The Silent Patient: Review

I have just turned the last page of The Silent Patient, and I have to admit that I am impressed. I am pleasantly surprised by this, considering how I felt about his second novel The Maidens, which I read first. Unlike The Maidens, The Silent Patient has a cunningly well-thought-out plot and a jaw-dropping twist to finish. A twist that makes you want to go right back to the beginning to see how you missed it.

The Silent Patient blurb:

Alicia Berenson lived a seemingly perfect life until one day six years ago. When she shot her husband in the head five times. Since then she hasn’t spoken a single word. It's time to find out why.

Theo Faber is a psychotherapist just starting his new position at The Grove psychiatric facility, hoping to work with the infamous Alicia Berenson. Despite his previous employer warning him of The Grove’s possible closure, Theo does not want to miss out on the opportunity to treat Alicia. Throughout the story, he has several sessions with her, trying his best to get her to speak or at least get some emotional reaction out of her. He seems determined, and rather confident, that he can get her to talk again.

During the first half of the book, although I did not dislike him, Theo’s seemingly arrogant approach to the situation put me off him a bit. He seemed to have this hero complex and assured belief that only he could get her to talk again, which came across as egotistical for someone who did not know or have any connection to her. Other than that I didn’t take much issue with him as a character. He always seemed genuine when fighting for what was right for Alicia, for example getting her medication reduced so she could be present in everyday life, and protesting when she was punished after an altercation with another patient. You also gain sympathy for him when you learn that his wife is potentially having an affair, and he can’t even bare to confront her about it.

In addition to their sessions, Theo conducts a little investigation of his own, in an attempt to better understand Alicia and her state of mind. We meet multiple characters, all with a connection to Alicia, and all with a somewhat tumultuous relationship with her, making them possible suspects, or accomplices, as it is still unclear at this point if Alicia did indeed kill her husband. Alex Michaelides sets the story up well, and carefully paces it out so that we get the most out of the bittersweet ending.

*spoilers ahead*

The chapters of the book intercut between Theo at work and Theo at home, where he conducts two different investigations: Alicia’s silence and his wife's possible infidelity. While investigating Alicia he begins to add a few more pieces to the puzzle, albeit a very complicated puzzle. He gains many different accounts of Alicia, but his so-called leads almost seem to give more insight into the people around her, than into Alicia herself. As for their accounts of Alicia’s relationship with her husband, Theo cannot seem to get an accurate picture. For two people who were supposedly very much in love, Theo cannot seem to understand what would drive her to kill her husband Gabriel.

Similar to The Maidens, Michaelides gives little hints from multiple characters that mislead us to a possible conclusion. For example, when Theo meets Yuri, Yuri tells him that he fell in love with a beautiful woman who lived on his street and had taken to following her now and again, and the infatuation he had with her almost destroyed his marriage.

“It was love at first sight… I saw her on the street. It took me a long time to get the courage to talk to her. I used to follow her… I’d watch her sometimes, without her knowing. I’d stand outside her house and look, hoping she would appear at the window.”

Alicia is described, from the very beginning to be a very beautiful redhead, and a little later in the book, we find out that a man was stalking her from afar. There is also a point where we suspect Christian when we learn that Alicia had multiple unofficial therapy sessions with a doctor, named Dr. West. Theo then makes his way to Christian’s office and we see his full name on his office door: Dr. Christian West. At this point we realise why Christian decided to work there; so he could stay close to her and avoid losing his licence. Contrary to The Maidens, the clues we are given are far more subtle, and more interspersed throughout the story. The Maidens gave clues left, right, and centre, even for characters who were not important to the plot, which felt like lazy writing and a cheap form of misdirection.

As Theo’s methods for finding out the truth about his wife begin to crossover into stalker territory, we start to wonder about this mysterious man who has stolen her heart. As the reader, we assume that is it possible we know him already, however when Theo sees him there does not seem to be any recognition. One night, Theo follows the man home and learns that he is also married, only adding more betrayal to the torrid affair. At one point I thought it could be Gabriel and then realised that was not possible because he was dead.

The biggest lead that Theo gets is Alicia’s diary, given to him by Alicia herself. Her diary tells the whole truth, exposing the people around her and the lies they told Theo. It speaks of the man who was stalking her, and how no one believed her. Granted, there was no evidence or sightings from anyone else that she was being stalked. The people around her chalked it up to her bad mental health. However, Theo believed her, and for good reason, as it turns out.

After crossing too many professional lines in his quest to get through to Alicia, Theo is forbidden to treat her anymore. In a last attempt, Theo has one more session, to tell her that he won’t be able to see her anymore. He tells her that he understands her silence after hearing a particular story from her childhood when her father had told her he wished she had died instead of her mother. To his astonishment, by the end of the session, Alicia speaks her first words in six years.

Theo wastes no time in asking her about the night her husband was killed, and Alicia obliges. She tells him some fanciful story about an intruder forcing his way into her home and tying her up, making her watch as he does the same to her husband. However, Alicia’s story does not add up on multiple accounts, and Theo knows she’s lying.

He plans to confront her about the story, but when he arrives at work he is told that Alicia has had an overdose. It is unclear if she will survive. The doctors and nurses leave to give Theo a moment with her. Once they are gone, Theo finds an almost indistinguishable mark on her wrist, from a needle.

“Something had been overlooked. Something insignificant, something no one had noticed - not even Yuri… here under my fingertip, on the inside of Alicia’s wrist, was some bruising and a little mark that told a very different story. A pinprick along the vein - a tiny hole left by a hypodermic needle - revealing the truth… this wasn’t an overdose. It was attempted murder.”

A couple of chapters later, Theo returns to his wife’s lover’s home and waits for him to leave. However, instead of following him, he goes around the back of the house, looking for the man’s wife so he could tell her the truth about her husband. He finds her in the summer house in the back garden, and sneaks inside, where the woman is finishing a phone call. The setting and blocking sound eerily similar to the beginning of Alicia’s fanciful story. Then the chapter ends:

“This was the first time I came face to face with Alicia Berenson. The rest, as they say, is history.”

Suddenly you are completely stopped in your tracks while you wrap your mind around what you just read. It was Theo. Theo was the mysterious man that Alicia kept seeing around her house. Gabriel was his wife’s lover. You suddenly realise that Theo at work and Theo at home are separated by different chapters and that they do not exist in the same timeline. The chapters about his wife are from before Alicia killed her husband. WHAT!

Theo broke into her home to tell her about the affair, he tied her up and they waited for Gabriel to come home. When he did, Theo tied him up and faced them away from each other. He gave Gabriel a choice; either he dies, or Alicia does. After a painful ten-second countdown of screaming and pleading, Gabriels says he doesn’t want to die. Theo then pretends to kill Alicia, making Gabriel thinks she is dead. He then unties Alicia and leaves the gun with her. She stays silent, letting Gabriel believe she is dead because in a sense she was. He had condemned her to death.

“I remained silent. How could I talk? Gabriel had sentenced me to death. The dead don’t talk.”

And so began her silence. Michaelides frames his story within the Greek tragedy Alcestis (he loves his Greek tragedies, if you don’t believe me, just read The Maidens), which is about Admetus finding someone to take his place when Death comes for him. His wife, Alcestis, volunteers to take his place. Alcestis, however, returns from the underworld and refuses to speak - a loving wife wronged by her husband.

All these realisations started hitting me at once. My mind started racing back to earlier parts of the book, to moments I thought were a little strange but had no other reason to suspect them. For example, when Theo gets Alicia to paint to try and get through to her in some way, she paints The Grove on fire, burning to the ground, and two figures on the fire escape, a man holding a woman in his arms. Theo knows that the woman is Alicia and that the man is unmistakably himself, and the chapter ends with:

“I couldn’t tell if I were depicted in the act of rescuing Alicia - or about to throw her in the flames.”

At the time you can excuse it as Alicia being unsure if she can trust Theo, however by the end we know that she recognised him from their very first session as her stalker and the reason that Gabriel died. And the paragraph about him discovering the needle puncture in her wrist was not written as a discovery, it was written like he knew it was there because he did it.

The superiority complex also makes far more sense. He knew he was the only one who could get her to talk because he was the only one that knew the truth. He was the only other person there. He was the only other person that knew about his affair, his betrayal.

After reading that ending I wanted to go back to the beginning and start again to see if the truth was littered throughout the book. Michaelides chose his words very carefully when writing this, in a way that makes the ending so rewarding. If you read it, already knowing the ending, it all still fits together.

The only question I had about the plot, was why Theo chose to work at The Grove and see her again. She had been silent for six years. If he had stayed away, it might have been safe to assume that she would have stayed silent forever. She also never would have known his identity if he had kept his distance (he wore a Balaklava when he broke into her home), and if she did eventually speak of her own volition and told the truth, it is unlikely anyone would have believed her.

In the book, she says:

“How could it possibly be Theo? What purpose could he have in coming here to taunt me like this? And then I understood. All that bullshit about wanting to help me- that was the sickest part of it. He was getting a kick out of it, he was getting off on it - that’s why he was here - he had come back to gloat.”

For me, that felt like a weak excuse. After finding out the ending you realise that Theo is a little unhinged since he tied two people to a chair with naked wires and psychologically tortured them. But he always speaks of Alicia like she is his equal because they were both deceived by the ones they loved. He constantly says that he wants to help her, and seems - in his own morally questionable way - to care about her.

However, once you know how the story ends, their conversations throughout the book, and the words they say to each other, suddenly have underlying meanings that you would never have picked up on before you knew the truth. So in a sense, it was like a little game. They both knew who each other were, and yet they both kept up their pretenses. Almost like playing a game of chicken. So you could excuse that as getting off on it in some way.

Other than that small plot detail I had no issue with the book, and I enjoyed it. I would highly recommend it. A perfect mystery carefully plotted and meticulously executed.

*If you liked this review and analysis you can find my review for Alex Michaelides’ second novel The Maidens on my author's page!*