The title is an anagram of "truths and lies", and "truths/denials".
Mark Ruffalo won the role of Chuck Aule after sending Martin Scorsese a fan letter saying how much he wanted to work with him.
Through most of the story line, it is cloudy and the rain turns heavier as the story gets deeper. The sun only comes out in the final scenes. This is another reference to Freud, who described the subconscious as a confusing cloudy weather in opposition to the clear skies of the consciousness.
The movie's $40.2 million opening weekend take in the U.S. marked a career best for Martin Scorsese. It went on to gross over $293 million worldwide, making it the highest grossing movie of his career. This was later surpassed by The Wolf of Wall Street (2013).
The quote "Remember us, for we too have lived, loved and laughed", seen on a plaque on the way to the mental institution, is taken from Medfield's Vine Lake Cemetery. A contest was held to come up with a quote to be used on a stone marker as a remembrance of those who died in the 1918 influenza epidemic known as the Spanish flu.