The Silent Patient - Alex Michaelides

Obsession, betrayal, paranoia, madness, murder, mystery; there’s a lot going on within the first few chapters of The Silent Patient. Not content with it using these elements to be a just a run-of-the-mill female-in-distress thriller, Alex Michaelides layers in references to Greek mythology, Freud and psychoanalysis into the novel. What this suggests is that there are subconscious elements at play here with the unsuspected secrets and troubled personal histories lying beneath the surface hiding dark motivations that are capable of springing unexpected twists. There’s definitely nothing ordinary about this murder case.

It’s not going to be easy to get to the truth of the murder of photographer Gabriel Berensen however, because his wife Alice hasn’t spoken a word since his violent death in their home, having apparently shot him in the face five times while he was strapped into a chair. Alicia, a painter of some renown, has remained silent and impassive throughout her trial, leaving the court no option but to put the killing down to ‘diminished responsibility’, sending her to a psychiatric ward. Even there at The Grove under the care of Professor Diomedes, Alicia remains unresponsive to treatment, never speaking a word.

Psychotherapist Theo Faber however is fascinated by the case and by the enigmatic artist herself and believes he can rescue her. Faber himself has had a difficult upbringing that has resulted in him having to seek therapy in the past and his relationship to his actor wife Kathy is starting to show some cracks that Theo isn’t ready or willing to acknowledge. Having successfully been appointed at The Grove, Theo believes however that his own experiences will perhaps give him greater understanding of what Alicia might have been going through and this might help him succeed where others have failed, finding a way to break through the silence of the heavily sedated and apparently dangerous patient.

In The Silent Patient you can find all or most of the elements that make up a typical Patrick McGrath neo-Gothic melodrama (Asylum, Port Mungo, Constance); a therapist, an artist, an actress, sexual obsession, betrayal and murder. And, most crucially, there’s a certain ambiguity and uncertainty over the relationship between the doctor and his patient to such an extent that you wonder who is the doctor and who is the patient, who is the sane person and who is the mad one. This therapist, relating from a first person narrative viewpoint, clearly has issues in his own relationship and you get the impression that perhaps his obsession with his patient Alicia is just a way to work through his own problems.

Where Alex Michaelides differs from Patrick McGrath is in the tone of the writing. There’s none of McGrath’s arch Gothic narrative and clean lucid prose, but Michaelides covers the procedural and the character development of the characters well and establishes a natural progression that takes in the separate journeys of Theo and Alicia (the silent patient having a voice through diary entries). Through these perspectives and strongly suspicious secondary characters, the author holds interest and builds towards what is inevitably going to be a shock revelation and conclusion. It’s so cleverly done that you almost feel like going back and rereading to see everything differently, and if you do I’m sure that you’ll find that The Silent Patient is pretty much watertight.