1.  Wally Lamb has said that what interested him most about his character, Dominick Birdsey, was the protagonist's conflictedness. Discuss some of the ways in which, as both child and adult, Dominick is pulled in opposing directions and wrestles with conflicting emotions.

2. How does this novel reflect the attitudes toward and the treatment of the mentally ill as they have evolved through the 20th century?

3. Do you see Dominick Birdsey as a hero or an anti-hero? Why?

4. The author has commented that his discovery of an ancient Hindu myth, "The King and the Corpse," allowed him to discover, in turn, Dominick's story. In this ancient tale, a cadaver whispers riddles into the ears of a naive king and the solving of these puzzles allows the king to save himself. In what ways does the plot of I Know This Much Is True follow a similar path?

5. Wally Lamb has said, "Whereas Dolores Price, the main character of my first novel, She's Come Undone, deals with her pain and fear by imploding, Dominck tends to wrestle with pain and fear by exploding." Do females and males tend to respond differently to emotional pain? If so, why?

6. The principal female characters of this novel are Concettina Birdsey, Dessa Constantine, Lisa Sheffer, Dr. Rubina Patel, Ignazia Tempesta, and Prosperine Tucci (the monkey). Discuss I Know This Much Is True's depiction of women.

7. Wally Lamb has stated that a worthwhile novel should not only draw you into the story but also kick you in the pants so that you'll be more inclined to go out and fix the world. Do you agree or disagree?

8. I Know This Much Is True is in development as a major motion picture. If you were the casting director, which actors would you choose for the major roles?

9. Discuss the themes of mirror vs. images, wholeness vs. fragmentation, connection vs. separation as they are explored in I Know This Much Is True.

10. To what extent is Dominick Birdsey's life shaped by his ethnicity? To what extent do you feel your life is defined by the place and the culture of your forebearers? Discuss.