66 pages 2 hours read

I Know This Much Is True

Fiction | Novel | Adult | Published in 1998

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Background

Social Context: Mental Health and Schizophrenia

The condition that Thomas Birdsey has—schizophrenia—is a serious but rare mental health condition, affecting only 0.25% to 0.64% of the population (“Schizophrenia.” National Alliance on Mental Illness). It is characterized by a series of traits, often including hallucinations or delusions. The individual’s understanding of reality is inaccurate: They may hear voices that are not present or believe themselves to be someone other than who they are. Further, people with schizophrenia can also be affected by symptoms similar to those of depression, such as taking little interest in life or disassociating from other people. They may have a flat affect or awkward social skills. They often experience cognitive symptoms, including a medical condition called “anosognosia,” meaning “lack of insight.” This means that the individual does not understand that they are afflicted with an illness.

The disease does not manifest itself until adulthood—typically early twenties for men and between ages 20 and 30 for women. The causes of schizophrenia are complex and still not entirely understood. It has strong genetic and chemical components, meaning that both brain chemistry and inherited genes work in tandem to manifest the disease. Certain environmental factors, such as those that impact the fetus in utero, or outside factors, such as use of hallucinogenic drugs at a very young age, are thought to possibly contribute.

Schizophrenia cannot be cured, but it can be successfully treated so that those afflicted with the illness can live normal lives. Treatment generally includes a combination of medication and cognitive behavioral therapy.

Historical Context: US Intervention in the Middle East

The historical events that set the novel’s plot in motion occur in August 1990, when Iraqi dictator Saddam Hussein invaded neighboring Kuwait after accusing the nation of siphoning crude oil that Hussein claimed belonged to Iraq. The United States, pressured to intervene by its allies Saudi Arabia and Egypt, under the leadership of President George H. W. Bush, issued a deadline for Iraqi withdrawal of troops under the authority of the United Nations. When the actions were not carried out, the US began a bombing campaign in January 1991 termed “Operation Desert Storm.” Iraqi forces were swiftly overcome while remaining troops fled Kuwait. Technologically advanced weapons were credited with giving the US a sharp advantage over Iraqi troops. A ceasefire was called, and the campaign ended on February 28, 1998. Conditions of the peace agreement required Hussein’s complete evacuation from Kuwait and a surrender of all its nuclear, biological, and chemical weapons. Hussein, however, remained in power in Iraq.

In 2002, President George W. Bush renewed efforts to force Hussein out of power. United Nations weapons inspectors returned to Iraq, and the Bush administration called for renewed military action against Iraq to force Hussein to relinquish weapons. This second war began on March 17, 2003.

Critics of both or either war often cite access to oil as the motivating factor in such military interventions. Though Hussein was removed from power in December 2003, US military involvement in Iraq continued until 2011.

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