The Silent Patient

“I am not the hero of this tale. It is Alicia Berenson’s story, so I must begin with her—and the Alcestis.” 

At this point of the novel, Theo’s identity is not yet known. By taking the role of the nameless narrator, devoid of personal details, Theo focuses the narrative on Alicia’s story. This suggests that Alicia is the driving force of the narrative and, at first, this seems to be the case—after all, her murder of Gabriel drives the central plotline. However, Theo is the driver of this action, having been the direct cause of Alicia’s mental breakdown. Theo’s attempts to fade into the background in the first chapters thus appear disingenuous—as does his labeling Alicia a “hero” once Theo’s role of “rescuer” opposite her comes to light.  

“There was no time to waste: Alicia was lost. She was missing. And I intended to find her.” 

Theo claims the mantle of the rescuing hero. He describes Alicia as “lost” and suggests he’s the one who can “find” her. His real motive isn’t to help her, however; he’s driven by personal and professional curiosity, determined to figure out just why she ended up shooting Gabriel and why she stopped talking. 

“You are not the first. I believed I would succeed. Alicia is a silent siren, my boy, luring us to the rocks, where we dash our therapeutic ambition to pieces.” 

Lazarus, perceiving Theo’s desire to “rescue” Alicia, warns him of the futility of the task. Sirens appear in Greek mythology, and are mythical creatures of the sea that lure sailors to their deaths with their beautiful singing. Alicia, on the other hand, lures psychoanalysts like Theo with her silence. The juxtaposition of Alicia and the siren figure foreshadows the destruction ahead.    

“It’s hard to imagine two more different women than Kathy or Alicia. Kathy makes me think of light, warmth, colour and laughter. When I think of Alicia, I think only of depth, of darkness, of sadness. Of silence.” 

These two female characters represent different ends of the mental health spectrum. While Alicia remains burdened by mental health issues from her traumatic childhood, Kathy seems healthy. Theo points out that Kathy uses phrases like “I’m so crazy,” but that she actually doesn’t seem to be—at all. By the novel’s end, Kathy will become more like Alicia, depressed and silent. 

“Marijuana was doing something much more than soothing me: crucially, it altered the way I experienced my emotions; it cradled me and held me safe like a well-loved child. In other words, it contained me.” 

With these words, Theo explores one of his own childhood traumas—his mother’s inability to “contain” him. He explains that persons who lacked containment from their mother can’t self-soothe as adults and therefore seek containment elsewhere, such as through drugs. Eventually, Kathy will become his drug. This addict-like state sheds light on just why Theo was unable to leave Kathy.

“But that’s what Alicia did for you. Her silence was like a mirror—reflecting yourself back at you. And it was often an ugly sight.” 

Trying to engage in talk therapy with a mute patient, Theo ends up talking mostly about himself—and reveals unsavory details regarding his feelings of hatred for Kathy. The “silent mirror” represents therapy. Patients must confront their emotions and traumas, as if looking into a mirror. The result can, as Theo himself knows, be difficult to stomach.

“How little I knew her. Those emails demonstrated I’d been living with a stranger. And now I saw the truth. Kathy hadn’t saved me—she wasn’t capable of saving anyone. She was no heroine to be admired—just a frightened, fucked-up girl, a cheating liar. This whole mythology of us that I had built up […] now collapsed in a matter of seconds—like a house of cards in a gust of wind.” 

Theo elucidates just why Kathy’s betrayal is so difficult for him to handle here. He had seen Kathy as rescuing him, giving him a life of normalcy and intimacy—things he never thought he’d attain after his traumatic childhood. He now must take her off this pedestal and acknowledge that she’s not a rescuer—and, consequently, the fact that perhaps she never rescued him.

“She was the love of my life—she was my life—and I wasn’t ready to give her up. Not yet. Even though she had betrayed me, I still loved her. Perhaps I was crazy, after all.” 

Realizing that Kathy didn’t “rescue” him and spiraling mentally in the face of her betrayal, Theo must face facts. He’s shown a desire, repeatedly, to escape his past—and part of that means escaping his mental health issues. He doesn’t even like to admit that he smokes, for instance, seeing this as an indicator of unresolved psychiatric issues. So for him to acknowledge, “Perhaps I was crazy, after all” is a huge step.

“Real love is very quiet, very still. It’s boring, if seen from the perspective of high drama. Love is deep and calm—and constant.” 

Ruth says this to Theo after he tells her about Kathy’s affair. Ruth’s assertion that love is “quiet” brings to mind the silence surrounding Alicia. This line also speaks to the importance placed on non-verbal communication by the narrative. Real love might not be shouting it from the rooftops, for instance, but might be apparent in small, quiet actions—like holding someone’s hand.

“There’s an aggressive side to Gabriel, a part of him I only glimpse occasionally—and when I do, it scares me. For those brief moments it’s like living with a stranger.” 

Alicia writes this in her diary. Kathy likewise once says Theo seems like a stranger to her, and Theo says that Kathy seems like a stranger to him. The idea that a romantic partner, the individual a person is most intimate with, can seem like a “stranger” is scary. Theo, Alicia, and even Kathy (when she finds out Theo is secretly smoking marijuana) all grapple with the realization that their loved one may not be who they thought they were. The trope of the “stranger” in this case offers a subtle nod to the thriller genre. Instead of an actual stranger being the threat, however, it’s the person each character is closest to. 

“I don't believe that Max is in love with me. I believe he hates Gabriel, that’s all. I think he’s madly jealous of him—and he wants to take everything that belongs to Gabriel, which includes me.” 

Alicia writes this in the diary entry revealing Max’s sexual harassment. With this information, the author places a red herring, suggesting that perhaps Max—the jealous brother—had something to do with Gabriel’s death. The false clue gets confirmation by the fact that Max was the sole beneficiary in Gabriel’s will.

“Within these walls her personality had formed: the roots of her adult life, all causes and subsequent choices, were buried here. Sometimes it’s hard to grasp why it is that the answers to the present lie in the past. A simple analogy might be helpful: a leading psychiatrist in the field of sexual abuse once told me she had, in thirty years of extensive work with pedophiles, never met one who hadn’t himself been abused as a child.” 

Theo says this upon viewing Lydia’s house, where Alicia grew up after Eva died. He’s explaining just why Alicia’s childhood is so important—to the point that it has him playing the part of detective, running around London and Cambridge in search of clues. Ironically, Theo is condemning himself with this point of view, unconsciously informing the reader that the roots of his own adult life and his own choices lie in his troubled childhood. 

“‘You know, you sound more like a detective than a psychiatrist.’

‘I’m a psychoanalyst.’ ‘Is there a difference?’” 

Jean-Felix says this when Theo is grilling him about the last time he saw Alicia before the murder. Lazarus has already accused Theo of acting like a detective and this label mirrors a shift evident in Part 2, which presents a narrative with more typical traits of a mystery-driven thriller. Since Theo can’t talk to Alicia about her childhood, he must go out in search of “clues” to her past. This exchange between Theo and Jean-Felix also highlights Theo’s preference for psychoanalysis when it comes to mental health treatment. Psychoanalysis, developed by Sigmund Freud, involves treating emotional disorders by encouraging the patient to talk freely about personal experiences, especially their childhood and dreams. 

“If you really want to get Alicia to talk […] give her some paint and brushes. Let her paint. That’s the only way she’ll talk to you. Through her art.” 

Jean-Felix highlights the power that non-verbal communication can hold. Coming on the heels of the gallery tour, in which he has showed Theo Alicia’s paintings, it’s a powerful statement. Even when she could talk, it seems Alicia communicated just as well through her art. 

“I have the feeling I let him down. It’s a feeling I’ve always had about Paul, since we ere kids. I’ve always failed to live up to his expectations of me—that I should be a mothering figure to him. He should know me better than that. I’m not the mothering type.” 

These lines speak to one of Alicia’s central fears—whether her mother’s insanity lives on in her. Alicia has acknowledged that she wonders if her mother meant to kill Alicia and make her suicide a murder-suicide. This fear leads Alicia to disavow any maternal instinct. Still, when Gabriel asks her if she’ll have a baby with him, she’s happy and agrees, indicating the complexity of her mental state—wanting to have a baby but being afraid she’ll fail as a parent (just as her own parents did). 

“How would you feel? The person you love most in the world has condemned you to die, through their own cowardice. That’s quite a betrayal.” 

Lazarus says this to Theo when Theo seeks his help in understanding the Euripedes play about Alcestis. The question leads to a moment of illumination as Theo realizes that such a betrayal would inevitably result in a deep rage (much like his own rage in the face of Kathy’s betrayal—which he never verbalizes to her).

“You’re over-identifying with her. It’s obvious. She’s the patient, you know—not you” 

As Theo gets deeper and deeper into his work with Alicia, his own mental health issues become more apparent. He’s unraveling. Christian’s words here underscore the blurred line between doctor/patient and unstable/stable. 

“I registered my emotions with shock—I ought to have been hugely relieved that Kathy had been telling the truth. I ought to have been grateful. But I wasn’t. I was disappointed.” 

Theo says this after he has followed Kathy to what he thought would be a clandestine meeting with her lover—only to discover that Kathy was, as she claimed, meeting a friend. His disappointment speaks to his desire to nail Kathy to the cross, metaphorically speaking, now that he’s taken Kathy from her pedestal. His rage leaves no room for him to view his former “Goddess” in any positive light; just as he once only wanted to see the good in her, now he only wants to see the bad.

“I thought of my father—I knew what he’d do in this situation. He’d murder the guy. Be a man, I could hear my father shouting. Toughen up. Was that what I should do? Kill him?” 

Theo shows an attempt to disavow himself from his father. The words point to his delusional self-image. He seems to think he’s escaped his childhood trauma thanks to his work with Ruth but he’s actually backsliding and will soon take violent actions that, although not literal murder, certainly are beyond the realm of what’s considered sane (stalking, assaulting Alicia, etc.). 

“Imagine it—hearing your father, the very person you depend up on for your survival, wishing you dead. How terrifying that must be for a child, how traumatizing… Over time you would lose contact with the origins of your trauma, dissociate the roots of its cause, and forget. But one day, all the hurt and anger would burst forth, like fire from a dragon’s belly—and you’d pick up a gun. You’d visit that rage not upon your father, who was dead and forgotten and out of reach—but upon your husband, the man who had taken his place in your life.” 

This passage serves to explain just why Alicia’s childhood trauma could have led to her killing Gabriel. By putting Theo into “psychoanalyst mode,” the author allows his character to connect the dots for the reader.

“I remember thinking, there’s no going back now. We were crashing through every last boundary between therapist and patient. And soon it would be impossible to tell who was who.” 

Here, Theo acknowledges the increasingly blurry line between him and Alicia. The power dynamic started with Theo—the stalker and the doctor—in control of Alicia, the victim and the patient. This will ultimately shift as Alicia will gain control of the narrative and determine its outcome through her final diary entry.

“I felt a small flicker of pride—a son congratulated by his father.” 

This is how Theo responds to the positive feedback that Lazarus, the senior psychiatrist at The Grove who he has tried to impress from day one, gives him. Theo’s lack of a decent father figure receives illumination by the attachment he forms to Lazarus, seeking approval and praise (which his father never gave him as a child). Theo also views certain older women, notably Ruth but also Indira, as replacement mothers, imbuing them with maternal characteristics and turning to them for guidance. 

“He was afraid of me—of what I might say. He was scared—of the sound of my voice.” 

Alicia writes this in her final diary entry, in which the truth about Theo comes to light. It’s an ironic moment: Theo has been striving to get Alicia to talk but now that she’s talking, he’s afraid—and will try to silence her through the morphine overdose. After six years of silence, however, Alicia knows she can still get the upper hand without talking, namely through her writing.