Book Review: The Silent Patient by Alex Michaelides

I can never guess the culprit in Agatha Christie novels until Hercule Poirot lays it all out at the end. In the same way, I didn’t see the signs or the twists coming in Alex Michaelides’ debut novel The Silent Patient (2019), even if at times they might have seemed obvious. Just not to me. Maybe I wasn’t paying attention, so absorbed was I in this cleverly crafted psychological thriller.

The Silent Patient, to use a cliché, pulls you in from the start with a simple but unsettling theme: thirty-three-year-old Alicia Berenson, a once-famous painter, shoots her husband and stops talking completely. Theo Faber, a psychotherapist, reads about her case in the papers and is determined to make her talk and find out why she did it—and, in fact, you can’t wait until he does. After all, Alicia, by her own admission, loved Gabriel and couldn’t imagine life without him.

Alicia is sent to a psychiatric hospital called The Grove, where Theo manages to find a job and convinces its director, Professor Diomedes, to assign her case to him. Theo begins his therapy sessions with Alicia but gets nowhere with her. For anyone else, it would be like banging their head against a wall, but not Theo, who comes across as kind and patient. He believes it’s only a matter of time before he can get Alicia to speak again.

The Theo-Alicia relationship and all that transpires between them are told through Theo’s first-person narrative—his point of view—and entries from Alicia’s secret diary and her art—the latter, just as silent and mysterious as she is. Together, they help the reader understand the whole story and how, in many ways, their lives are similar and linked in unexpected ways.

The Silent Patient deals with themes like trauma, guilt and repression, and the somewhat complicated relationship between a therapist with a single-minded obsession and a patient who doesn’t seem to care whether she ever speaks again. What’s clear from the start is that Alicia may be the patient, but her therapist is no less troubled. Here, the author, who, according to online sources, studied psychotherapy and screenwriting, does a brilliant job of not giving away much even as he keeps the suspense alive.

What made the novel stand out for me is its focus on how trauma at a young age can shape our behaviour as we become adults, often compelling us to hide the truth from others and even from ourselves, and how we might sometimes turn to silence instead of words—for better or worse.

I liked Alex Michaelides’ writing. It’s straightforward and easy to follow. The author sets up everything nicely—especially Theo and Alicia’s stories and their perspectives—until you reach the last few pages and are left wondering, ‘What the hell just happened?’

I will be reading his other two books, The Maidens (2021) and The Fury (2021).