There is a lot that is unsettling about The Silent Patient, by Alex Michaelides. First, there is a patient—Alicia Berenson—who will not speak after she was convicted of shooting her husband. Then there are all the conflicting accounts of Alicia’s character; there are a lot of liars in this novel. But I think that unsettled me most was the way that Theo Faber wrangled so hard to become Alicia’s psychotherapist at the facility where Alicia has been confined. Something about his declarations that Theo wants to get Alicia to speak feel a little desperate. It’s only at the end of the book that we learn the full, shocking truth in a twist that absolutely floored me. I haven’t been snookered so completely, in the best way, by a book in a very long time.
After short prologue introduces us to Alicia’s voice, via a journal she kept before she was tried and convicted of her husband’s murder, we meet Theo Faber. Theo has been delighted to learn that he has secured a job at the Grove, a facility for criminals with mental illness. Alicia has been incarcerated there for seven years by the time Theo shows up. The first time he sees her at the Grove, Theo can see the tell-tale signs of overmedication. Alicia is on a strong dose of anti-psychotics and has restricted privileges due to her history of violence and suicide attempts. But even once Theo convinces the director to allow him to become Alicia’s therapist, reduce her dose, and give her access to art supplies and a temporary studio, Alicia still refuses to speak.
At the same time that we see Theo using everything in his psychoanalytic arsenal to try and get Alicia to talk, we get more excerpts from Alicia’s journal, as well as conversations Theo has with her friends and relatives to try and discover what is keeping Alicia from speaking. He finds a long, often contested history of abandonment, suicidal depression, and betrayal. Meanwhile, alternating chapters reveal that Theo has his own problems. His beloved wife has cheated on him and he is reeling from the shock.
I can’t say anything else about the plot of The Silent Patient without ruining its brilliant twist. Instead, I can say that this book is an astounding tale of psychological cat and mouse. There were a few times I rolled my eyes at Theo’s more Freudian statements about Alicia’s state of mind, but I had to admire his drive to break through Alicia’s silence. The rest of the staff at the Grove seem to have consigned the former artist to medication and given up on talk therapy. Even if I thought there was something inexperienced and off about Theo, Alicia needs rescuing. Any port in a storm, eh? But as every chapter and every conversation reveals just how far down the rabbit hole of deception and psychological horror goes, one has to wonder if there really is a safe harbor anywhere for her—or if she really deserves one at all.
Agh! I’m saying too much. Thriller fans, especially fans of psychological mysteries should definitely pick this one up.