I Know This Much Is True, Sky Atlantic/HBO, review: this well-acted miseryfest will pummel you to the floor

A couple of years ago, a novel called A Little Life by Hanya Yanagihara was a runaway bestseller. It was a well-written tale of unrelenting misery. Just when you thought the lead character might finally be allowed to come up for air, the author pushed him back down again. I was reminded of it while watching I Know This Much Is True, a new drama starring Mark Ruffalo and directed by Derek Cianfrance.

The HBO series is also based on a novel, by Wally Lamb, which was published in 1998 and selected for Oprah Winfrey’s book club. Oprah likes a story that packs an emotional punch, and this one will pummel you to the floor. Ruffalo plays twins, Dominick and Thomas, living in Connecticut in the early Nineties. Dominick is divorced and depressed but just about holding things together. Thomas is a paranoid schizophrenic who hacks off his own hand in a public library as schoolchildren run screaming from the building. This is not the apogee of suffering, and happens before we even get to the opening credits.

Ruffalo is one of America’s finest actors and it is testament to his talents that the dual casting - he filmed his scenes as Dominick first, having lost 20lbs, then piled on the weight to play Thomas - never feels like a gimmick. He will win awards for his work here, and rightly so. But watching him as Dominick, all you can think is: when will this man get a break?

A schizophrenic twin who mutilates himself, a dying mother who refuses to tell him the secret of his father’s identity, a dreadful stepfather - they’re just Dominick’s baseline problems. In episode one, his mother gives him his grandfather’s life story but instead of uncovering a rich family history, it reveals that the grandfather was a terrible person. Dominick hires someone to translate the memoir, and she’s played by a kooky Juliette Lewis, but instead of bringing some happiness into his life she turns out to be a nutcase who gets blind drunk and accuses him of sexually harassing her.

Then Thomas is released from hospital but instead of going back to his usual facility he is transferred to a high security prison. The officers who take him there are, of course, the worst examples of their profession.

The scene in which Thomas is dragged away while Dominick watches helplessly is stressful and upsetting. How much more pain can these characters bear? From previews of later episodes, I can tell you: a lot. I Know This Much Is True is a heart-rending examination of mental illness and trauma. It is technically accomplished, impeccably acted. Would I recommend it as your new boxset? Hell, no.

I Know This Much Is True starts on Sky Atlantic tonight at 9pm. It is also available on NOW TV