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The Silent Patient

By Alex Michaelides, A twisty psychological thriller

Movie Adaptation
Detailed Summary
Book Review
Read it or Skip It?

The Silent Patient by Alex Michaelides shows you exactly what type of book it’s aiming to be from the very first sentence: “Alicia Berenson was thirty-three years old when she killed her husband.” No messing around here.

For people who like their thrillers-slash-mysteries to have twisty plots and straight-forward writing, this recent release is one to look at (but with some big caveats, so keep reading). Since its February 2019 release, it’s been climbing all over the bestseller charts and is being developed into a movie by heavy-hitters Annapurna and Plan B. See below for more details on the adaptation.

Update: For answers to questions like What happens at the end of The Silent Patient? and other spoiler-ish things or explanations, scroll down to the end of the post!

Plot Summary

For the Detailed Plot Summary, click here or scroll all the way down.

Six years ago, Alicia Berenson, a well-known painter, murdered her husband and hasn’t spoken a word since. He was found bound to a chair with gunshot wounds to his face, and she was convicted soon thereafter.

Theo Faber is a psychotherapist who hopes to treat Alicia and uncover the mystery behind her motives for killing her husband. As they sit in silence, the main clue he has is a painting she completed. She titled it Alcestis, named after a heroine in Greek mythology who sacrifices her life to save her husband.

Check out the Silent Patient on Amazon.

Book Review: the Good Stuff

Let’s start with the good stuff. The premise of this book is fantastic. I was engaged right away. The ending is surprising, even if you guess the twist (I didn’t, but some might), and the way the crucial scene of the book plays out is well done. I was skeptical of whether the book would come together, and I pleasantly surprised that it ultimately does.

For most thrillers, I think, the ending is the make-it-or-break it aspect of the story, and this one is pretty solid. Michaelides’s debut novel is an easy, accessible and entertaining read, and it will undoubtedly make for a thrilling movie if and when that is released.

Overall, the story keeps your interest and is well-paced. It reads pretty much the way a thriller should read, with plenty of twists and intriguing bits of information doled out at a steady clip.

Book Review: the Not-So-Good Stuff

So, the flaws in this book are numerous, but they’re also pretty standard for the genre. The characterizations of characters are sort of silly or cartoonish (the motherly female doctor! the arrogant doctor who gets in the way! and so on). Michaelides throws in so many red herrings and false starts that the book begins to have an unintentionally campy feel. (Without giving anything away, when we find out why Theo gets knocked out, I actually rolled my eyes.)

As for the writing, it’s passable, but leaves a bit to be desired. It serves to move from one plot point to the next (sometimes rather clumsily), and that’s about it. And while I liked the ending, a lot of the minor plot “twists” are pretty uninspired — there’s a lot of “he said, she said” in the mushy middle of the book that more closely resembles a jumbled mess than an entertaining mystery. Most of those red herrings are left unresolved.

Finally, despite the steadily moving pace of the book, it takes a while to get into the meat of the book. There’s a range of characters to be introduced and decent chunk of background information to go over before the action starts to happen. As a result, it relies frequently on one of my least-favorite literary/mystery “tricks” to try to sustain the reader’s interest as it doles out background information — it throws out ominous-sounding narration to reassure you that things will get interesting later (I didn’t know then that it was doomed, I would later realize my mistake, etcetera and etcetera). Not a big deal, but I wish people wouldn’t do this.

The Silent Patient Movie Adaptation

For anyone wondering about the adaptation, as of April 2019, it’s listed as “in development”, so it’s fairly early in the process. Annapurna and Plan B (Brad Pitt’s production company) have optioned the rights as part of their three-year production pact. Their other recent collaborations include If Beale Street Could Talk and Vice.

For all the details, see Everything We Know About the Silent Patient Movie Adaptation.

Read it or Skip it?

The Silent Patient is a thriller that nails the ending, and for that reason alone I’m inclined to forgive a lot of its imperfections. I was perplexed by the main mystery in this book and felt that gratifying “oh man, I should have guess this!” feeling when it was revealed. For me, this goes a long way.

As a fan of thrillers, I’m fairly forgiving of books in this genre that aren’t perfect. I found this book mildly entertaining, and I think there’s lots of people who will enjoy reading it, especially if you love smartly laid out plots.

That said, my main thought is that it will be much better as a movie. (And I wouldn’t be surprised if the potential to sell movie rights is why the publisher picked it up in the first place.) The basic frame of a really good plot is there, it just needs some retooling and a little more nuance. Given the fantastic reputation of the studios developing it, anyone who is not a fan of a genre should probably just watch to movie when it comes out.

That said, if you do like psychological thrillers and are not nit-picky about your books, this is a quick and fun read overall. If you liked The Wife Between Us, for example, you might like this book. Check out the Silent Patient on Amazon.

P.S. Listen to my discussion of this book on the Most Read Books podcast, Ep. 1 The Silent Crawdads & the Six.

Spoilers and Explanation start here! Don’t read beyond this point if you haven’t read the book! Keep reading if you’ve read the book, but have questions!

Where can I find a full plot summary of The Silent Patient?

For the full summary of The Silent Patient, scroll down a little and click Show/Hide Detailed Plot Summary

Help! I’m confused. What’s happens in The Silent Paient?

Show/Hide Answer
Okay, this is the quick and dirty version. A detailed summary of the book is at the end of the post.

The Silent Patient is told with two intertwined timelines. The first is before the murder where Theo falls in love but gets cheated on. Theo then tracks down the “other man” (Gabriel), who turns out to be married to Alicia. Theo (wearing a ski mask on his head) ties them up, outs Gabriel as a cheater, and gets Gabriel to show what a jerk he is. (Theo asks Gabriel which one of the two of them — Gabriel or Alicia — he should shoot, and Gabriel chooses Alicia). Theo doesn’t actually shoot anybody, but Alicia is horrified enough by Gabriel’s answer that she shoots Gabriel.

The second timeline is what happens afterwards. Theo gets the job as Alicia therapist because he genuinely feels bad about what happened with her. However, Theo eventually figures out that Alicia does, in fact, recognize him as the masked man. He ends up killing her to protect himself, but not before she writes the truth in her diary. The book ends with the police coming to question him about the diary.

The big twist is when you realize that they are two different timelines (one before the murder, the other after) being told at once, and Theo was the “masked man” that prompted the murder (though Alicia is the one who actually did it).

What happens at the end of The Silent Patient?

Show/Hide Answer
At the end of The Silent Patient, Theo goes to confront the guy that Kathy has been cheating on him with and we find out that it’s Gabriel. Gabriel’s wife is Alicia Berenson.

In other words, the entire book has been told jumping back and forth in time. The parts involving Kathy are all in the past. The entire book is happening because Kathy cheated on him (with Gabriel) and then it resulted in Theo showing up at Gabriel and Alicia’s house.

Theo tied up Gabriel and Alicia to scare them and to expose Gabriel as the slimeball he is. He forces Gabriel to admit that he’d be willing to let Alicia get shot to save himself. What Theo did not foresee was that Alicia would go ahead and shoot Gabriel.

The way that it plays out in present day is that after many months of therapy, Alicia finally talks. When she speaks, she tells Theo what happened on the night of Gabriel’s death — but she changes the story slightly to test his response.

However, from that story, Theo realizes that Alicia does recognize him as the masked intruder who tied them up. As a result, he injects her with something to force her to overdose, and it puts her in a coma.

Unbeknownst to Theo, before Alicia blacks out from the drugs, she wrote down her story and revealed Theo as the masked intruder. Jean (Alicia’s friend/gallery owner) ends up finding it and turning it into the police. The book ends with the police inspector showing up to confront Theo about Alicia’s admission.

What was Theo’s motivation in The Silent Patient?

Show/Hide Answer
Why did Theo want to treat Alicia? Theo initially genuinely wants to help Alicia. He didn’t think she would recognize him, and a part of him felt guilty about triggering the chain of events which landed her in the asylum.

Why did Theo kill Alicia? He had been wearing a mask when he tied them up and didn’t think Alicia would recognize him. He didn’t think Alicia would shoot Gabriel, because he didn’t know her past mental instability. When he planned out the scene revealing Gabriel to be a cheater, he genuinely just wanted to out him. Later, Theo realizes that Alicia is stuck in an asylum and not coping, so he feels bad that he started all this and goes there to help her. However, when he realizes that she has figured out who he is, he has to kill her.

How did Theo end up with the gun?

Show/Hide Answer
So, I’m not sure this is fully explained in the book (someone feel free to correct me if I’m wrong).

Basically, Theo shows up to the house with a knife, but ends up with Alicia/Gabriel’s gun. (In her diary, Alicia mentions that they have a gun, and she moves it into their cupboard at one point.) It’s not clear how exactly he knows where it is or how to find it.

I figured that Theo had seen the gun while stalking them. After threatening Alicia with the knife and tying her up, Theo probably went and found it. Alternatively, perhaps Theo saw Alicia go hide it while he was stalking them.

I don’t think there’s a clear answer here, but that’s what I figured probably happened.

Have more questions? Drop a comment, and I’ll try to answer if I can!

Detailed Book Summary (Spoilers)

Quick(ish) Synopsis

The detailed section-by-section summary is below, but here's the quick version.

Part I introduces Alicia, a painter. Her husband was found tied up and shot dead. She has not spoken a word since, though she produced one last painting (entitled "Alcestis"). Alicia was found guilty and sent to a mental facility. Six years later, Theo takes her case over from another doctor, Christian. Theo learns about Alicia's prior trauma, stemming from her mother suicide attempt with a young Alicia in the car.

In Part II, Theo tries to treat Alicia by reducing her meds, allowing her to paint and talking to outside sources to learn more. (Theo finds out Alicia had once been assaulted by her brother in law, Max. And Jean owns the gallery Alicia's art was in, but she had been planning on switching galleries.) Alicia and her neighbor had also noticed a man (Alicia had suspected Max or Jean) hanging outside her house in the time prior to Gabriel's death. Theo also learns that "Alcestis" is the story of a Greek goddess who was sent to Hades (death) in the place of her husband. She was later saved, but never spoke again. Meanwhile, Theo discovers his wife Kathy is cheating on him.

In Part III, Theo follows Kathy and sees that her lover is also married. Theo also learns that Christian (Alicia's doctor before Theo) had actually treated her even before Gabriel's death. Christian didn't tell anyone because it had been an unlicensed practice. This leads Theo to learn more about Alicia's prior trauma (after her mother's suicide, Alicia father wished Alicia had died instead). When Theo brings this up to Alicia, she finally begins to speak. Alicia tells him about the night of Gabriel's death. She says that man showed up, tied them up and shot Gabriel. Before he can follow up, the next day Alicia is found in a coma. Theo sees that she was injected by morphine, tells the others about Christian and Christian is arrested.

In Part IV, Theo goes to the house of Kathy's lover. It's Gabriel, and his wife Alicia is there, too. (This is the big reveal of the book. In other words, all the sections about Kathy, her cheating, and her lover were in the past. Theo is the mysterious man Alicia had seen hanging around the house and who showed up the night of Gabriel's death).

In Part V, we learn the real story from Alicia's diary. Theo went to Gabriel's house to show what a dirtbag Gabriel was. Theo tied Gabriel and Alicia up, exposed him as a cheater, and told Gabriel to choose which one of them he should kill. Gabriel chose Alicia, but instead Theo simply untied Alicia, and left. Then, Alicia shot Gabriel.

From Alicia's diary, we learn that Theo is the one who gave her the morphine. Theo knew from her story that she must have recognized him (she told an inaccurate story to test him). The night of Gabriel's death, Theo hadn't known about her traumatic history of feeling uncared for, and didn't know his stunt would result in her killing Gabriel. Later, Theo had taken for her case to genuinely try to treat her (he felt guilty about his involvement), but when Theo realized she recognized him, he had to kill her. The book ends with the police having found her diary and showing up at Theo's house (to ask him about it and presumably to arrest him).

Section by Section Summary

The book is in second-person with Alicia's psychotherapist (Theo Faber) as the narrator. It is interspersed with Alicia's old diary entries.

Part One

Pt I, Chapters 1-2. Alicia is a painter. She murdered her husband Gabriel six years ago on August 25. A neighbor (Barbie Hellman) heard shots. Police arrived to find a gun with her prints and a knife, the dead body of Gabriel tied to a chair with gunshot wounds to the face, and Alicia with her wrists slit.

Alicia has not spoken since. Awaiting trail, she paints a nude self-portrait entitled Alcestis. Alicia was convicted and admitted to the psych unit at the Grove.

Pt I, Chapters 3-10. Theo (narrator) is interested in her case and applies to the Grove when an opening appears. His father was abusive. He tried to kill himself in college, which led to him getting help from a therapist (Ruth). He's happily married to Kathy, who he has a passionate, wild and loving relationship with.

At the Grove, Theo meets Indira (psychotherapist), Yuri (nurse), Stephanie (manager), Prof. Diomedes (director). Also, Christian is head of Alicia's care team and Theo's former co-workers. Diomedes tells Theo the Trust is concerned about the Grove's finances.

Theo meets Alicia and reads Diomedes's notes. Alicia has mostly been withdrawn, but once attacked another patient (Elif) with a broken plate.

Part Two

Pt II, Chapter 1. July 16-21 entries. Alicia writes about a painting of Jesus she's working on, except it looks like Gabriel. She writes about her mother killing herself by driving into a brick wall with Alicia in the car as well.

Pt II, Chapters 2-12. Theo asks Diomedes to talk to Christian about reducing Alicia's medication. Christian is unhappy but agrees. Theo meets with Alicia after and she attacks him. Theo thinks it means Alicia hasn't given up, and Diomedes cautiously gives him 6 weeks to get results.

Theo meets with Alicia and gets her to shake her head in response to him asking if a part of her hated Gabriel. Theo asks Elif about the plate incident. She says she provoked Alicia by asking if Gabriel deserved it and about his brains being splattered everywhere.

At home, he gets high and comes across Kathy's e-mail and finds out she is cheating on him. Theo goes to Ruth. Ruth tells Theo she thinks he's drawn to Kathy's unpredictable nature because instability is what he became accustomed to due to his abusive father. Ruth recommends leaving Kathy, but Theo decides Ruth is wrong.

Theo meets with Max (Gabriel's brother, Alicia's lawyer). Max was adopted, but not Gabriel. Max admits he hated Alicia. He says she was always crazy (violent, etc) and attempted suicide after her dad died. Theo senses Tanya (Max's wife) is afraid of Max.

Pt II, Chapter 13. July 22-25 entries. Alicia writes about Max assaulting her and keeping it secret from Gabriel. She says Max resents his brother.

Pt II, Chapter 14-21. Theo finds out Max was Gabriel's beneficiary in his will. Diomedes tells Theo to stop contacting Alicia's relatives. Theo goes to find her cousin Paul anyway. Paul knocks him out when he arrives, saying he mistook him for a burglar. Lydia (Paul's mom) is there too. She is angry about a painting Alicia did of her.

Theo visits Alicia's gallery. The owner (Jean-Felix Martin) says Gabriel didn't like him. Theo sees Alicia paintings. One is of her mother's death. The Gabriel-Jesus one is there too, and in it Gabriel is holding the rifle he would later be shot with. The one of Lydia (looks grotesque) is there too, as is Alcestis.

Theo find a copy of the Alcestis story. In it, her husband is fated to die, Apollo allows someone to take his place. Alcestis agrees and dies. Hercules rescues her but when she comes back she doesn't speak.

Pt II, Chapter 22. August 2. Paul asks Alicia her for money to pay off gambling debts, and Gabriel objects. Alicia tells Jean she's planning on switching galleries.

Pt II, Chapter 23-33. Theo arranges for Alicia to be able to paint. He gets the supplies from Jean. Christian tells Theo to be careful not to be seduced by Alicia. Alicia does a painting of the Grove burning, with Theo carrying her.

Theo meets with Barbie (neighbor) who thinks Alicia is innocent and saw a man hanging around the house. Theo returns to the Grove to find that Elif has been stabbed in the eye with a paintbrush. Against Theo's wishes, Alicia's therapy is terminated. Theo goes to tell Alicia and she gives him her journal.

Part Three

Pt III, Chapter 1. August 8-25 entries. Alicia tells Gabriel about a man hanging out outside the house. Gabriel is skeptical and wants her to see a shrink, Dr. West, who she also saw after her dad died. Dr. West writes her a prescription, but she doesn't take it. She keeps seeing the man around. She suspects Jean or Max.

Part Four

Pt IV, Chapters 1-20. Theo reads the diary and returns it to Alicia. He confronts Dr. West -- it's Christian, who has never said anything about being Alicia's shrink from before. (The diary is how he finds out it's Christian). Christian says it was unofficial and unreported, he could lose his license, begs Theo not to tell Diomedes. He also says she is crazy and delusional.

Theo catches Kathy cheating on him. Theo follows his wife's lover and finds out that guy is married.

Theo goes to see Paul. Paul tells him that as a kid, Alicia overheard her dad say he wished Alicia had died in the car wreck instead of her mother, Eve, and it "killed her". Theo asks Alicia about it and she finally agrees to speak.

Alicia describes how the masked man had a knife, tied her to a chair, and attacked Gabriel when he got home. He tied him up, shot him in the face and left. Theo is skeptical and notes some factual inconsistencies. Diomedes agrees, says Alicia's mysterious man is mental projection so she can cast herself as a victim and let him be the murderer.

He gets the Grove the next day and finds out Alicia has OD'd and is in a coma. When everyone leaves, Theo realizes from her wrist that she didn't take pills like they think -- she was injected with morphine by someone. Theo tells Diomedes about it and about Christian's motive to keep her quiet. The police arrive and arrest Christian.

Pt IV, Chapters 21. Theo goes to Kathy's lover house and meets his wife -- it's Alicia Berenson. Theo brings a knife. (In other words, all the sections about Kathy and her lover were in the past. Gabriel was Kathy's lover. Theo is the mysterious man Alicia had seen hanging around the house).

Part Five

Pt V, Chapter 1. February 23 entry. Theo has just shoved the needle in her wrist and Alicia knows she will feel drowsy soon.

She had suspected Theo was the mystery man, and her previous story was intentionally inaccurate to test his response. Instead, after Theo tied them both up, he revealed Gabriel as a cheater and offered Gabriel a choice, either he or Alicia would die. Gabriel chooses Alicia. Theo says ok and shoots a shot straight up. Gabriel thinks she's dead but then realizes she's ok. Theo unties only Alicia and leaves. Alicia shoots Gabriel.

Pt V, Chapter 2. Theo is still with Kathy, who has never copped to having an affair. He never thought Alicia would shoot Gabriel. He went to the Grove to try to help Alicia, but had to kill her when he realized she was going to out him.

(Why did Theo do this? He had been wearing a mask when he tied them up and didn't think Alicia would recognize him. He didn't think Alicia would shoot Gabriel, because he didn't know her past mental instability. When he planned out the scene revealing Gabriel to be a cheater, He genuinely just wanted to out him. Later, Theo realizes that Alicia is stuck in an asylum and not coping, so he feels bad that he started all this and goes there to help her. However, when he realizes that she has figured out who he is, he has to kill her.)

Jean comes to pick up some of Alicia's stuff. Theo goes through the rest of Alicia's things and realizes the journal is missing. Inspector Allen shows up to his house to ask him about it (Jean found it and turned it in). The book ends with Allen reading the relevant diary passage to him.

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See The Silent Patient on Amazon.