Lamb’s focus on mental illness is apparent from the outset. In the opening pages, a central character amputates his hand while on pass from the local psychiatric hospital. With that baptism, the story thrusts the reader into the lives of Thomas and Dominick Birdsey, identical twin brothers born to a single mother and raised in a 1950s Connecticut Naval town. Thomas has schizophrenia, a reality that becomes apparent to the family during his first year of college. In real time, the book covers a short period, from the mutilation episode through several months of Thomas’ inevitable commitment. However, the use of flashbacks and other clever devices (a rediscovered grandfather’s diary is beautifully woven into the story line) allows the story to begin many years before the twins’ birth. This history provides a rich contextual background for the book’s present events and supplies the psychological underpinnings of the main characters.