One of the reasons schizophrenia is so difficult to manage is that no one understands it. Not only are new advances made in mental health every day, but people who have schizophrenia are often manifesting their symptoms in new ways every day, too.