Alex Michaelides builds layers of psychological suspense in The Silent Patient. It’s tempting to think you’ve got it all figured out. But the maze of the characters’ minds is complex. In this drama of betrayal and therapeutic potential, Theo is a psychologist treating Alicia. She’s convicted of killing her husband Gabriel and subsequently institutionalized, in part because she can not or will not speak. 

Throughout the book, Michaelides teases out the threads of each character’s story. We hear this in the voices of both Theo and Alicia, who offer contrasting perspectives. Alicia has a history of mental illness, but she’s also just a woman in love with her husband. She’s trying to make it in the competitive world of art, as is Gabriel. And their past and present family relationships are fraught with conflict.

At the same time, we learn about the damaging effects of Theo’s childhood and early adulthood. He’s the classic psychologist involved in the profession to heal himself as well as others. And Alicia’s case fascinates him as soon as it hits the news. 

As we follow Theo’s journey, Michaelides also shows us the inner workings of a struggling psychiatric ward. The infighting between staff members, politics with the governing board, and the patient outbursts just add to the atmosphere. Plus, they create a few red herrings as well.

My conclusions

This was a twisty roller coaster ride. About three quarters of the way through, I was convinced I’d solved the mysteries. And then Michaelides sent the car crashing around an unseen corner and surprised me. 

His revelation was actually a lot more logical that my suppositions. And I left the ride both invigorated and wanting to talk about it. Good thing this is my book group’s choice for the month! Several of our members are therapists, so I’m looking forward to their thoughts.

Using the individual voices of two dominant characters makes the story more compelling. Individually, Theo and Alicia are their own specific kind of mystery. I wondered regularly about narrator reliability, since so much dialogue is internal. Michaelides plays that close to the vest, and I’m not about to spill the beans here.

When this came out in 2019, its buzz was strong. Deservedly so, The Silent Patient is a creative and unique mystery about the psychology of murder and healing deep inner wounds.

Pair with another psychological thriller, The Woman in the Window by A.J. Finn or for a historical fiction look at psychiatric wards, try Woman 99 by Greer Macallister.