Review: “The Silent Patient” by Alex Michaelides

the silent patient by alex michaelides book cover from goodreads on unsplash background photo by hans eiskonen
Original background cover photo credit: Photo by Hans Eiskonen on Unsplash

July 14
I don’t know why I’m writing this.
That’s not true. Maybe I do know and just don’t want to admit it to myself.

The Silent Patient, Chapter 1 opening

Author: Alex Michaelides
Publication Date: February 5th 2019
Publisher: Celadon Books
Genre: Psychological Thriller
Find it on: Goodreads


Alicia Berenson’s life is seemingly perfect. A famous painter married to an in-demand fashion photographer, she lives in a grand house with big windows overlooking a park in one of London’s most desirable areas. One evening her husband Gabriel returns home late from a fashion shoot, and Alicia shoots him five times in the face, and then never speaks another word.

Alicia’s refusal to talk, or give any kind of explanation, turns a domestic tragedy into something far grander, a mystery that captures the public imagination and casts Alicia into notoriety. The price of her art skyrockets, and she, the silent patient, is hidden away from the tabloids and spotlight at the Grove, a secure forensic unit in North London.

Theo Faber is a criminal psychotherapist who has waited a long time for the opportunity to work with Alicia. His determination to get her to talk and unravel the mystery of why she shot her husband takes him down a twisting path into his own motivations—a search for the truth that threatens to consume him….

The Silent Patient is a shocking psychological thriller of a woman’s act of violence against her husband—and of the therapist obsessed with uncovering her motive. 

From Goodreads


Book Content Warnings: suicidal actions/attempt, child abuse, self harm, car accident, infidelity, assault

The Silent Patient is a book I’ve seen all over bookish social media communities over the last few months. It’s been well-loved and highly recommended as a great twisted psychological thriller by debut author Alex Michaelides. Published early 2019, The Silent Patient helped put Alex’s name on the map and enabled him to release a second successful standalone in 2021 called The Maidens. I read The Maidens a few weeks back and ended up feeling flat about it, but the experience didn’t damper my excitement for circling back to read The Silent Patient. I finally had a chance to get a hold of this first book a few weeks back through Book of the Month and dug into it with high anticipation. I especially looked forward to the London psychiatric hospital setting and first person criminal psychotherapist perspective. These elements were a satisfying hit and overall it was a fun read with a big twist at the end – I can see why there was so much hype about the book! Unfortunately I foresaw parts of the end twist that somewhat lessened its impact, but the book on whole was enjoyable and has at least one more re-read left in it. 😄

The primary perspective in The Silent Patient is from Theo’s point of view, a criminal psychotherapist who becomes invested in helping our second main character, Alicia. Theo pulls what may be a career-killing move, leaving his successful post at another institute for one at The Grove, by all accounts a floundering hospital soon to go under. Alicia has lived as a psychiatric patient there since her committal a few years back following a guilty verdict on the count of murdering her husband. During the trial and up until now she’s become infamous not only for her notorious case, but for her silence. The silent patient. Alicia refuses to talk to anyone about what happened that day, and has not said a word since. As Theo attempts to uncover the true events of that night, numerous suspects emerge and the story begins to break open.

It’s odd how quickly one adapts to the strange new world of a psychiatric unit. You become increasingly comfortable with madness – and not just the madness of others, but your own. We’re all crazy, I believe, just in different ways.

The Silent Patient, pg18

Character-wise I felt a bit lost in this story. Although she’s one of the two main characters, Alicia was tough to connect with. Present day she’s completely flat (which makes sense being so over-medicated and depressed), and in past diary entries she presented as either chaotic or sympathetic – quite different personas. In both cases I didn’t really feel a strong sense of personality to connect with, and I didn’t have that much to root for. She’s a conundrum, and that’s mostly how she’s treated in the story as well. Theo was also interesting. Although I enjoyed his perspective, I was plagued by a nagging suspicion most of the time that never let myself connect with him either – perhaps a paranoia from reading so many thrillers 😛 In the end my sympathies floated loosely between the two. There are also plenty of potential suspects introduced as side characters in the story, but to me many didn’t seem sufficiently fleshed out.

Structurally we alternate between Theo’s present-day investigation and Alicia’s past diary entries, which eventually converge as the plot crescendos towards the end. This pattern really worked for me! Pacing was a bit slow in the beginning, but had enough elements to keep it interesting. Since it’s a psychological thriller The Silent Patient is lower on adrenaline-pumping action, but there are some violent outbursts at the institute which contrast Alicia’s stoic silence. Chapters were short so the pages flew by.

Overall while I enjoyed the concept, setting, and structure, the character work didn’t follow through for me. The ending was a good twist but unfortunately not well enough hidden in my opinion. In the end I liked the book but didn’t love it. Because I loved the idea of the book so much, however, I would probably pick up another book by Alex if it has a setting that piques my interest.

Let me know what your non-spoiler thoughts are if you’ve also had a chance to read The Silent Patient!


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