Tom was on tour in western Pennsylvania in May 1889 on the day of the Johnstown Flood, and rumor spread that he was among the casualties. Despite his continued appearances on the U.S. concert circuit, the rumor persisted for years, with some observers expressing skepticism that the Blind Tom who appeared in concert after 1889 was the "real Blind Tom."
In this phase of his career, Tom usually introduced himself onstage in the third person, imitating the pronouncements of his various managers from years past. He talked about his mental state with a characteristic lack of self-awareness. He had been diagnosed as non compos mentis by a doctor, and in his foggy netherworld the phrase was a matter of personal pride. Willa Cather described the poignance of one such concert: "It was a strange sight to see him walk out on stage with his own lips—another man's words—introduce himself and talk quietly about his own idiocy. There was insanity, a grotesque horribleness about it that was interestingly unpleasant. One laughs at the man's queer actions, and yet, after all, the sight is not laughable. It brings us too near to the things that we sane people do not like to think of."