Themes
Key
LitCharts assigns a color and icon to each theme in The Silent Patient, which you can use to track the themes throughout the work.
Empathy, Identification, and Boundaries
Tragedy and Destiny
Honesty vs. Deception
Childhood Trauma
Silence vs. “The Talking Cure”
Summary
Analysis
In a July 22nd diary entry, Alicia fumes about the fact that Gabriel keeps a gun in their house. The night before, Alicia had gone for a walk and noticed two little boys playing; suddenly, tears were streaming down her face. Alicia wants to have a child, but she is scared that she is “not to be trusted” with children—“not with my mother’s blood running through my veins.”
If Theo believes that childhood trauma can impact adults’ social behavior, Alicia thinks in even more biological terms: her mother was a dangerous woman, and Alicia fears that such danger is literally in her “blood.” Theo, like Alicia, is similarly childless—could he, too, be afraid of what runs in his “veins”?
Themes
After her walk, Alicia returned home already in a bad mood, and things only got worse once she noticed Gabriel cleaning his gun. Though he claims the gun has sentimental value (it belonged to his father), Alicia also sees the weapon as a testament to Gabriel’s “aggressive side.” Whenever she sees that part of him, Alicia begins to feel that “it’s like living with a stranger.” Gabriel and Alicia did not resolve their fight until the next morning, when they had sex and apologized to each other. Alicia allowed Gabriel to keep the gun.
Alicia’s sense that Gabriel is a “stranger” parallels Theo’s sentiment about Kathy, which he has expressed only a few chapters earlier. The introduction of Gabriel’s gun, which is known to be the murder weapon, reflects a classic trope of tragic structure: as the famous Russian playwright Anton Chekhov would say, “if in the first act you have hung a pistol on the wall, then in the following one it should be fired.”
Themes
The next day, Alicia is writing in her diary in the air-conditioned café. She expresses a strong desire to “disappear,” especially because Gabriel has arranged for the two of them to have dinner with Max, even though he knows Alicia can’t stand him. The cool café is about to close, and Alicia knows it is time for her to visit with Max—whom she dreads.
Once more, Alicia’s desire to seek out the cool hints at her troubled mental state—and links to Theo’s love of snow. And though she does not disappear in this moment, she will later successfully become “invisible” at the Grove.
Themes
Alicia returns to the café the following day, July 24th, where she summarizes the night before in her diary. She recalls Max showing up to the house in shorts, sweating profusely and refusing to make eye contact. He made a big deal out of not having been invited to the house for a while, which annoyed both Alicia and Gabriel. After a while, Alicia retreated to the kitchen, but Max followed her to grab another beer.
Max’s inability to meet Alicia’s eyes is a sure sign that he is hiding something. And his sweaty, awkward disposition could not be more different from Gabriel’s easy, handsome appeal.
Themes
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Once they were alone, Alicia told Max that she was going to tell Gabriel about what Max did to her the last time they saw each other. Max claimed he was drunk and doesn’t remember, but Alicia accused him of assaulting her, kissing and touching her against her will. At first Max denied it, but then he confessed his love for Alicia, forcibly kissing her again. When he rammed his tongue down her throat, Alicia panicked and bit down on it, drawing Max’s blood.
So Max does not “loathe” Alicia, as he claims—instead, he resents her for not returning his attraction. Symbolically, Alicia’s decision to bite Max’s tongue resurfaces the question of speech and silence. By wounding Max in this way, Alicia is temporarily denying him speech—the same thing she will later deny herself.
Themes
Max warned Alicia not to say anything to Gabriel and returned to the dinner table. Max then spent the entire dinner staring at Alicia. Alicia could not eat anything for the remainder of the evening, as she kept feeling the taste of Max’s blood. She reflects how different the two brothers are. After Max left, Gabriel complains that Alicia should have made more of an effort. She claimed that she was just distracted by the thought of all her unfinished work.
Max is the first person in the novel to tell Alicia to stay quiet—and for the first time, silence comes across not as an act of protest but as an act of secret-keeping. So is Alicia’s silence now a result of her intense emotions, or is there something about the murder she does not want (or is afraid) to reveal?
Themes
July 26th is Alicia’s birthday: now, she is 33. This is a monumental age for Alicia because her mother Eva died at 32 (“I will grow older and older—but she won’t”). In the morning, Gabriel presented Alicia with 33 red roses, pricking his fingers on one of the thorns: “a bloodred teardrop.” After breakfast, the couple went to the park and had a picnic, lounging in the heat.
Again, Alicia measures every step of her life in terms of her mother’s. And just as the heat adds to Alicia’s constant mental stress, her sense of having outlived her mother becomes another daily burden as soon as she turns 33, heightening her already potent feelings of distress.
Themes
As Alicia lay there, she recalled a similar memory from her childhood, sunbathing under a willow tree in Cambridge—“it was as if the past and the present were coexisting simultaneously in one perfect moment.” Alicia sketched Gabriel, and then they returned home. After having sex, Gabriel proposed having children, and Alicia joyously agreed. After he fell asleep, she snuck out to write down her feelings, trying her best to capture the happy moment.
The novel has frequently shown how childhood trauma can impact one’s adulthood. But in this lovely moment, a peaceful “present” allows Alicia to access the happier, more “perfect” moments from her past. So just as harmful childhood experiences can create pain in adult life, happy adult experiences can help rewire some childhood memories (as Theo initially experienced with Kathy).
Themes
