I Know This Much Is True

In the opening chapter the story of identical twin brothers is told, one who struggles with the differences of their minds, and the other who is in a world of his own. The writer, who watches his brother deal with demons in his mind, struggles with guilt and anger over an incident in which his twin severs his own hand as a offering to the Lord God Almighty. He sees his twin even more rickety than the cart from which he sells cigarettes and newspapers from at the state hospital. He feels he should have noticed signs of what was to come. The writer struggles with his love/hate relationship with his brother.