Alex Michaelides’s The Silent Patient is a rare psychological thriller that plays with secret agendas while constantly inhabiting the realm of psychotherapy and trauma. There is murder and violence here, which makes it fit nicely in the category of crime fiction and offers fans of the genre a lot to enjoy, but the series of secrets at the core of the narrative and the revelations in the novel’s last act set it apart from most contemporary crime novels and make it a unique, memorable hybrid.

Alicia Berenson appeared to have a great life. She had a successful career as a painter and loved her husband Gabriel, a popular fashion photographer. The couple didn’t struggle financially and lived in a beautiful house in one of London’s most expensive residential areas. Then Gabriel got home late one evening and Alicia shot him in the face five times and waited for the police to arrive. What went down? That’s impossible to tell, because she never spoke another word. Because of her refusal to speak, Alicia’s act became a sensationalized event and she landed not just in jail but locked up at the Grove, a secure forensic unit in North London where she shared space with all kinds of patients. After all attempts at treatment failed and she tried to commit suicide, the doctors drugged her into a zombielike state. The Grove is also where Theo Faber, a criminal psychotherapist, accepts a job in hopes of treating Alicia. He has worked hard to get there and has wanted to treat her for a long time. He wants to get her to talk, and thinks he knows how to do it. It means a lot to him because he and Alicia are tied in ways no one around them suspects, and those ties are full of dark, deadly secrets.  

Under the crime fiction umbrella, psychological thrillers are a healthy subgenre. However, sometimes the name is used loosely. That is not the case with The Silent Patient. This novel embodies psychological trauma and psychotherapy. Most of the action takes place inside the microcosm of an institution that treats people with serious mental health issues. Furthermore, there are half a dozen characters who are psychotherapists and have enlightening conversations about what is best for their patients and why. Theo is an interesting, nuanced character whose relationship to his patient is unprofessional for a plethora or reasons, but he treats her like a professional because getting her to speak means a lot to him and he uses his knowledge to achieve. The way he explains Alicia’s past is informative without ever turning into an info dump that bogs down the narrative:  

A tormented, abused child can never take revenge in reality, as she is powerless and defenseless, but she can—and must—harbor vengeful fantasies in her imagination. Rage, like fear, is reactive. Something bad happened to Alicia, probably early in her childhood, to provoke the murderous impulses that emerged all those years later.

As the narrative moves forward, Theo’s interests and secrets start to affect his professional performance. Meanwhile, the reader learns about his traumatic past and how the near-collapse of his relationship to his wife affected him in the past and continues to affect him in the present. These past events also show that he, like most professional in psychology and psychiatry, is unable to apply his techniques to himself and even starts wondering if divine intervention is to blame for what he is going through:

I burned with hate. This man had come from nowhere and invaded my life. He had stolen and seduced and corrupted the one thing in the world that was precious to me. It was monstrous—supernatural. Perhaps he wasn’t human at all, but the instrument of some malevolent deity intent on punishing me. Was God punishing me? Why? What was I guilty of—except falling in love? Was it that I loved too deeply, too needily? Too much?

The beauty of The Silent Patient is that Michaelides takes his time revealing everything while never slowing the narrative down. The events surrounding Gabriel’s murder spread in many directions and touch more than just his and Alicia’s life. There are entire life narratives colliding on that awful night, and the author gives it all away piece by piece, keeping the reader intrigued throughout by slowly showing the hidden nature and truths of his two main characters. Ultimately, the last third of the novel, and the finale, work very well and together make for a very satisfying read. Readers who enjoy their crime fiction multilayered and full of emotion would be remiss to skip this one.    

***

The Silent Patient
by Alex Michaelides
Celadon Books; 336 p.

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