Dominick develops relationships with his brother's social workers, one of whom helps him begin taking apart his anger issues to rebuild a healthier life. During his visits to the therapist, he relives a life spent protecting Thomas from Ray and the rest of the world, as well as his own feelings of abandonment stemming from his mother always choosing Ray over him. He flashes back to the summer of 1969, when Thomas began showing symptoms of mental illness, and a summer job defined his life in ways he couldn't comprehend at the time.
Oh, and there's the translated manuscript of his immigrant grandfather's life, in which Dominick finds more comparisons than he's comfortable with.
It sounds like a lot, but Lamb does a wonderful job of keeping the story moving. Ultimately, this is a story about responsibilities to yourself vs. family, grief and regret, anger and moving forward. Those are pretty universal themes, so you could probably find something in there to relate to. It's great to see a 40-year old man really change his ways throughout the course of the novel, and Lamb manages to develop each character into full-blown personalities in your head. By the end, you'll feel as if you know them personally.