The Silent Patient

The Silent Patient

by

Alex Michaelides

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Empathy, Identification, and Boundaries Theme Analysis

Themes and Colors
Empathy, Identification, and Boundaries Theme Icon
Tragedy and Destiny Theme Icon
Honesty vs. Deception Theme Icon
Childhood Trauma Theme Icon
Silence vs. “The Talking Cure” Theme Icon
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 Theme Icon

Over and over again in Alex Michaelides’s thriller The Silent Patient, Theo Faber—the book’s first-person narrator and a trainee psychotherapist—insists that the goal of his job is to feel his patients’ pain for them. He recalls his own beloved therapist, Ruth, shedding the tears he himself was unable to as a young boy; later, in his own practice, he takes on his patients’ mystifying rage or thumping headaches. And while he prides himself on his ability to feel other people’s pain, he is consistently disdainful of his friends’ and colleagues’ self-involvement, of their narcissistic monologues and thoughtless behavior. Empathy, Theo suggests, is the essential ingredient of any meaningful relationship, therapeutic or otherwise; to fail to see others’ perspectives is to fail to care for them.

But when Theo takes on the troubled Alicia Berenson as his patient, he becomes far too obsessive about entering her mind—about trying to absorb her emotional state as his own. Theo’s determination to empathize with Alicia is so obvious that one fellow therapist warns him he is “over-identifying.” And indeed, by the end of the novel, Theo will feel unable to distinguish himself from Alicia. Whether it’s “crashing through every last boundary between therapist and patient” or entering her marital home because it reminds him of his own, Theo transgresses every personal and professional line between himself and Alicia. Thus even as The Silent Patient calls for empathy, it also calls for distance—because if identifying with someone’s pain can be healing, blurring the boundaries between self and other can only do harm.

Related Themes from Other Texts
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Empathy, Identification, and Boundaries ThemeTracker

The ThemeTracker below shows where, and to what degree, the theme of Empathy, Identification, and Boundaries appears in each chapter of The Silent Patient. Click or tap on any chapter to read its Summary & Analysis.
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Empathy, Identification, and Boundaries Quotes in The Silent Patient

Below you will find the important quotes in The Silent Patient related to the theme of Empathy, Identification, and Boundaries.
Part 1, Chapter 2 Quotes

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.”

Related Characters: Theo Faber (speaker), Alicia Berenson
Related Symbols: Alcestis
Page Number: 9
Explanation and Analysis:
Part 1, Chapter 3 Quotes

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.

Related Characters: Theo Faber (speaker), Ruth
Page Number: 17
Explanation and Analysis:
Part 1, Chapter 8 Quotes

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.

Related Characters: Theo Faber (speaker), Alicia Berenson
Page Number: 39
Explanation and Analysis:
Part 1, Chapter 10 Quotes

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.

Related Characters: Theo Faber (speaker), Alicia Berenson, Kathy Faber
Page Number: 51
Explanation and Analysis:
Part 2, Chapter 2 Quotes

[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.

Related Characters: Theo Faber (speaker), Lazarus Diomedes (speaker)
Related Symbols: Cigarettes
Page Number: 67
Explanation and Analysis:
Part 2, Chapter 4 Quotes

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.

Related Characters: Theo Faber (speaker), Alicia Berenson, Ruth
Page Number: 76
Explanation and Analysis:
Part 2, Chapter 7 Quotes

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.

Related Characters: Theo Faber (speaker), Alicia Berenson
Page Number: 94
Explanation and Analysis:
Part 2, Chapter 26 Quotes

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.”

Related Characters: Theo Faber (speaker), Christian West (speaker), Alicia Berenson
Page Number: 174
Explanation and Analysis:
Part 2, Chapter 30 Quotes

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.

Related Characters: Theo Faber (speaker), Alicia Berenson
Page Number: 191
Explanation and Analysis:
Part 4, Chapter 5 Quotes

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.

Related Characters: Theo Faber (speaker), Kathy Faber
Page Number: 242
Explanation and Analysis:
Part 4, Chapter 11 Quotes

“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.

Related Characters: Theo Faber (speaker), Alicia Berenson (speaker), Paul Rose, Lydia Rose, Eva Rose
Page Number: 265
Explanation and Analysis:
Part 4, Chapter 21 Quotes

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.

Related Characters: Theo Faber (speaker), Alicia Berenson, Gabriel Berenson, Kathy Faber
Page Number: 303
Explanation and Analysis:
Part 5, Chapter 1 Quotes

I wish I could say I struck a blow for the defeated—that I was standing up for the betrayed and brokenhearted—that Gabriel had a tyrant’s eyes, my father’s eyes. But I’m past lying now. The truth is Gabriel had my eyes, suddenly—and I had his. Somewhere along the way we had swapped places.

I saw it now. I would never be safe. Never be loved. All my hopes, dashed—all my dreams, shattered—leaving nothing, nothing. My father was right—I didn’t deserve to live. I was—nothing. That’s what Gabriel did to me.

That’s the truth. I didn’t kill Gabriel. He killed me.

All I did was pull the trigger.

Related Characters: Alicia Berenson (speaker), Gabriel Berenson, Vernon Rose
Page Number: 311
Explanation and Analysis: