I Know This Much Is True begins with a mentally ill man's sacrificial amputation on behalf of God and peace. This well-crafted, character-driven novel maintains that edgy discomfort throughout. This isn't escapist fiction; it's better, drawing the reader into a convoluted web of twins, fatherhood, love and mental instability, and then demanding emotional involvement.

The story revolves around Dominick Birdsey, the sane twin responsible for his schizophrenic brother Thomas. Lamb creates Dominick with such complexity and so much baggage that he's not entirely easy to like. I could sympathize with his challenges, but the character's incredible resentment over his deathbed promise to his mother and her favoritism toward his weaker twin causes irrational outbursts and basically stupid actions.

The novel focuses on the 40-year-old twins, Dominick's quest to have his brother released from a full-security mental hospital, and their current relationships with their stepfather, Ray. The plot, revealed through flashbacks, therapy sessions and their grandfather's egocentric autobiography, incorporates five generations into a revealing family portrait, layered with abuse and varying degrees of mental instability. The similarities between Dominick's life and that of his grandfather Domenico are startling and at times sickening, but always compelling.

I Know This Much Is True, Lamb's second novel, is developed with such intricacies, it would be tempting to write a literary analysis about the repetitive mistakes among the generations, the names Tempesta and Prosperine, or the motifs of twins and monkeys.

The novel also has much to say about recovery, kindness and spirituality. It challenges the reader to question the nature of sanity. I Know This Much Is True is truly an amazing book.