'I Know This Much is True' Episode 4: Mark Ruffalo as Dominic drowns in desperation after missing the hearing

'I Know This Much True' Episode 4 revels in forcing us to face the reality of caring for someone who is mentally ill. It is dark considering how much Dominic wants out of Thomas' life, and if possible to escape from his "fucked up family" while he is at it. He first tried to draw a line between himself and Thomas when they were in college when he decided to room with his friend Leo instead of Thomas after the first year in college. The result of distancing himself from Thomas was his brother's grade slipping down, him facing the reality of being drafted to serve in the army. Every time Thomas was close to an outburst, Dominic forced his brother to "screw his head on straight" and repeatedly stated "You are not crazy" as if he meant to convince himself more than his brother.

In the present, Dominic is off the kelter after hearing about Joy's pregnancy, his accident and the upcoming board hearing to decide if his brother can be sprung from the maximum care facility to Dominic's care. With bruises all over his face and a black eye, Dominic's friend Leo tells him that it is not in Thomas' best interest to appear at a hearing in his present state but Dominic says he has no choice. If he were to postpone the hearing, that would mean more time at the psychic ward for Thomas which most certainly will have a negative impact on Thomas. The only choice he is left with is to make it to the hearing and hope that things turn out as they should.

After seeing Dominic's repeated attempts in the past to try and move away from his brother, try and ensure that he isn't his brother; it is hard to believe that Dominic would go to the extent that he did in the present. It seems like they are two different people, but soon enough, it becomes clear that what drives Dominic to do what he does for Thomas is guilt. It is guilt at having once thought of cutting himself off from his brother, not being there when the first signs of schizophrenia arose.

The loss of his daughter had broken something inside Dominic, which has seen him transform from the intellectual college professor to a guy in the construction business. His temperament, his outlook towards life, and the hatred that he had buried within himself for his stepfather Ray have all become different. Despite the accident the previous night, Dominic tries to pull the shutter down at one of his worksites and so he climbs to the top of the building. Despite having taken pain medication that he knows would make him "goofy" and a fractured hand, Dominic decides to go ahead and finish the job.

At this time, he sees an old man through the window eating a bullet as his brains are shot out and that shocks him enough to slip and fall from what could be the second floor of a building. The accident occurs hours before the hearing for his brother's release, which makes us wonder if Dominic subconsciously sabotaged the chances for his brother. However, when he wakes up days after the accident and realizes that he couldn't be at the hearing, his tears and desperation show that he truly does want his brother out of the maximum care facility. However, things do not go as he had hoped and lawyer Scheffer is disappointed that she couldn't help his brother, but that's how things are.

Following this, we see a series of nightmares that Dominic has, which are influenced by the morphine that he continues to take to escape from everything and this is the most shocking and painful portrayal of pain buried deep within the subconscious to watch.

'I Know This Much Is True' airs on Sundays at 9 pm ET on HBO.