The Silent Patient

I’m getting ahead of myself. I must start at the beginning and let events speak for themselves. I mustn’t color them, twist them, or tell any lies. I’ll proceed step by step, slowly and cautiously. But where to begin? I should introduce myself, but perhaps not quite yet; after all, I am not the hero of this tale. It is Alicia Berenson’s story, so I must begin with her—and the “Alcestis.”

There was a heavy snowstorm that night. My mother went to bed and I pretended to sleep, then I snuck out to the garden and stood under the falling snow. I held my hands outstretched, catching snowflakes, watching them vanish on my fingertips. It felt joyous and frustrating and spoke to some truth I couldn’t express; my vocabulary was too limited, my words too loose a net in which to catch it. Somehow grasping at vanishing snowflakes is like grasping at happiness: an act of possession that instantly gives way to nothing. It reminded me that there was a world outside this house: a world of vastness and unimaginable beauty; a world that, for now, remained out of my reach. That memory has repeatedly returned to me over the years.

As I talked, I found that no matter how distressing the details I related, I could feel nothing. I was disconnected from my emotions, like a hand severed from a wrist. I talked about painful memories and suicidal impulses—but couldn’t feel them.

I would, however, occasionally look up at Ruth’s face. To my surprise, tears would be collecting in her eyes as she listened. This may seem hard to grasp, but those tears were not hers.

They were mine.

At the time I didn’t understand. But that’s how therapy works. A patient delegates his unacceptable feelings to his therapist; and she holds everything he is afraid to feel, and she feels it for him. Then, ever so slowly, she feeds his feelings back to him. As Ruth fed mine back to me.

I wrote down another word: CHILDHOOD. If I was to make sense of Gabriel’s murder, I needed to understand not only the events of the night Alicia killed him, but also the events of the distant past. The seeds of what happened in those few minutes when she shot her husband were probably sewn years earlier. Murderous rage, homicidal rage, is not born in the present. It originates in the land before memory, in the world of early childhood, with abuse and mistreatment, which builds up a charge over the years, until it explodes often at the wrong target. I needed to find out how her childhood had shaped her, and if Alicia couldn’t or wouldn’t tell me, I had to find someone who would. […]

As I look back, this is my first professional transgression in dealing with Alicia—setting an unfortunate precedent for what followed. I should have stopped there. But even then it was too late to stop. In many ways my fate was already decided—like in a Greek tragedy.

God hadn’t abandoned me during my childhood when I had felt so alone and so scared—He had been keeping Kathy hidden up his sleeve, waiting to produce her, like a deft magician.

I felt such humility and gratitude for every second we spent together. I was aware how lucky, how incredibly fortunate I was to have such love, how rare it was, and how others weren’t so lucky. Most of my patients weren’t loved. Alicia Berenson wasn’t.

It’s hard to imagine two women more different than Kathy and Alicia. Kathy makes me think of light, warmth, color, and laughter. When I think of Alicia, I think only of depth, of darkness, of sadness.

Of silence.

[Diomedes] pulled out a little box from his desk, sliding off the cover to reveal a row of cigars. He offered me one. I shook my head.

“You don’t smoke?” He seemed surprised. “You look like a smoker to me.”

“No, no. Only the occasional cigarette—just now and then…I’m trying to quit.”

“Good, good for you.” He opened the window. “You know that joke, about why you can’t be a therapist and smoke? Because it means you’re still fucked up.” He laughed and popped one of the cigars into his mouth. “I think we’re all a bit crazy in this place. You know that sign they used to have in offices? ‘You don’t need to be mad to work here, but it helps’?”

Diomedes laughed again. He lit the cigar and puffed on it, blowing the smoke outside. I watched him enviously.

As we sat there in silence, my head started to throb at the temples. The beginnings of a headache. A telltale symptom. I thought of Ruth, who used to say, “In order to be a good therapist, you must be receptive to your patients’ feelings—but you must not hold on to them—they are not yours—they do not belong to you.” In other words, this thump, thump, thumping in my head wasn’t my pain; it belonged to Alicia. And this sudden wave of sadness—this desire to die, die, die—did not belong to me either. It was hers, all hers. I sat there, feeling it for her, my head pounding, my stomach churning, for what seemed like hours. Eventually, the fifty minutes were up.

Idiot, I thought to myself. You idiot. What was I doing? I pushed her too far, too hard, too soon. It was horribly unprofessional, not to mention totally fucking inept. It revealed far more about my state of mind than hers.

But that’s what Alicia did for you. Her silence was like a mirror—reflecting yourself back at you.

And it was often an ugly sight.

She was right. I have been groping for the right words to express that murky feeling of betrayal inside, the horrible hollow ache, and to hear Ruth say it—“the pain of not being loved”—I saw how it pervaded my entire consciousness and was at once the story of my past, present, and future. This wasn’t just about Kathy; it was about my father, and my childhood feelings of abandonment; my grief for everything I never had and, in my heart, still believed I never would have. Ruth was saying that was why I chose Kathy. What better way for me to prove that my father was correct—that I’m worthless and unlovable—than by pursuing someone who will never love me?

I buried my head in my hands. “So all this was inevitable? That’s what you’re saying—I set myself up for this?”

Leaving Kathy would be like tearing off a limb. I simply wasn’t prepared to mutilate myself like that. No matter what Ruth said. Ruth wasn’t infallible. Kathy was not my father; I wasn’t condemned to repeat the past. I could change the future. Kathy and I were happy before; we could be again. One day she might confess it all to me, tell me about it, and I would forgive her. We would work through this.

I would not let Kathy go. Instead I would say nothing. I would pretend I had never read those emails. Somehow, I’d forget. I’d bury it. I had no choice but to go on. I refuse to give into this; I refuse to breakdown and fall apart.

After all, I wasn’t just responsible for myself. What about the patients in my care? Certain people depended on me. I couldn’t let them down.

This was the house where Alicia had been born. It was where she spent the first eighteen years of her life. Within these walls her personality had been formed: the roots of her adult life, all causes and subsequent choices, were buried here. Sometimes it’s hard to grasp why the answers to the present lie in the past. A simple analogy might be helpful: a leading psychiatrist in the field of sexual abuse once told me she had, in thirty years of extensive work with pedophiles, never met one who hadn’t himself been abused as a child. This doesn’t mean that all abused children go on to become abusers, but it is impossible for someone who is not abused to become an abuser. No one is born evil. As Winnicott put it, “A baby cannot hate the mother, without the mother first hating the baby.” As babies, we are innocent sponges, blank slates with only the most basic needs present: to eat, shit, love, and be loved. But something goes wrong, depending on the circumstances into which we are born, and the house in which we grow up. A tormented, abused child can never take revenge in reality, as she’s powerless and defenseless, but she can and must harbor vengeful fantasies in her imagination. Rage, like fear, is reactive. Something bad happened to Alicia, probably early in her childhood, to provoke the murderous impulses that emerged all those years later.

It was just as beautiful and mysterious as I remembered it. Alicia naked in the studio, in front of a blank canvas, painting with a blood red paint brush. I studied Alicia’s expression. Again it defied interpretation. I frowned.

“She’s impossible to read.”

“That’s the point—it is a refusal to comment. It’s a painting about silence.”

“I’m not sure I understand what you mean.”

“Well, at the heart of all art lies a mystery. Alicia’s silence is her secret—her mystery, in the religious sense. That’s why she named it Alcestis. Have you read it? By Euripides.” [Jean-Felix] gave me a curious look. “Read it. Then you’ll understand.

Christian gave me a doubtful look. “Be careful, mate.”

“Thanks for the warning. But it’s rather unnecessary.”

“I’m just saying. Borderlines are seductive. That’s what’s going on here. I don’t think you fully get that.”

“She’s not going to seduce me, Christian.”

He laughed. “I think she already has. You’re giving her just what she wants.”

“I’m giving her what she needs. There’s a difference.”

“How do you know what she needs? You’re overidentifying with her. It’s obvious. She’s the patient, you know—not you.”

I had a sudden image of myself as a child. A little boy close to bursting with anxiety, holding in all my tears, all my pain; pacing endlessly, restless, scared; alone with the fears of my crazy father. No one to tell. No one who listened. Alicia must have felt similarly desperate, or she’d never have confided in Barbie.

I shivered—and sensed a pair of eyes on the back of my head.

I spun around—but no one was there. I was alone. The street was empty, shadowy, and silent.

I knew I should hide. I was exposed and in plain sight—if Kathy turned around, she’d be sure to see me. But I couldn’t move. I was transfixed, staring at a Medusa, turned to stone.

Eventually they stopped kissing and walked into the park, arm in arm. I followed. It was disorienting. From behind, from a distance, the man didn’t look dissimilar to me—for a few seconds I had a confused, out-of-body experience, convinced I was watching myself walking in the park with Kathy.

“[Vernon] was a mean bastard. The only person he ever cared about was Auntie Eva. I suppose that’s why he said it.”

“Said what?” I was losing patience. “I don’t understand what you’re saying to me. What exactly happened?”

“Vernon was going on about how much he loved Eva—how he couldn’t live without her. ‘My girl, he kept saying, ‘my poor girl, my Eva…Why did she have to die? Why did it have to be her? Why didn’t Alicia die instead?’”

[…] “And Alicia whispered something to me—I’ll never forget it. ‘He killed me,’ she said. ‘Dad just—killed me.’”

I stared at Paul, speechless. A chorus of bells started ringing in my head, clanging, chiming, reverberating. This is what I’ve been looking for. I’d found it, the missing piece of the jigsaw, at last.

“What do you want to talk about?” I asked.

“I don’t know. Nothing. I just want to talk.”

So we talked. We talked about Lydia and Paul, and about her mother, and the summer she died. We talked about Alicia’s childhood—and mine. I told her about my father, and growing up in that house; she seemed curious to know as much as possible about my past and what had shaped me and made me who I am.

I remember thinking, There’s no going back now. We were crashing through every last boundary between therapist and patient. Soon it would be impossible to tell who was who.

I watched his wife through the windows. As I watched, I felt increasingly sure I had to do something to help her. She was me, and I was her: we were two innocent victims, deceived and betrayed. She believed this man loved her—but he didn’t.

Perhaps I was wrong, assuming she knew nothing about the affair? Perhaps she did know. Perhaps they enjoyed a sexually open relationship and she was equally promiscuous? But somehow I didn’t think so. She looked innocent, as I had once looked. It was my duty to enlighten her. I could reveal the truth about the man she was living with, whose bed she shared. I had no choice. I had to help her.

If you were cynical, you might say I revisited the scene of the crime, so to speak, to cover my tracks. That’s not true. Even though I knew the risk of such an endeavor, the real possibility that I might get caught, that it might end in disaster, I had no choice—because of who I am.

I am a psychotherapist, remember. Alicia needed help—and only I knew how to help her.

Even worse than the shock or repulsion, or possibly even fear, in Ruth’s eyes as I told her this would be the look of sadness, disappointment, and self-reproach. Because not only had I let her down, I knew she would be thinking she had let me down—and not just me, but the talking cure itself. For no therapist ever had a better shot at it than Ruth—she had years to work with someone who was damaged, yes, but so young, just a boy, and so willing to change, to get better, to heal. Yet, despite hundreds of hours of psychotherapy, talking and listening and analyzing, she was unable to save his soul. Perhaps I was wrong. Perhaps some of us are simply born evil, and despite our best efforts we remain that way.

I felt strangely calm as I sat in the chair by the window.

[Inspector Allen] cleared his throat and began. “Theo just left. I am alone. I’m writing this as fast as I can…”

As I listened, I looked up at the white clouds drifting past. Finally, they had opened—it had started to snow—snowflakes were falling outside. I opened the window and reached out my hand. I caught a snowflake. I watched it disappear, vanish on my fingertip. I smiled.

And I went to catch another one.