Study Guide

I Know This Much is True Madness

By Wally Lamb


When it comes to I Know This Much is True, we mean madness more in a One Flew Over the Cuckoo's Nest way instead of a Dr. Jekyll and Mr. Hyde way. Thomas Birdsey is dealing with a severe form of paranoid schizophrenia, and it affects both him and his family. What's best for Thomas? To keep him at home? To institutionalize him? Where? What to do if medication doesn't work? The questions are endless, and the seem to haunt both Thomas and his twin, Dominick, alike.

Questions About Madness

  1. Could Thomas's life have been saved? How?
  2. Which treatments work for Thomas? Which don't? Could anything work for Thomas?
  3. How does Thomas's mental illness affect others?
  4. Does Dominick share some of Thomas's mental illness?
  5. Could Thomas's illness have been avoided if he were raised differently, or would his schizophrenia have been inevitable?

Chew on This

Being mentally ill, Thomas is marginalized and abused like the other minorities portrayed in the novel.

If Domenico lived in the 1990s, he might have been diagnosed with a mental illness, what with the whole "chosen by God" thing.