Schizophrenia Stars in TV Series 'I Know This Much Is True'

In the new HBO seriesI Know This Much Is True, Mark Ruffalo portrays twin brothers Dominick and Thomas Birdsey, two men who hail from a Sicilian immigrant grandfather who settled in Connecticut in the early 1900s. Born out of wedlock, the boys grow up without a father, and without knowing who their father is. As the boys get older, they begin to discover that Thomas suffers from severe mental illness. The series is based on the best-selling novel by authorWally Lamb, who took some time to discuss with Everyday Health how he developed the characters of Dominick and Thomas Birdsey and whyschizophreniaand mental illness looms large throughout the work.

Why This TV Series Was 22 Years in the Making

When Lamb’s novel debuted in 1998, the story was sold to 20^thCentury Fox, which struggled for years to get a script that could create a faithful interpretation of the book in under two hours. After 15 years, the screen rights returned to Lamb. When his agent asked who he could see as the lead actor in the film version, Lamb immediately suggested Mark Ruffalo. “I had seen his films; I knew he would be great.” Lamb’s agent sent the actor a copy of the book. Once Ruffalo had the chance to read it, he urgently wanted to be part of the project. It was taken to HBO, and the idea of creating it as a six-episode series cracked the code on how to tell Lamb’s ambitious novel on the screen.

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Lamb grew up in Norwich, Connecticut, which was also the location of one of the oldest, and largest, mental health facilities in the state. “I remember riding in the back of my parents’ station wagon and occasionally we would drive by there,” Lamb says, “It was both mysterious and scary to me, but also fascinating. It was only years later, when I was a teenager that I found out that my maternal grandfather had been locked away there in the forensic building of the hospital.”

Lamb explains that though he didn’t realize it at the time, “When I started writing the novel, I was trying to create a grandfather in the vacuum of all that I didn’t know about this guy. He died when I was 3 years old, soNorwich Hospitalbecame an interest to me.”

The Inspiration Behind Thomas, a Man With Severe Mental Illness

Lamb was a high school English teacher in Connecticut when he began writing fiction. While teaching history students about writing, he created a project for his teenage students to interview people who were teenagers during the Great Depression. After placing an ad in the local paper for volunteers, he was flooded with calls. Several volunteers came to class, and after trying to match each student with an interview subject, there was one unpaired, standoffish gentleman who was missing a hand and an eye.

“I hadn’t planned on interviewing anyone, but the kids were afraid of him. In talking to him, I found something noble," Lamb recalls. “He told us he had been a pacifist, and I would describe him now as a religious zealot, who decided he could stop World War II by making a biblical sacrifice,” Lamb says, alluding to the volunteer’s self-mutilation as an anti-war protest.

“About 10 years later,” Lamb explains, “I sat down to write Dominick’s story, and all of a sudden this brother [character] emerged. He had done something similar. He made a similar biblical sacrifice with which he hoped to stop the Gulf War by cutting off his hand.”

The Authenticity of Thomas’s Character, Illness

Lamb began writing the novel within a writer’s group. When he submitted the first chapter of the book to the group eager for feedback, an elderly woman in the group provided it.

“This woman had triplets, one of whom had developed mental illness,” Lamb says. “She had an angry look on face, slapped her notebook shut, stood up and said, “You know, if you’re going to take up this subject matter, you better get it right. Because there’s so much crap out there in the culture — psycho this and psycho that. Don’t you dare write this in a stereotypical way!”

Lamb says that she stormed out of the restaurant, leaving him in agony. “Ultimately, I was glad that she challenged me in that very aggressive way, because it was incumbent on me that if I was going to write about a character who was mentally ill, I had to get it right.”

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The Evolution of Thomas’s Disease

“I didn’t know Thomas would be a paranoid schizophrenic,” Lamb stresses. In the early '90s, while doing research, he was able to arrange to visit Norwich Hospital before it closed. While on the tour, he was introduced to apsychiatristat the facility. “I said, ‘Hey doc, I have a character who is obviously mentally ill. Could you give me a diagnosis for him?’ The doctor said, ‘Well, it sounds likeparanoid schizophrenia. A paranoid schizophrenic tries to makes sense of what he hears, tells himself a story, and he is the hero of the story. The villains are the bad spirits. That’s why he’s hearing those voices — because they’re the villains in the story.’ That," the author explains, "led me to researching paranoid schizophrenia.” (Note: Doctors no longer recognize paranoid schizophrenia as an official subtype of schizophrenia.)

Lamb read every book and article he could find, but said there’s no doubt what was the main source of his research: Real people. “I spoke to people who had paranoid schizophrenia in their family and that was hugely helpful. Much of the knowledge I gained was cobbled together by speaking to them.”

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Mark Ruffalo’s Preparation To Portray Very Different Twin Brothers

To create the characters of twin brothers Dominick and Thomas Birdsey, Ruffalo first lost 20 pounds to film his scenes as Dominick. Director Derek Cianfrance would often have Ruffalo do dozens of pushups before his scene to help bring out Dominick’s aggressiveness on screen. After filming those scenes, the crew took six weeks to film other parts of the series that didn’t require Ruffalo.

“When Mark returned to play Thomas, the cast didn’t recognize him,” Lamb says. “Mark is such an affable guy; he talks to everyone on set. On the first day of playing Thomas, Derek had to go to the trailer to get him because he wouldn’t come out. When he did, Mark had put on so much weight, and began shuffling his feet, the crew sort of gasped. They couldn’t believe it was Mark. But he transformed himself into Thomas.”

Lamb explains that Ruffalo gained weight because his character would likely have experienced side effects of certainantipsychoticmedications; the Academy Award nominee also watched hundreds of hours of videos to help prepare for the role. “It’s a wonderful performance,” praises the author.

How Lamb Views the HBO Series Based on His Book

Lamb couldn’t be happier with the timing of bringing his work to the screen. After twenty years, despite the huge success of the book, he still thinks about how he could make it better.

“Having tried to write screenplay for my first novel,She’s Come Undone, I realize that it’s apples and oranges — how much more limited you are with a screenplay. Over the years, some of the people who read the novel [I Know This Much Is True] were unhappy with ending. If I were to redo it, maybe I would consider a different ending.”

As it turned out, the version of the story that appears on HBO resolves in a new way. “I love the ending that they come up with for the series. It’s different than the book, it’s a more hopeful ending, and maybe it’s even better,” Lamb says. “I hope that it’s a comfort for people when they watch it. I know it’s a dark and jarring story.”

The Feedback That Matters Most to Lamb

“The best gift that I’ve received over the years is letters from people who have read the novel, family members of people with mental illness,” says Lamb. “Reading the novel made them feel that they were not alone. They weren’t the only person that had these challenges or was angry that this card had been dealt to them having a mentally ill brother, sister, father, mother. Ultimately, I want my art to bring comfort to people. I hope that happens as people get to the end of the series as they have at the end of the book.”

I Know This MuchIs True airs Sunday evenings at 9 p.m. EDT onHBO.