This book discussion guide contains spoilers
Alex Michaelides’ debut novel, The Silent Patient (February 5, 2019, Celadon Books), is a gripping psychological thriller that follows the unravelling mystery of a woman’s selective mutism after she allegedly murders her husband. Since his debut in 2019, the British Cypriot author has released two other novels in the thriller genre. These novels are The Maidens and The Fury.
The Silent Patient is predominantly narrated by Theo Faber, a 42-year-old forensic psychotherapist. The second narrator’s voice in the novel is that of Alicia Berenson, who is the subject of the story. Theo’s voice relays the present-day activities. While Alicia’s voice details the events that transpired six years ago, through her journal, as Alicia is the silent patient.
The connection between Theo and Alicia is that of psychotherapist and patient. Alica is currently a patient at the Grove mental institution and Theo is a new member of staff who is determined to get Alicia to talk.
Plot Summary for The Silent Patient
In the first pages of the novel, Theo introduces Alicia and her husband, Gabriel Berenson, with the announcement of Gabriel’s death. He details the events that transpired immediately after Gabriel’s murder, which includes Alicia’s suicide attempt, her mutism, and her painting of the Alcestis.
Theo then hints at the significance of the Alcestis painting concerning Alicia’s situation. He also makes a very disconcerting statement: “I must start at the beginning and let events speak for themselves. I mustn’t color them, twist them, or tell any lies. I’ll proceed step by step, slowly and cautiously.”
When he introduced himself as Theo the psychotherapist in the following chapter, I thought, what reason would a psychotherapist have to want to twist, lie, or colour the events of a patient’s life? However, as the story progresses and we see Theo’s genuine efforts in trying to understand and help Alicia, my doubts about him begin to subside.
The Journal
The novel begins with a prologue in the form of a journal entry from Alicia, dated July 14, which we soon realize is the year of Gabriel’s murder. Alicia’s journal plays a vital role in the story as it gives us a sense of what her life was like before Gabriel’s death.
By all indications, their relationship was that of a loving couple with some problems, but it was difficult to see Alicia killing Gabriel. As the journal entries progress, we learn about the mysterious man who was watching Alicia, and things start to make a little more sense. I began to think that maybe this mysterious figure was somehow involved in Gabriel’s death.
This was until I learned that something like this had happened before, but at that time, Alicia was having a breakdown and imagining things. During this time, were introduced to different figures in Alicia’s life who seemed capable of being the mysterious man.
First, there was Gabriel’s adopted brother, Max Berenson, who was in love with Alicia. Secondly, there was Jean-Felix Martin, an old friend of Alicia who had a strange and strained relationship with her. The third viable suspect was Alicia’s cousin, Paul Rose.
Alicia’s initial journal entries end on August 25, the day of Gabriel’s murder. But this final entry ends abruptly and there are no details about Gabriel’s death, only that there is an intruder in their home.
Theo’s Life
The bulk of Theo’s narrative centres around the Grove, counselling Alicia, and interviewing the people who were a part of her life. However, now and then we get a glimpse into Theo’s life. We quickly learn about his childhood, how he met his wife (Kathryn), and what is presumably the current day-to-day of his home life.
We learn that Kathryn, whom Theo calls Kathy, is a spouse that he has placed on an unrealistic pedestal, claiming that she saved him. His image of Kathy comes tumbling down when He learns that Kathy is being unfaithful, a fact that he later confirms.
Theo’s home life disaster is happening during the time that he is counselling Alicia, or that’s what Alex led me to believe.
Theo’s Fixation on Alicia
At the beginning of the novel, Theo reveals his fascination with Alicia’s case, stating that “without wishing to sound boastful, I felt uniquely qualified to help Alicia Berenson.” His unrealistic fixation on helping Alicia is further amplified when we learn that Theo taking the job at the Grove meant that he was abandoning a more secure career path at his previous workplace.
As Theo’s counselling sessions with Alicia prove to be fruitless, a desperate plea from Theo persuades Alicia to share the journal that she kept six years ago with him. Theo reads this journal, that we have been reading from the beginning, and it blows his investigation wide open.
Now Theo had what was presumably the facts that he needed to revisit the three original suspects Max, Jean-Felix, and Paul. Additionally, he now had a fourth suspect, Christian West, who was Alicia’s psychologist six years ago and was today treating Alicia at the Grove. The fact that Christian knew and treated Alicia before Gabriel’s death is information that he failed to disclose.
But the real completion of the puzzle came for Theo when he revisited Paul. Paul revealed what happened on the night that Alicia’s mother died, and everything came into place for Theo.
Alicia’s Breaking Point
What made Alicia’s case clear to Theo was this statement from Paul: “Yeah. And Alicia whispered something to me –I’ll never forget it. ‘He killed me’ she said. ‘Dad just—killed me.’” Alicia’s statement came as a response to overhearing her father say that she should have died instead of her mother. Alicia was ten years old at the time and this traumatic experience stayed with her.
Theo returns to Alicia, and this is when she finally breaks her silence. Alicia eventually tells Theo what happened the day that Gabriel died, but her story doesn’t align with the evidence. So, Theo knew she was lying, but we didn’t know just how certain he was.
At this point, we get to understand that the events that Theo was relaying about Kathy are not present day but rather from six years ago. Theo was the mysterious figure watching, following, and finally breaking into Alicia’s home six years ago.
However, Theo did not kill Gabriel. Instead, he revealed to a fragile Alicia that Gabriel was cheating on her. Theo told Gabriel that he would kill either him or Alicia, but Gabriel had to decide who died. Gabriel chose to save himself.
Then Theo left Alicia alone with a loaded gun and a restrained cheating husband, who would send her to die (as in the story of Alcestis). Gabriel’s decision reopened Alicia’s childhood trauma and caused her to shoot him in the face five times after Theo left.
Theo claims that he had no idea that Alicia would kill her husband. But he must have known that leaving a scorned woman with a loaded gun and a restrained husband could potentially lead to murder.
The Culmination
In the final pages of the novel, it seems that Alicia attempted suicide, which left her in a coma. But in reality, Theo had injected her with a massive dose of morphine. Though Theo was wearing a mask at the time he broke into Alicia’s home six years ago, he feared that Alicia had recognized him, and he was correct. Alicia had recognized Theo as the intruder from their second therapy session many weeks before.
Just before Alicia slipped into the coma, she made a final entry into her journal, implicating Theo, and then she hid it. A detective finds the journal later and visits Theo at his home, where we finally get to meet present-day Kathy, who is now just a shell of the Kathy we came to know.
Discussion Questions for The Silent Patient
- The Silent Patient begins with an epigraph “But why does she not speak? –EURIPIDES, Alcestis” What is its significance to the novel?
- How would you describe Theo’s personality?
- Does your initial impression of Theo change throughout the novel or does it remain the same?
- What is your impression of Alicia?
- Of the two main characters, which (if any) do you identify with and why?
- How do you feel about the way the novel ended? Was it satisfying? Did you expect more? If you could choose an alternate ending, what would it be?
Important Quotes from The Silent Patient
“I must start at the beginning and let events speak for themselves. I mustn’t color them, twist them, or tell any lies. I’ll proceed step by step, slowly and cautiously.” -Theo
“You know, Theo, one of the hardest things to admit is that we weren’t loved when we needed it most. It’s a terrible feeling, the pain of not being loved.” – Ruth (Theo’s therapist)
“Most of my patients weren’t loved. Alicia Berenson wasn’t.” -Theo
‘” He killed me,” she said. “Dad just killed me.”’ -Paul (relaying Alicia’s words)
What I Loved About The Silent Patient
The Twist
Throughout the novel, many little twists help to build the suspense, such as Alicia having a history of thinking she is being watched when she isn’t, and Christian knowing Alicia before Gabriel’s death. However, the truly draw-dropping moment came when we learned that the mysterious man existed, and that man was Theo.
I thought that Theo’s and Kathy’s story was a subplot that was only connected to the main plot by way of Theo being Alicia’s therapist. But when the revelation of the connection occurred my mind was truly blown, this is some first-class plotting.
The Two Mian Characters Were Disasters
At different points in the novel, I started wondering if I should truly be rooting for this character, and this happened with both leads. Their characters seemed real because they struggled with strong emotions, difficult decisions, and harmful character traits. In the end, Theo and Alicia’s character evoked both sympathy and dislike.
Theo Faced Justice
In some psychological thrillers, readers never get to truly see the perpetrator face justice. In Gone Girl Amy comes home to what seems like a dysfunctional happily ever after with Nick and Josie goes on the run in None of This Is True. However, even though it is not explicitly stated, we know that Theo gets arrested.
What I Didn’t Love About The Silent Patient
Theo hints at the fact that he might be an unreliable narrator very early in the novel. If a reader saw Theo as unreliable from the beginning, then the major twist wouldn’t have been as impactful to that read, as they might have seen something like that coming.
Overall Assessment of The Silent Patient
The plotting of The Silent Patient was superb. The novel began with a strong hook that made the book a real page-turner. The pacing and little twists throughout the novel ensured that it was suspenseful.
But by the end, there wasn’t a good guy. There were just two damaged people who made some bad choices due to intense emotions and poor self-control. However, the novel did provide enough psychological depth for the choices of each of the main characters to be believable. The Silent Patient fits seamlessly into the psychological thriller genre.
Some critics of the novel have said that the portrayal of the daily activities in the mental institution and Theo’s transformation into an amateur detective was unrealistic and unethical, respectively. Though this might be so, it didn’t diminish my reading experience as I have no knowledge of of how a mental institution operates. So, I would give this novel a four-point-five stars (4.5) rating.
Further Information on The Silent Patient
Enjoyed The Silent Patient? Elevate your reading experience with these recommended resources for fans of Alex Michaelides’ the Silent Patient.
- Visit Alex Michaelides’ website.
- Watch a video of Alex Michaelides discussing the novel.
- Listen to a podcast interview of Alex discussing his writing routine, the novel, and so much more.
The Stats:
The Silent Patent by Alex Michaelides
Published February 5th, 2019 by Celadon Books
336 pages (hardcover)
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