I believe The Silent Patient by Alex Michaelides is a true psychological thriller. Many novels claim the right to be in this genre, but this novel is uniquely qualified for such placement. I was surprised to not find this classification on the Amazon page for the novel. The Silent Patient is categorized as a mystery and Thriller & Suspense. The two categories are accurate, but a novel in which the content is about repressed childhood trauma, obsession, betrayal, suicide, and the lives of mental health professionals might also qualify as a psychological thriller.
Alicia Berenson was a successful artist. Her work hung in galleries. She enjoyed income from sales and exhibitions. Husband Gabriel Berenson was a successful fashion photographer. The two enjoyed a happy, comfortable marriage up to the day Alicia killed Gabriel. There was no mystery about who murdered Gabriel except for a neighbor who held a blind faith in Alicia’s innocence. The secret was not “who,” but “why?” Alicia was, literally, not talking. She had not spoken one word since being taken into custody. She did not speak during her trial and had not spoken since her arrival at the Grove, a treatment facility for the mentally ill. The staff at the Grove kept Alicia sedated on high dosages of drugs, but medication was not the reason for her silence. On or off drugs, Alicia was not speaking.
Theo Faber was a forensic psychotherapist interested in Alicia’s case. Theo was able to follow his interest through the press due to Alicia’s fame as an artist. Theo worked at Broadmoor prison for almost six years before he saw an advertisement offering a position at the Grove. Finally, he would have a chance to help, possibly rescue, Alicia. During the interview process for the job, Theo had to answer the predictable question, “Why did you want to be a forensic psychotherapist?” Wisely, Theo gave the expected response “I have a desire to help people.” The answer was a lie, and it is at this point, Chapter Three, where readers get a hint at how complicated this novel might be. Theo believed that he had chosen his profession out of a desire to heal himself. He had gone through years of therapy to deal with his childhood, one that featured an abusive father.
Once hired, Theo had to fight to assume responsibility for Alicia’s case. Other staff members had all but given up on Alicia. She was a patient for whom the Grove would supply maintenance, not treatment. Theo believed he was uniquely qualified to help her and suggested innovative treatment not agreed upon by several of the Grove staff. He only needed the agreement by the Chief of Treatment, Dr. Diamodes. After getting approval from the boss, there was only one more problem. Alicia would not talk. During an early meeting, she physically attacked Theo. What could he do that would prompt her to talk? The measures he tried will capture reader interest for the rest of the novel.
Background information was crucial for unlocking Alicia’s mind. Theo became a detective. When he found out Alicia’s mother had died in a car crash while Alicia was young and Alicia had to live with an aunt she didn’t love and a father who didn’t like her, Theo saw similarities between Alicia’s background and his own. Both had come from a loveless childhood. Alicia had attempted suicide, which led her to years of therapy. Theo held his hatred of his father in check but had also gone through years of treatment.
Theo would travel a lot during his off hours to investigate the backgrounds and relationships of people important to Alicia. Gabriel had a brother who attempted to be too affectionate to Alicia. Jean-Felix Martin ran the gallery where Alicia displayed her work. Jean-Felix wanted a closer relationship with Alicia than she wished. There was a mysterious Dr. West who had treated Alicia after the death of the father she hated. Theo wanted to find Dr. West. Aunt Lydia and cousin Paul had provided a home for Alicia after the death of her mother. Aunt Lydia was an evil person who hated Alicia because of the way Alicia had portrayed her in a painting. Her son Paul was a confidant of Alicia in her youth but now lived only to serve his mother. Theo was sure Paul knew childhood secrets that Theo could use in motivating Alicia to speak.
Theo was happily married to Cathy, a performing artist in the theater. His relationship, one that was deteriorating due to Cathy’s suspicious behavior, was the one point I found unrealistic. The psychological analysis and interchange between most characters are in-depth and intense. It requires energy to keep things, such as treatment, on track. Such a focus cannot be maintained if, at the same time, near-cataclysmic events are happening in the personal life of a key player. I felt Theo’s suspicions of Cathy’s infidelity and his efforts to prove or disprove questionable circumstances would be all-consuming. He wouldn’t have time to worry about Alicia. This sense of unreality stayed with me to the conclusion of the novel.
The pacing of the novel is fast. Sections in which Theo mulled over Cathy’s possible infidelity were excellent; I wanted to read faster to get past the pain Theo had to be feeling. When Theo suddenly dropped his marital musings to think about Alicia’s medication dosage, the jolt in the mental shift was unnerving.
The Silent Patient is a debut novel for this author/screenwriter. I listened to the audiobook in one session and resisted the urge to increase the narration speed. I will read, or listen to, more work by this author. After the conclusion of the story, there is an interview with the author of this five-star work. It is worth listening to as Michaelides describes the background experiences that led him to write such intricate work.