After paranoid schizophrenic Thomas Birdsey has a violent public breakdown, Dominick Birdsey finds himself stepping up to defend his identical twin brother in unexpected ways. As he navigates the fallout, Dominick reflects on their childhood growing up under the tyrannical rule of their volatile stepfather, Ray, and their desire to know the identity of their biological father.

Tensions rise between Dominick and his live-in girlfriend, Joy, as the media begins to take an interest in Thomas' case. In his attempt to have Thomas released from the Hatch forensic institute for the criminally insane, Dominick finds a potential ally in social worker Lisa Sheffer, but learns that helping his brother may be more difficult than he thought.

Sheffer preps Dominick for a pivotal hearing with Hatch’s review board that could decide Thomas’ fate. A chance encounter with an old classmate brings painful childhood memories to the surface. Dominick reflects on his and Thomas’ time together at college, during which he met Dessa and the signs of his brother’s illness first began to manifest. Joy attempts to remedy the problems in her and Dominick’s relationship.

Despite the protestations of those closest to him, Dominick returns to work before fully recovering from his accident. Heavily medicated, Dominick recalls the disturbing incident that lead to Thomas’ first hospitalization while counting down the hours to Thomas’ hearing with the Hatch review board.

Upon learning the details of his Sicilian grandfather's arrival in the early 1900s to Three Rivers, Dominick becomes convinced his family is cursed. A startling update on Thomas from an unlikely source prompts Dominick to take drastic action.