Book Review: The Silent Patient

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I have been handed books by my (now-eighteen-year-old) daughter a couple times (right after she read them), and she has handed me a couple that I loved (like We Were Liars). When I walked in her room several days ago she was balking at the final pages of The Silent Patient. When I said, “What?”, she said that she had just read a real doozy of a twist (not her words, exactly. I don’t believe she’s ever used the word “doozy” in her life). Then a fraction of an hour later, she handed the book to me to read.

I am going to say two things before I begin the review of The Silent Patient by Alex Michaelides. First, the relatively new book is extremely popular and its ratings are consistently high, making it likely that you would enjoy reading it. Second, it is billed as a psychological thriller, but I don’t think that is accurate. There is plenty of therapy and therapists involved in this story, but it is actually more of a murder mystery. If you persist in wanting it to be a psychological thriller, you might have a more interesting ride (while you create all sorts of possible scenarios and endings in your mind as you read) but you might—like me and some others—find the ending lacking. Because it’s not, ultimately, about the psychology or even about the patient’s silence. It’s about the murder (or whatever happened to Gabriel Berenson). All those Shutter Island and Fight Club scenarios you’re wondering about as you read are not going to pan out. Wonder, instead, what happened to land Alicia Berenson in the prison psych hospital (or whatever that’s called). Just assume she’s silent so that we can’t get the story straight from her.

Alex Michaelides has exploded onto the scene in the past few years, after a dream-ascension from Greece to Cambridge to an LA film institute followed by a failed film-making career that led him to write his first book in middle age. (He now lives in London.) Since The Silent Patient was published to much acclaim in 2019, he has also written another best-seller, The Maidens (which I am told (by the internet) is similar in many ways to The Silent Patient). There’s not too much more to say about him. He’s the new guy enjoying a lot of popularity.

As for the book, it has two protagonists, basically. The primary narrator is Theo Faber, a psychotherapist who desires to become the therapist to a notorious domestic murderess, Alicia Berenson. Alicia is a famous painter and the former wife of the murdered fashion photographer, Gabriel Berenson. Alicia was found at the scene of the crime with the gun, the blood, the body, and her wrists slit. Since then, she’s been in a women’s, criminal, psychiatric ward and hasn’t spoken a single word, not even at her trial something like seven years before this story begins. She is the other protagonist in the story, the epistolary narrator, and we hear from her from a series of journal entries that begin mere weeks before the murder. The two narratives weave back and forth as Theo gets his dream job working with Alicia and Theo’s own life fills a good fifty-per cent of the story, both his work life and his home life with a wife he adores.

Here’s the thing. I am not one of the five star or even four-star reviews, here. I am a three. The enjoyment of reading this book along the way gives it some redemption, but the ending just cast a shadow back across the whole thing, such that I am more in line with the one- and two-star reviewers, in spirit. Let’s start with the good. The writing is acceptable, I thought, especially for the genre. It was not distracting. I understood what was happening, followed easily, and remained on the edge of my seat wanting to know what was really going on behind all those adequate words. I was also pulled into the characters, though this was more of a mixed bag because I ended up hating all the characters (except two or three minor ones), including Theo and Alicia. If this gradual despising (from initial sympathy, which almost all books need to get the reader engaged) had played out in the end, I would have actually thought it was brilliant, in its way. But it kinda didn’t. (I don’t want to say too much. I try not to write spoilers without fair warning.) Let’s put it this way: many of the characters that we were supposed to sympathize with in the end, I just plain didn’t.

But here’s the other things, in no particular order:

  • Once we get to the end, we see that there are a number of plot holes (see spoiler reviews on Goodreads for more details) and even more dropped plots. In a mystery, red herrings are normal and even necessary, but to drop most of the plots at the end of the book without a backward glance is extremely unsatisfying for the reader. I could see a reader thinking “Bam!” at the end of The Silent Patient, but then their smile turning to a frown over the next couple hours or days as they consider the finer points. What happened to ___? Wait, why did ___ do ___? Etc. The vast majority of the plot lines in The Silent Patient are red herrings. I suppose that gives something away, but I’m just trying to warn you not to get too attached to these subplots: they won’t be tidied up, at all. In fact, there is one main thing that weaves through almost the whole book that is just like, Why the heck did he even do that? Let alone that many times?
  • The female characters (including Alicia) are complete duds. They’re cliché and despicable and they tend to either blindly worship or relentlessly attack the men around them. I believe men can write great female characters, but Michaelides has done no such thing (here).
  • There is little to no reality about psychology, psychiatry, therapists, or mental illness. Some of it I went along with because I know some things about this field but I’m no expert. I did become increasingly suspicious, however, and was confirmed in my suspicious reading reviews by actual experts. They have issues with medication, policy, and malpractice, etc. I have issue with being misled as a reader when I don’t know any better. It’s not like it’s supposed to be fantastical. And many of the issues here could lead to furthering harmful fallacies and stereotypes, keeping actual people from seeking the help they actually need.
  • As I already mentioned but less specifically, I ended up hating almost every character in this book. I know that some high-fallutin’ reviewers are all about enjoying books built with despicable characters, but that’s not me. I almost always need at least one main character to remain sympathetic and likable, which doesn’t mean they can’t also be complex. The Silent Patient was riddled with small-minded, cruel, manipulative people with not a speck of an authentic or warm relationship between them, and I just wanted to forget about all of them by the end. Michaelides gave us broken pasts, but he failed to use that to create real people who we might relate to or even pity.
  • For a lot of people, the ending does become obvious before the big reveal, at least in the chapters leading up to it. I’m sure this disappoints some people.
  • The only way this book works (as it is. It notoriously makes its critics want to re-write it) is to trick the reader. I have always demanded of a piece of fiction that the ending feel inevitable. I want to be able to look back and see that this is the ending that was always meant to happen, that had to happen given the words and scenes I was given. This is the big fail for me in The Silent Patient. Not only had I dreamt up much more satisfactory endings along the way, but Michaelides had to trick me in order to even make the ending work. Like, if you had a clear understanding of the timeline (and it does seem he deliberately keeps you from it), things would be more obvious. It wouldn’t have to be this way, though. He could have written it without sleight-of-hand and I resent him for (mixed metaphor warning) not putting all the cards on the table.
  • I trusted Michaelides. With the glowing reviews and my daughter’s reaction, I placed myself into his writerly hands thinking that he had everything under control. I feel a little betrayed.
  • Also, what was up with the Greek tragedy thing? Sure, Michaelides is Greek and Greek mythology is trending (when is it not?), but it didn’t pan out in The Silent Patient though it really, really wanted to. The book would have been better as a re-write of Alcestis (does it even exist? Yes, it does) with the original twists kept from us until the end. But in that case, we would have needed to explore in great depth Alicia, her psyche, and her love of her husband, which you may think happens in The Silent Patient, but truly doesn’t. For that sort of thing, see Till We Have Faces or even Circe and Song of Achilles. Or Shakespeare.
  • Also, London. Not just London, but we are faced with a cast of characters in a particular place and time. These things do not come to life in The Silent Patient. Particularly London and the areas of London where the story takes place: they just stay an unimportant backdrop and, if you are unfamiliar with them, a blurry one where significance (like the wealth and privilege of some of the characters) is lost on you. Even old Victorian writers (Dickens, Conan Doyle) do a much better job of this.
  • Also, we are asked, in the end, to take everyone and the interactions at face value. I dunno. I thought this book was ripe with unreliable people, including the narrator, but in the end, no one had really lied directly to us or misled us or Theo. Everybody was pretty up front, no matter how shifty they seemed, and I reeeeaaaly thought there was going to be a real hard psychological bent to who was the most unreliable and why (like a character who was a manifestation of another or something like that). I wanted a big snap at the end to shift our perspective of truth and who was the most far gone (psychologically speaking) in the end. After all, a number of these characters are not only certifiable, but certified. Including both narrators. I found every word of Alicia’s journal to be suspicious, as well as much of how Theo read the other characters and reacted to them, so… Nothin’.
  • Finally, given the selling points of this book (Alicia doesn’t speak! Read it! It’s called The Silent Patient! Read it!), I thought there HAD to be a solid, psychological reason for Alicia’s silence. I am not alone here with saying that there isn’t, at least not one that passed muster. I didn’t think the explanation worked with her personality, her journaling (which is, of course communication), with the plot, and with real psychology and Alicia’s psychological diagnoses from the past. Again, not an expert, but I didn’t find this bit (and what an important bit) to be believable or honest.

That all sounds horrible. But it’s not. And yet, every word I just said is true to my reading of The Silent Patient. Perhaps, if you just want a nice little read and you promise not to think too much afterward, just sit in your enjoyment until you move on to something else, I could recommend this book to you. I mean, everyone else is reading it, right? And I enjoyed the journey until the destination deflated the whole balloon for me. It was like watching a high rise being constructed day by day and then on the final day arriving to find a bungalow in its place. What could have been! I am not alone, but you wouldn’t be alone either, if you read this on a beach this coming summer and gave it four or five stars.


There is a movie in the works (not much news since 2019), though we should all know by now that is no guarantee of a movie. But we’ll see.


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