Abstract
In I Know This Much is True, we accompany Dominick Birdsey through his 42nd year, when the secrets and silences of his past are thrown into sharp relief by a series of traumatic events. In his voyage of discovery, his life unravels and is reconstituted. The novel begins with an account of the day his identical twin, Thomas, who has schizophrenia, amputates his hand in a public library in an effort to abort the looming Gulf War. This results in admission to a forensic psychiatric facility. In parallel, Dominick's relationship and business falls apart, he has a serious car accident and contemplates suicide. Dominick's impetus for seeking professional help and re-examining the stories of his past is a desire to assist his brother, but ultimately it is Dominick who is brought to face his demons and move beyond them.
The author creates a vivid transgenerational view of Dominick's family, though the novel never underestimates the difficulty of articulating the pain and meaning of the past. Dominick's Italian grandfather, approaching death, decides that his life story must be written. Dominick's search for a translator offers a literal enactment of the psychological journey that must be undertaken. In the life story, we come to see his grandfather as a narcissistically sensitive individual, with a profoundly vulnerable sense of his own worth. This vulnerability renders him so threatened by those around that he cannot effectively be in relationships with others. All good is located within himself and all the bad is split off into those around him, whom he must control and humiliate. For Dominick, the capacity to recognise and integrate the good and bad in himself, and the others who form his familial and personal history, takes him beyond his grandfather's rigidly constructed egocentrism. The grandson, his namesake, is able to construct a different psychic landscape:
I am not a smart man, particularly, but one day, at long last, I stumbled from the dark woods of my own, and my family's and my country's past, holding in my hands these truths; that love grows from the rich loam of forgiveness; that mongrels make good dogs; that the evidence of God exists in the roundness of things.
Notions of twinship and questions of paternity in each generation are powerfully used to mark this journey. Dominick's mother, who has a cleft lip, is also a twin although her twin brother did not survive long. At his most driven, Dominick's grandfather projects his own fear of unworthiness so intensely that he disavows his paternity of Dominick's mother. She mirrors this in her life by concealing the identity of Dominick's father from him. The intense division between good and bad frame the life narrative of Dominick and Thomas. ‘Smart–sweet’, ‘bad–good’, ‘sick–healthy’ ‘monkey–rabbit’: these are the ways in which the mother differentiates the two boys. While his mother and Thomas are linked by their vulnerability, Dominick's ‘health’ distinguishes him from both of them. Boundaries between members in the family become indistinct at times: when Dominick hurts Thomas he hurts his mother. He looks after his mother by looking after Thomas: ‘You can go [i.e. die] now Mum, I will look after him’. The different way his mother loves Dominick and his brother is a source of pain and reassurance. As Dominick works through his feelings of jealousy, guilt and shame, this difference comes to be understood through the diverging accounts of paternity that their mother offers to each of the twins.
The novel offers complex and sophisticated notions of nature and nurture. Born with the same genetic make up as Thomas, Dominick seeks to carve out a separate subjective identity. The story suggests it could not be otherwise, a view shared in our profession: ‘most environmental influences tend to serve to make children growing up in the same family different rather than similar in their characteristics’[1].
In a more direct way, the book offers a description of psychiatry as practised in the early 1990s in North America. The distress of seeing his brother experiencing extrapyramidal side-effects on older antipsychotics, the frightening experience of accompanying his brother during an after-hours involuntary admission to an unfamiliar hospital and the betrayal of the trust are graphically described. The account of the systematic abuse that exists in the facility in which Thomas is confined owes much to real-life accounts that have been documented. As a psychiatrist, I found the portrayal of the professionals and their relationships least convincing. Blurred professional boundaries and the existence of ‘compassion’ only outside the rules offered a disturbing portrait of an unresponsive and fragmented system of care. The psychiatrists were portrayed as distant, out of touch and unreachable by the patient's family.
The novel has a captivating story line and an engaged and straightforward style of delivery. It is accessible and rewarding to read without sacrificing a rich and densely layered account of an individual's connection to, and differentiation from, his ‘identical’ twin and his family history.