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Content snapshot
Flag an inaccuracy →What's in this book, at a glance — five things readers want to know before they start.
Violence
Some
Thomas's self-mutilation; violence in mental health institutions; disturbing scenes throughout
Language
Some
Strong language including racial slurs from a character
Sexual Content
Some
Sexual abuse is part of the backstory; adult sexual content
Substance Use
Some
Substance abuse depicted
Emotional Intensity
Very heavy
One of the most psychologically intense novels in contemporary fiction — schizophrenia, generational trauma, and survivor guilt explored unflinchingly
What this book is about
Dominick Birdsey has spent his life in the shadow of his identical twin Thomas, who suffers from paranoid schizophrenia. When Thomas commits a violent public act, Dominick must navigate the mental health system, his own fractured family history, and the secrets that have shaped both their lives. An immense, emotionally exhausting novel about love, guilt, and the limits of loyalty.
Notes for sensitive readers
Reader-flagged moments and themes that may affect your experience.
Self-mutilation depicted graphically
Mental illness and institutionalization in detail
Sexual abuse in family history
Extreme psychological distress throughout
Reader Verification
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