{"id":2815,"date":"2021-02-15T10:00:27","date_gmt":"2021-02-15T09:00:27","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=2815"},"modified":"2021-02-05T11:48:43","modified_gmt":"2021-02-05T10:48:43","slug":"man-can-do-what-he-wills-but-he-cannot-will-what-he-wills-on-the-freedom-of-the-will-arthur-schopenauer-1839","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2021\/02\/15\/man-can-do-what-he-wills-but-he-cannot-will-what-he-wills-on-the-freedom-of-the-will-arthur-schopenauer-1839\/","title":{"rendered":"Review of \u201cI Know This Much Is True\u201d TV series (Derek Cianfrance, USA, 2020)"},"content":{"rendered":"<p style=\"text-align: center\">\u201cMan Can Do What He Wills But He Cannot Will What He Wills\u201d<br \/>\n<em>On the Freedom of the Will<\/em>, Arthur Schopenauer, 1839.<\/p>\n<p><strong>By Dr. Franco Ferrarini, gastroenterologist and film reviewer.<\/strong><\/p>\n<p>This short HBO series centres on the life of two twin brothers, Thomas, and Dominick Birdsey (both played by Mark Ruffalo), the former affected by Paranoid Schizophrenia (PS), a condition which plays a pivotal role in the plot. The core of the story is Dominick\u2019s persistent attempts to help Thomas after seeing him being bullied as a kid by their stepfather Ray (John Procaccino) who did not understand the kid\u2019s behavioral abnormalities and social withdrawal triggered by his mental condition.<a id=\"ftnte1.1\"><\/a><sup><a href=\"#ftnte1\">1<\/a><\/sup> The situation of the Birdsey brothers reaches a nadir when Thomas cuts off his own right hand as a sacrifice for the wrongdoings of the Unites States during the First Gulf War. He refuses the surgeons\u2019 advice to attach his hand. Following that traumatic experience, Thomas is sentenced to involuntary commitment in a judicial mental asylum. His mental situation worsens in the asylum soon reaching a catastrophic crisis.<\/p>\n<p style=\"text-align: center\"><style type=\"text\/css\">\r\n       .errordiv { padding:10px; margin:10px; border: 1px solid #555555;color: #000000;background-color: #f8f8f8; width:500px; }#advanced_iframe {visibility:visible;opacity:1;}#ai-layer-div-advanced_iframe p {height:100%;margin:0;padding:0}<\/style><script type=\"text\/javascript\">  var ai_iframe_width_advanced_iframe = 0;  var ai_iframe_height_advanced_iframe = 0;var aiIsIe8=false;var aiOnloadScrollTop=\"true\";\r\nif (typeof aiReadyCallbacks === 'undefined') {\r\n    var aiReadyCallbacks = [];  \r\n} else if (!(aiReadyCallbacks instanceof Array)) {\r\n    var aiReadyCallbacks = [];\r\n}    function aiShowIframeId(id_iframe) { jQuery(\"#\"+id_iframe).css(\"visibility\", \"visible\");    }    function aiResizeIframeHeight(height) { aiResizeIframeHeight(height,advanced_iframe); }    function aiResizeIframeHeightId(height,width,id) {aiResizeIframeHeightById(id,height);}<\/script><iframe loading=\"lazy\" id=\"advanced_iframe\"  name=\"advanced_iframe\"  src=\"https:\/\/www.youtube.com\/embed\/U4KBGydqlVk\"  width=\"560\"  height=\"315\"  frameborder=\"0\"  border=\"0\"  allowtransparency=\"true\"  allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\"  style=\";width:560;height:315;\" ><\/iframe><script type=\"text\/javascript\">var ifrm_advanced_iframe = document.getElementById(\"advanced_iframe\");var hiddenTabsDoneadvanced_iframe = false;\r\nfunction resizeCallbackadvanced_iframe() {}function aiChangeUrl(loc) {}<\/script><\/p>\n<p style=\"text-align: center\"><strong>\u2018I know this much is true\u2019 HBO series, official <\/strong><a href=\"https:\/\/www.youtube.com\/watch?v=U4KBGydqlVk\"><strong>YouTube trailer<\/strong><\/a><\/p>\n<p>PS is the commonest form of Schizophrenia characterized by dominance of positive symptoms (hallucinations and\/or delusions) over negative and cognitive symptoms such as blunting of affect, impaired volition, disorganised speech, thought and\/or attention. \u00a0The pathophysiology of PS implies alterations in neurotransmitters such as dopamine, serotonin, glutamate. However, its etiology is not yet well understood; genetic factors play a role, but environmental and psychological factors, notably also play a role. These underlying factors are evident in Thomas\u2019s childhood trauma and first and second-generation immigrant background (see below).<a id=\"ftnte2.1\"><\/a><sup><a href=\"#ftnte2\">2<\/a><\/sup><\/p>\n<p>This series addresses several important issues such as the role played by families and society in supporting or neglecting patients with psychiatric conditions. As seen in Thomas\u2019s case, bullying at home, being brutally treated in a judicial mental asylum where he is deprived of his brother\u2019s help, and being denied the opportunity of socializing, all exacerbate his mental illness. Beside medications (e.g. antipsychotics) the treatment of PS is based on psychosocial support and both cognitive behavioural therapy and family interventions, all recommended approaches in the UK NICE guidelines.<a id=\"ftnte3.1\"><\/a><sup><a href=\"#ftnte3\">3<\/a><\/sup><\/p>\n<p>From a psychological viewpoint, one should also consider the complicated relationship and interdependency between the twin brothers: Dominick feels great responsibility for Thomas while Thomas is in desperate need of his brother\u2019s help often saying, \u201cyou are me\u201d. Thomas\u2019 reminder to Dominick to support him is crucial for their combined well-being as neglecting one\u2019s twin is like neglecting oneself.<\/p>\n<p>In analyzing the background to Dominick\u2019s protective attitude towards Thomas, the viewer is introduced to an earlier school event when Dominick wrongly accused a school mate, of native American descent, of a theft she did not commit. Dominick accused her because he simply did not like her. The girl was subsequently expelled from school, escaped home, and was never seen again. It is tempting to speculate that having acted unjustly against a member of an ethnic minority group, Dominick feels obliged to redeem his guilty conscious by helping his desperate twin.<\/p>\n<p>Dominick\u2019s sense of obligation introduces another relevant plot device which is \u2018the freedom of will\u2019. In this regard, the director uses a long flashback to introduce us to the Birdsey brothers\u2019 grandfather, Domenico (Marcello Fonte), who emigrated from Italy to the United States.\u00a0 Domenico got rid of his brother in a similar unjust way as Dominick did with his school mate, implying the existence of a possible connection between our actions and those of our ancestors thus adding a transcendent feature to the \u201cnature versus nurture\u201d debate in relation to the underlying motivations of our decisions. We may believe that we can make decisions of our own free will, but our decision-making process can be heavily influenced by variables that we cannot control. Ancient Greeks were well aware that under the influence of these variables we may be forced to make only one decision in a given situation, in fact in their pantheon sat Ananke, the goddess of necessity and constraint, not surprisingly mother of the three Parcae who inflexibly decided the duration of each human being\u2019s life.<a id=\"ftnte4.1\"><\/a><sup><a href=\"#ftnte4\">4<\/a><\/sup> The Greeks thus concluded that humans are inescapably bound to live and die according to the dictate of the Gods which cannot be modified.<\/p>\n<p>Besides the multitude of mental health issues it raises, \u201cI know this much is true\u201d is worth watching because of both Cianfrance\u2019s directorial skill and Mark Ruffalo\u2019s astounding acting brilliance in the twin roles, for which he won the 2020 Primetime Emmy Award for Outstanding Lead Actor in a Limited Series or Movie.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>References<\/strong><\/p>\n<p><a id=\"ftnte1\"><\/a><a href=\"#ftnte1.1\">1.<\/a> Howes OD, Murray RM <em>Schizophrenia: an integrated sociodevelopmental-cognitive model<\/em>. Lancet 2014; 383(9929):1677\u201387.<\/p>\n<p><a id=\"ftnte2\"><\/a><a href=\"#ftnte2.1\">2.<\/a> Owen MJ et al, <em>Schizophrenia<\/em>. Lancet 2016; 388(10039):86-97.<\/p>\n<p><a id=\"ftnte3\"><\/a><a href=\"#ftnte3.1\">3.<\/a> <a href=\"https:\/\/www.nice.org.uk\/guidance\/cg178\/evidence\/full-guideline-490503565\">https:\/\/www.nice.org.uk\/guidance\/cg178\/evidence\/full-guideline-490503565<\/a>. Accessed November 30 2020.<\/p>\n<p><a id=\"ftnte4\"><\/a><a href=\"#ftnte4.1\">4.<\/a> Ker\u00e9nyi K, <em>The Religion of the Greeks and Romans<\/em>, Greenwood Press, 1973.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u201cMan Can Do What He Wills But He Cannot Will What He Wills\u201d On the Freedom of the Will, Arthur Schopenauer, 1839. By Dr. Franco Ferrarini, gastroenterologist and film reviewer. This short HBO series centres on the life of two twin brothers, Thomas, and Dominick Birdsey (both played by Mark Ruffalo), the former affected by [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2021\/02\/15\/man-can-do-what-he-wills-but-he-cannot-will-what-he-wills-on-the-freedom-of-the-will-arthur-schopenauer-1839\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":345,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[206],"tags":[15099],"class_list":["post-2815","post","type-post","status-publish","format-standard","hentry","category-film","tag-film-review"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Review of \u201cI Know This Much Is True\u201d TV series (Derek Cianfrance, USA, 2020) - Medical Humanities<\/title>\n<meta name=\"description\" content=\"Dr. Franco Ferrarini reviews Derek Cianfrance&#039;s 2020 HBO series, \u201cI know this much is true,\u201d starring Mark Ruffalo as the twin brothers Thomas and Dominick Birdsey.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2021\/02\/15\/man-can-do-what-he-wills-but-he-cannot-will-what-he-wills-on-the-freedom-of-the-will-arthur-schopenauer-1839\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Review of \u201cI Know This Much Is True\u201d TV series (Derek Cianfrance, USA, 2020) - 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