The Silent Patient Study Guide

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.

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.   

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.