The Silent Patient

The Silent Patient

by

Alex Michaelides

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The Silent Patient Study Guide

Welcome to the LitCharts study guide on Alex Michaelides's The Silent Patient. Created by the original team behind SparkNotes, LitCharts are the world's best literature guides.

Brief Biography of Alex Michaelides

Michaelides was born in Cyprus to a British mother and a Greek Cypriot father; he was raised at the height of the conflict known as the Cyprus Problem, in which the Turkish government occupied the northern part of Cyprus. After high school, Michaelides moved to the United Kingdom, where he got a masters in English literature from Cambridge University. He also studied psychology for several years, even working in a ward for troubled teenagers. After obtaining an M.A. in screenwriting at the American Film Institute in Los Angeles, Michaelides embarked on a career as a screenwriter. In his mid-30s, frustrated with the logistical hurdles of a film production process, Michaelides switched gears, writing and publishing The Silent Patient as his debut novel. The Silent Patient spent more than a year on the New York Times bestseller list and has been optioned for film by Plan B and Annapurna Pictures. In 2021, Michaelides followed up with The Maidens, about a professor of Greek tragedy who is accused of killing his students.
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Historical Context of The Silent Patient

Budget cuts loom over the Grove, the fictional psych ward at the center of The Silent Patient—and indeed, the 2008 banking crisis led to a wide variety of cuts across the British National Health Service. But because the novel focuses more on internal states than external circumstances, it is also important to note the history of psychology that is woven throughout the text. Several of the book’s epigraphs come from Sigmund Freud, the father of modern psychology whose early 20th century theories have since been largely discredited; like Michaelides, Freud (inventor of “the Oedipus complex”) often relies on Greek tragedy to make sense of the human mind. The Silent Patient also references Wilfred Bion, a British psychoanalyst who pioneered the theory of early childhood “containment,” and Donald Winnicott, an Englishman who focused largely on object relations.   

Other Books Related to The Silent Patient

The Silent Patient makes direct reference to Alcestis, a tragic play by the ancient Greek dramatist Euripides, and Michaelides cites Shakespeare as another formal influence (especially when it comes to using weather as a metaphor). But in terms of structure, the novel is most indebted to mysteries and thrillers by writers like Ruth Rendell, Henry James, and especially Agatha Christie. Michaelides names the Christie novels Five Little Pigs and And Then There Were None as providing two of his favorite twists in all of literature; there is also a definite similarity between Theo Faber in The Silent Patient and Roger Ackroyd in Christie’s The Murder of Roger Ackroyd, both of whom narrate their stories without revealing their own culpability.
Key Facts about The Silent Patient
  • Full Title: The Silent Patient
  • When Written: 2013–2017
  • Where Written: London, England
  • When Published: 2019
  • Literary Period: Contemporary
  • Genre: Psychological Thriller, Mystery
  • Setting: The Grove, a London psych ward; various locations in London, Cambridge, and Surrey, England
  • Climax: Therapist Theo helps his patient Alicia make sense of the man who, many years ago, kept following her—before revealing that he himself was that man.
  • Antagonist: Theo Faber
  • Point of View: Theo Faber is the story’s first-person narrator, though his account is intercut with excerpts from Alicia Berenson’s diary.

Extra Credit for The Silent Patient

Uma Epiphany. While Michaelides was writing The Silent Patient, he was also on the set of The Con is On, a movie he had co-written that featured Uma Thurman and Sofia Vergara. One day, when Michaelides was chatting with Uma Thurman about the plot of his new book, the movie star asked him what the character of Alicia did for a living. Michaelides admitted that he didn’t know—so Thurman suggested Alicia should be a painter, an insight that would prove crucial for the rest of Michaelides’s plotting. 

Diving into Diaries. Michaelides always knew that he would write Theo’s part of the book first, and then add Alicia’s diaries in at the end. But to get into the headspace of his troubled protagonist, Michaelides literally retraced her steps—and used his phone to record voice memos of what he imagined might be Alicia’s observations. Then, he split the diary entries up and divided them throughout the novel, ensuring that Alicia’s perspective was completely distinct from Theo’s.