The Silent Patient- A Review

 I found The Silent Patient, by Alex Michaelides, to be a well-thought-out thriller. The point of view and narrator switches between Theo Faber, a psychotherapist, and Alicia Berenson, a selectively mute patient accused of killing her husband, Gabriel.  

Alicia's crime puzzles everyone. The doctors can’t get her to talk, and there are no known witnesses, connections, or motives for the shots fired into Gabriel Berenson's skull. When Dr. Theo Faber meets Alicia, he is seemingly deeply distraught at Alicia’s condition and situation. He constantly thinks of her, expressing his deep desire to help her, to save her, to be there for her. She is heavily drugged at The Grove, the mental institution she has been sent to.

Theo, upon arriving as a new doctor at The Grove, immediately asks to be her primary psychotherapist. His wish is granted, and his first order is to lower the amount of drugs she is being administered.

Alicia Berenson, before the murder, was a quiet artist who deeply loved her husband. The first painting she creates at The Grove, surprisingly, features herself and Dr. Faber amidst a burning Grove. Theo notes that he cannot quite tell if he is meant to be saving her or carrying her to the flames. When we are thrown from Theo’s narration to her own, it is via a diary she hands Dr. Faber in one of their silent sessions.

We learn of her version of the days leading up to the crime, and while we do, her story is intermediately interrupted by a switch back to Theo’s perspective.

I find this split narration style to be a fantastic choice for this specific story, as it allowed for the pieces of the puzzle to fall into pace at a speed that made the most sense for the story.

We begin to realize, throughout this mixture of retelling and present actions, that Theo himself isn’t as happily married as he had thought. His wife, he discovers, is having an affair.

Like Alicia Berenson, Theo Faber is deeply devoted to his spouse, Kathy. The love that borders on codependent obsession that our two main characters feel for their partners is so similar, and ultimately,  it leads to both their demise.

When Theo finds evidence of Kathy’s affair, he begins to unravel. He follows her, suspicious of her every move. He yearns to hear the truth from her, to fix it, to solve whatever issues have lead to this.

Meanwhile, at the same time, Alicia was beginning to feel uneasy. We hear through her diary entries that days before the crime, she felt watched. Alicia described her terror amongst the journal’s pages, noting even that she glimpsed a man watching her home from the street.

Gabriel Berenson does not have the reaction to his wife’s fears that she would have hoped for. When she tells him of her recent anxieties and the man watching her, Gabriel can only seem to think of the past.

Years before, Alicia’s father committed suicide. Shortly afterward, she became extremely paranoid and attempted to end her own life. Gabriel now believes she having another psychotic break, and pleads with her to see an old therapist friend of his, under the table and off the record.  

Alicia reluctantly agrees, although she knows she isn’t crazy. She knows exactly what she has been seeing. She sees Dr. Chris, Gabriel’s therapist friend from college, and does not like him. He is flippant, condescending, and obviously does not believe a word she says.

When Theo finds out through Alicia’s detailed diary entries that she had seen Dr. Chris more than once under the table, he is enraged. Dr. Chris, as a matter of fact, is the very therapist Theo has found himself arguing with many times about Alicia’s medication, silence, and overall care. He is on the staff at the Grove, and yet, saw Alicia off the record in his own home, pocketing the money and not reporting the sessions. Faber confronts Chris immediately,  and after the other man’s sputtering and pleading, Theo decides not to tell the director just yet about Chris’s discrepancies. Instead, he drains any bit of information the other doctor may have about Alicia.

Finally, after Theo’s investigations reveal more of the truth, Alicia speaks. She breaks her silence of six years to tell Theo what happened the night her husband died: it was a masked intruder, not her, who killed Gabriel Berenson.

But Theo knows her story is a lie.

As the story lines begin to come together, Theo stalks his wife yet again. He sees her, then. He finally sees who it is she has been seeing.

There, his wife Kathy is hanging on the arm of none other than Gabriel Berenson.

Theo speaks of a profound sorrow, and it seems that he feels Alicia and himself can relate. They are both being deceived, both tossed aside unknowingly by their lovers they so dote on. He wants to help Alicia.

And he maintains throughout the story that that is all he ever wanted.

So Theo Faber breaks into Alicia and Gabriel’s home. He attacks Alicia, ties her up, waits for her cheating husband to arrive home.

Theo commandeers Gabriel’s gun, training it on the couple.

When Theo reveals to Alicia for the first time that Gabriel is unfaithful, her heart shatters. She can’t believe the man she lives for has betrayed her. Her shock renders her speechless, and she barely seems to process anything further.

Dr. Faber asks Gabriel who he should shoot. Who deserves to die, Alicia, or Gabriel? Alicia is silent. She’s stunned. But she is so sure, so positive, that Gabriel loves her. She knows he wouldn’t hurt her.

And then, “I don’t want to die.”

When the words leave Gabriel’s sobbing, sputtering lips, Alicia knows then she is dead. She thinks to herself the same thing she did when, years ago, she overheard her father wishing she had died instead of her mother: “He killed me.”

And so, with Gabriel’s back facing her, as he thrashes in the chair he is tied to, Theo turns the gun on her.

The gun is shot.

But, Alicia’s eyes open, and there stands Theo, smiling, a finger to his lips.

He leaves Alicia Berenson there, with her sniveling husband thinking she’s been shot, and her silence seeping into the walls.

Theo reveals later on that he didn’t actually expect anyone to die. But, the gun was Gabriel’s. So Dr. Faber left it there, and Alicia Berenson took hold of it. Silently, she revealed herself to Gabriel, dead-eyed and broken, and shot him. She writes, “I didn’t kill Gabriel, Gabriel killed me. All I did was pull the trigger.”

When Theo realizes that she remembers who he is and what he did, he panics. He cant help her anymore. Not without hurting himself.

So, with the resources of The Grove at his fingertips, he acquires a lethal dose of morphine. Unbeknownst to him, he does not get to Alicia in time. Before he stabbed her with the needle and administered the fatal dose, she wrote it all down.

She wrote that she recognized him, that she knew what Faber had done. She told her story, and she hid it in the canvas of a painting. Theo looked everywhere for the diary after killing Alicia, knowing it was the only thing that could cause a hiccup in his plans. He could never find it.

The next time he sees that diary, it is being read aloud to him in the hands of a police inspector. He watches snow fall as Alicia’s words are read. What truly impacted me was the words Alicia wrote pertaining to the reason Theo finally killed her.

“He was scared of my voice.”

She had finally spoken after six years and told her truth, only to be murdered before it could come to light. And it was because Theo was afraid of her voice.

What I found truly interesting about The Silent Patient was this concept of silence, and the reasons behind it. The novel is unraveled slowly by “reading between the lines” and piecing together the truth.

Alicia’s silence is fascinating, because of it’s origin. She is not quiet out of spite, or anger, or need. She is silent because, as she puts it, she has nothing to say.

Alicia Berenson’s selective mutism paired with her troubled past creates a wonderfully three-dimensional character that I honestly found relatable at times. Her struggles with self worth and depression stem from her desperation for approval and unconditional love. She never felt that love from her father, and when she finally found Gabriel, a man that she attached to and loved with all her heart, she felt safe. She felt cared for. Whole, loved.

And yet, just like her father, her husband cuts her deep. When Gabriel weakly admits he would rather her die than himself, Alicia finally snaps. But her rage and distress isn’t like we often see it portrayed. Her anger is sad. Her silence is empty. Without his love, she has become a husk.

Reeling in the shock and depression of losing the one thing she trusted and clung to for so long in the hopes it would keep her whole, she feels as though her world was shattered. Alicia Berenson genuinely feels as though she has died.

And when she kills Gabriel, to her, all she did was pull a trigger. In her mind, she’s the one that ended up dead.

Her attachment to relationships and the correlation to her own self worth and desire to live is what stands out to me in this story. Watching Alicia die, only to be revived by the one that caused it all and then be truly killed by the same man when she speaks again, felt like a hellish loop. Her descent into madness feels almost justified, and that is what made me love her character.

The Silent Patient was a great read, and I would absolutely recommend it to lovers of thrillers and unreliable narrators. Especially if you like a good depressing ending, like me! 😉