If you’re not intrigued by The Silent Patient, I don’t know how to help you. You’re certainly the exception rather than the rule. It debuted in 2019 at #1 on the New York Times Best Seller List, and went on to win the Goodreads Choice Award (Mystery & Thriller). Even now, years later, it remains a #BookTok darling and I still see it all over #Bookstagram. So, naturally, my curiosity was piqued.

The Silent Patient - Alex Michaelides - Keeping Up With The Penguins
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Michaelides has said he rewrote the draft of The Silent Patient about fifty times before locking it in. I suppose he was trying to mix the strange bedfellows of his influences in just the right measure. He drew from the Athenian tragedy Alecstis for the plot, and Agatha Christie novels for its structure and tone. That should give you a pretty good idea of what to expect.

The story begins with a forensic psychotherapist, Theo, drawn to the case of a woman at a psychiatric facility called The Grove. She has not spoken in over six years. Theo finagles his way into a job there, convinced that he’s the only one who can reach her and find the real reason for her protracted silence.

The crime? Well, it’s a doozy. One day, Alicia shot her husband Gabriel repeatedly in the face, and then cut her own wrists. There was no financial motive for the crime, and no apparent conflict in the marriage. She hasn’t said a word to anyone in the years since, not even in her own defense. The judge sent her to the asylum instead of jail, on the grounds of diminished capacity (that’s “insanity”, to our Law & Order watchers), but her elective silence has endured even the staff’s best efforts and powerful psychotropic medications.

So, you’re curious, right? I sure am! I dove headfirst into The Silent Patient, desperate to find out why Alicia wouldn’t speak. It’s easy and interesting reading, and reminds me very much of Don’t Say A Word (one of the few psychological thriller films I’ve seen more than once). I think Michaelides’s background as a screenwriter shines through; he knows just how to set up a story to hook the audience, and pace it out to keep them there. It turns out he also spent a bit of time working at a secure psychiatric facility for teenagers when he was a student, which gives the setting a ring of authenticity.

As The Silent Patient progresses, you realise that both Theo and Alicia have been victimised by a nameless, faceless man in their lives. For Alicia, it was her stalker. For Theo, it was his wife’s lover. As the man gets closer to each of them (which feels like it’s happening in real time, with extracts from Alicia’s diary punctuating Theo’s timeline), the tension rises to almost unbearable heights. Is it just therapeutic countertransference between Alicia and Theo? Or are they actually connected?

If you plan on reading The Silent Patient for yourself, this is where you’re going to want to stop. If you’re just here to get some answers or you don’t give a shit about spoilers, work away.

Alicia finally does speak, around page 270 (in my edition). The Big Shock Twist(TM) comes about 30 pages after that. It turns out, Theo hasn’t been completely clear with the reader about the timeline of events. He’s led us to believe that his wife’s affair has been concurrent with his treatment of Alicia, but actually it happened six years prior – yep, in the lead-up to Alicia murdering her husband. Alicia’s husband was the one sticking it to Theo’s wife, and Theo was the one “stalking” her, figuring out how to insert himself into her life and reveal to her the truth of her husband’s infidelity. He basically goaded her into murdering her husband, and then tries to kill her once she starts speaking again so she can’t dob him in. He gets his just desserts, though, because Alicia magically manages to scribble out one last diary entry pointing to him as her killer.

Looking over that paragraph, it all sounds a lot more complicated than it felt as I was reading The Silent Patient. I suppose the frequent allusions to Greek mythology and the clues that Michaelides peppered throughout the novel made it all feel quite natural and inevitable as it played out. So, this might be one you just have to read for yourself to form a complete picture. I’m not sure it *quite* lives up to the unbelievable hype, but it’s definitely a decent, pacy read for the next time you want some twists and turns in your literary life.

My favourite Amazon reviews of The Silent Patient:

  • “The author did as much as he could to wreck the plot, and he succeeded.” – Donna
  • “Yet another “bestseller” glamorizing a psychopathic man-baby who deals with infidelity by torturing and killing innocent women.” – Dave
  • “OOOOh, how mysterious! Why is the patient silent? She likely didn’t want to be included in this boring novel. But she had no control, poor thing.” – frances henry