With medication, Thomas is able to live his life in relative peace and work at a coffee stand, but occasionally, he experiences severe episodes of his illness.

Dominick sees him through the ensuing decision not to attempt to reattach the hand, and makes efforts on his behalf to free him from what he knows to be an inadequate and depressing hospital for the dangerously mentally ill.

In June 1998, it was announced that 20th Century Fox had acquired film rights to I Know This Much Is True by Wally Lamb, with Clinica Estetico producing, and Jonathan Demme potentially directing.

[21] In April 2019, Melissa Leo, Rosie O'Donnell, Archie Panjabi, Imogen Poots, Juliette Lewis and Kathryn Hahn joined the cast of the series.

[22] In November 2019, it was announced Aisling Franciosi, John Procaccino, Rob Huebel, Philip Ettinger and Michael Greyeyes had joined the cast of the series.

[23] The members of the Psychiatric Security Review Board in Episode 4 are played by some local officials in Dutchess County, New York, where most of the series was filmed: State Senator Sue Serino, sheriff Butch Anderson, and his wife Danielle, president of the Mid-Hudson Civic Center in Poughkeepsie.

[24] Elsewhere in Dutchess County, Dominick and Joy's apartment is at Pleasant Valley Estates, and he and Leo play their racquetball match at a Fishkill club; Seasons restaurant in that community was also the location for some scenes.

In addition to the Ellenville car dealership used for the scenes with Leo, some other locations in Ulster County were used, including Awosting Falls in Minnewaska State Park Preserve on the Shawangunk Ridge west of New Paltz.

Club, Ines Bellina rated the series a B−, praising Ruffalo's performance but criticizing it for not being enjoyable to watch and summing it up as "an uneven journey, overwhelming in its self-indulgent trauma... [but] Against all odds, it ends on a more heartfelt and hopeful note than the preceding six hours would lead you to believe.

"[32] In May 2022, both HBO and Mark Ruffalo were sued by residents of Ellenville, New York, for not cleaning up a fire that broke out on the set of a car dealership that was used as a location for the miniseries.