Book Review: The Silent Patient

Major spoilers ahead!

Alex Michaelides’ 2019 novel, The Silent Patient, is the epitome of the “unreliable narrator” storytelling device, and more than that, there are multiple unreliable narrators.

The premise of the novel is that we are like psychological detectives, coming into story at the end, or at least, what seems like the end: After Alicia Berenson has shot her husband, Gabriel, in the face five times. After she’s been arrested, and convicted. And after she’s been sent to Grove, a secure psychiatric unit in North London.

She never spoke again. Six years later, she still hasn’t spoken. That’s where we’ve come in.

The narrator of the story, other than Alicia herself through entries in her diary, is Theo Faber, a criminal psychotherapist who comes to work at the Grove to specifically “help” Alicia “see clearly.”

Throughout the novel, we learn that Alicia is a painter, and is particularly fond of the Greek play, Alcestis, about a woman who sacrifices herself for her husband, but after being resurrected, realizes the sacrifice was in vain.

We also learn that Alicia’s mother committed suicide by driving a vehicle, which Alicia was in as a child, into a brick wall. We learn that Alicia’s father, Vernon Rose, said (which Alicia overheard), that he wishes the wife had survived and Alicia died. Later in Alicia’s life, her father killed himself.

Meanwhile, Theo also doesn’t seem to have a good relationship with his dad. Throughout the novel, he seemed rather needy, desperate, on-edge, easy to rattle, and falls far too easily for his wife, Kathy. It’s a sort of … unhealthy seeming love. That was my takeaway. He seemed obsessed with her. And once at the Gove, he was almost projecting that same sort of desperate obsession onto Alicia to get her to talk and open up. We later learn the reason for the obsession.

Theo, who comes to be a psychological detective in a way, too, talks to various people in Alicia’s life, and we also get juxtaposed to that, Alicia’s version of events through the aforementioned diary. Through the former, we learn of a few unreliable narrators:

• Jean-Felix, her supposed longtime best friend, and the one who showed her paintings at galleries. As it happens, Alicia couldn’t stand him, and was planning on leaving his gallery before the murder. He seemed to not be in love with Alicia, but her artwork and using it to prop up his gallery. He also detested Gabriel for interfering in their “friendship.”
• Max, the “brother” of Gabriel, who was obsessed and “in love” with Alicia. I put brother in scare quotes because Max’s parents adopted him, but birthed Gabriel, so they weren’t brothers by blood. As such, Max resented Gabriel. Add to that his toxic affection for Alicia (he sexually assaulted her a few times), and it was a recipe for him being the likeliest culprit.
• Paul, Alicia’s cousin, who had a gambling problem and a crazy aunt. He knew Alicia had a lot of money, and that she could help square his debts, if it wasn’t for Gabriel.
• Christian West, who was secretly pretending to be Alicia’s private psychiatrist before the murder at the request of his friend, Gabriel (whoa!). He had plenty of reason to keep Alicia quiet. Pretty messed up of Gabriel, too.
• Barbie, the neighbor, who made it seem like she and Alicia were super closer and Alicia confided in her, but in reality, Alicia couldn’t stand her. Unlike the others, I don’t think her being an unreliable narrator leads to her being a would-be killer of Gabriel. She had nothing to gain from killing Gabriel.

As it turns out, Theo was an unreliable narrator, too, because Kathy was having an affair with Gabriel, and Theo was stalking their torrid affair. In fact, he saw the “other woman” that Gabriel came home, too, which we came to realize was Alicia. Meanwhile, in her diary, Alicia kept talking about a man she didn’t recognize stalking her.

When those two beats came together for the twist that Theo was the bad guy, that he wormed his way into the Grove, that he wanted to hear more about Alicia’s story, to help her “see clearly,” that was wild. I mean, when Alicia kept mentioning in her diary a mysterious man, and we knew Theo knew about Kathy’s affair, I had a thought in the back of my mind that he could be the mysterious man, but I dismissed it for being too far-fetched.

You got me, Michaelides. I’m not sure how to feel about it! My initial reaction was to not like Theo as a bad guy. Because we learn he broke into the house that night. He tied up Alicia. He tied up Gabriel. He pretended to shoot Alicia after Gabriel said he didn’t want to die (thus, sacrificing Alicia, and once again, like Vernon Rose, her father, condemning her to death). And then he left. That’s when Alicia killed Gabriel.

(How come the police never asked: How did a woman manage to get a grown man tied up into a chair in order to shoot him in the face? And wouldn’t there have been ligature marks on Alicia’s skin?)

I didn’t think until that revelation at the end with Alicia’s last diary entry, that Alicia killed her husband. I was sad that she actually did and it really was a psychotic break of sorts (since she saw herself as “dead” anyway). I was hoping it would be one of the aforementioned people who had a motive to kill Gabriel.

After we learned all of this, Theo realized Alicia remembered him from that night, and injected her with morphine, sending her into a coma, in order to keep her quiet, and then he tried to frame Christian for it.

However, he somehow? forgot to retrieve the diary. The police found it, where Alicia hurriedly wrote down her knowledge of Theo, so he did get his comeuppance at the end. (I also think it’s far-fetched anyhow that Alicia was able to hide a diary from the police the night of the murder, and then to somehow get that diary into the Grove undetected.)

But I also think Michaelides’ Theo twist makes sense for being in line with what he was telling us the entire book: Don’t trust the characters narrating their perspective of the story with Alicia, including this character and narrator in Theo.

Overall, though, for a book just over 300 pages, I read this in two large big sittings across two days. I was that enthralled and curious. I say again, well-done, Michaelides. Even if I wasn’t immediately sold on the ending, or everything for that matter, it made me think and want to talk about it. That’s among the best you can ask for out of a book. Intrigue!