The Silent Patient

The Silent Patient

by

Alex Michaelides

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Honesty vs. Deception 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.
Honesty vs. Deception Theme Icon

“Choosing a lover is a lot like choosing a therapist,” advises Ruth, one of the many psychologists in Alex Michaelides’s thriller The Silent Patient. “We need to ask ourselves, is this someone who will be honest with me, […] admit making mistakes, and not promise the impossible?” But despite the high value Ruth—and the rest of the novel’s therapists—place on honesty, nearly every character in the narrative is a liar. Kathy is cheating on her husband Theo, the book’s narrator; Yuri, the kindly head nurse of the psych ward where the novel is set, sells drugs to patients; Max, a well-respected lawyer, secretly assaults his brother’s wife. And in each case, the betrayal has disastrous, sometimes literally fatal consequences.

Whether it is in the bedroom or the therapy room, The Silent Patient demonstrates the need for real honesty as a vital part of human safety and security. But despite the focus on honesty, deception is built in to both the story’s content and its form. For as Theo, a therapist, walks readers through his first-person perspective on the events of the psych ward, he is also obscuring the truth of his own circumstances. More than adding intrigue, then, the novel’s final twist allows readers to experience the kind of betrayal the characters have been struggling with all along. And in upending its readers’ expectations, The Silent Patient forces its audience to search for clues like any good detective (or therapist)—to pry open the gaps between professed honesty and practiced deception. 

Related Themes from Other Texts
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Honesty vs. Deception ThemeTracker

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

Below you will find the important quotes in The Silent Patient related to the theme of Honesty vs. Deception.
Part 1, Chapter 3 Quotes

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.

Related Characters: Theo Faber (speaker)
Related Symbols: Snow
Page Number: 15
Explanation and Analysis:

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 1 Quotes

Then I walked home, back up the hill, slowly, step by step. It seemed much steeper now. It took forever in the sweltering heat. For some reason I couldn’t stop thinking about the homeless man. Apart from pity, there was another feeling, unnamable somehow—a kind of fear. I pictured him as a baby in his mother’s arms. Did she ever imagine her baby would end up crazy, dirty and stinking, huddled on the pavement, muttering obscenities? […]

Tears collected in my eyes as I walked up the hill. I wasn’t crying for my mother—or myself—or even that poor homeless man. I was crying for all of us. There’s so much pain everywhere, and we just close our eyes to it. The truth is we’re all scared. We’re terrified of each other. I’m terrified of myself— and of my mother in me. Is her madness in my blood? Is it? Am I going to—

No. Stop. Stop—

I’m not writing about that. I’m not.

Related Characters: Alicia Berenson (speaker), Gabriel Berenson, Eva Rose
Page Number: 59
Explanation and Analysis:
Part 2, Chapter 9 Quotes

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?”

Related Characters: Theo Faber (speaker), Kathy Faber, Ruth
Page Number: 102
Explanation and Analysis:
Part 2, Chapter 10 Quotes

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.

Related Characters: Theo Faber (speaker), Kathy Faber, Ruth
Page Number: 107
Explanation and Analysis:
Part 2, Chapter 13 Quotes

I saw myself when very young, sitting under the branches of the willow tree in our garden in Cambridge. I’d spend hours hiding there. I may not have been a happy child, but during the time I spent under the willow tree, I felt a similar contentment to lying here with Gabriel. And now it was as if the past and the present were coexisting simultaneously in one perfect moment. I wanted that moment to last forever. Gabriel fell asleep, and I sketched him, trying to capture the dappled sunlight on his face. I did a better job with his eyes this time. It was easier because they were closed—but at least I got their shape right. He looked like a little boy, curled up asleep and breathing gently, crumbs around his mouth.

Related Characters: Alicia Berenson (speaker), Gabriel Berenson
Page Number: 126
Explanation and Analysis:
Part 2, Chapter 15 Quotes

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.

Related Characters: Theo Faber (speaker), Alicia Berenson
Page Number: 131
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 8 Quotes

“[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.

Related Characters: Theo Faber (speaker), Paul Rose (speaker), Alicia Berenson, Vernon Rose, Eva Rose
Page Number: 255
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:
Part 5, Chapter 3 Quotes

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.

Related Characters: Theo Faber (speaker), Ruth
Page Number: 320
Explanation and Analysis:

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.

Related Characters: Theo Faber (speaker), Alicia Berenson (speaker), Chief Inspector Steven Allen (speaker)
Related Symbols: Snow
Page Number: 323
Explanation and Analysis: