Psychological suspense novel set in England

26th December 2019

The Silent Patient by Alex Michaelides, psychological suspense novel set in England.

Childhood trauma – if you follow the Freudian interpretation of psychological behaviour and response – will invariably find warped and negative expression if it is not dealt with in a therapeutic and conscious way. Trauma will lie dormant until a trigger event unleashes stored experience, allowing it expression in any number of capricious ways.

Here the author places Alicia Berenson centre stage, a woman convicted of murdering her husband Gabriel. Since his death, she has turned mute and unresponsive and no-one in her care team can penetrate her world.

Theo Faber is a psychotherapist who is fascinated by her presentation. He immediately calls to mind the story of the Greek Myth of Alcestis, who was married to King Admetus. The Fates decreed that someone should die in his place and as a loyal wife she agreed to do so. However Heracles rescued her at her grave by wrestling with Death. Theo can see parallels with her situation and of course, just like Heracles, he is drawn to rescue her and consequently, with experience at Broadmoor, he feels he is suitably qualified to join the team at The Grove where she is incarcerated. Remember, psychological support is not there to rescue a patient! It is there in the main to offer safe boundaries and understanding and insight where applicable.

But we are not finished with Greek mythology as The Grove is run by Diomedes, who in a former mythic life wounded Aphrodite (an ancient Greek goddess associated with love, beauty, pleasure, passion and procreation) and to be honest there is obsessive love for Alicia bubbling away in Theo’s psyche. The structure of the book, too, is paced like a Greek tragedy.

Theo is certainly a determined chap, who consciously sidesteps many of the conventions and rules of psychiatric practise to further his own end. His obsession to get her to open up intensifies, whilst at home he has been contending with his wife’s infidelity, which inevitably serves to skew his reasoning.

Could Alicia’s medication be reduced and could she be given free reign to express herself through her art, he wonders? She was after all a celebrated artist before she murdered her husband. She even had him pose for her painting of a crucifixion, which is a really uncomfortable development, intended, I am sure.

There are hints that Gabriel had a controlling nature. He more than encouraged his wife to write down her feelings and experiences in a diary that he gave her. Or does he have to be tuned into her and in charge because she has had episodes of psychological instability? Who do you believe?

There is a lot of plausible psychology that feeds into the story. But, credibility is stretched in that Theo is a cog in a clearly failing psychiatric unit, where the boundaries have become alarmingly warped. Controlled drugs – an integral tool in managing patients’ symptoms in a unit such as this – are incredibly tightly supervised and it would be highly unlikely that any single person could have access to them without tight controls and colleagues in attendance. Spontaneous sessions between therapist and patient take place on a whim, in any old room that happens to be available. That is not conducive to a therapeutic relationship between patient and therapist. No, the unit would have been long gone if the practices outlined were taking place. And, wait until you find out who defended Alicia at her trial for murder! The law profession has ethics about who can and cannot represent a client but the choice in the book does underline how, unless people learn to hold appropriate boundaries, everything can go out of kilter and nobody is emotionally safe. It certainly makes for a bonkers, confusing and quite dangerous environment.

The author has sold multi million copies worldwide, the book is published in 44 territories, it was in The Sunday Times top 10 bestseller list and was no 1 in the New York Times bestseller list – remaining in the top 10 list for the NY Times for 7 months (from February to August) which is a record for a UK debut novelist. The film rights have also been acquired by Brad Pitt’s film company ‘Plan B’ and it is currently being made into a Hollywood film.

So, it is time to make up your own mind. This is indeed a gripping and well written thriller with intelligent hypothesising and psychopathology. Ignoring the, at times, ridiculous contraventions of protocol, it makes for a gripping, sinister and compelling read. Recommended.

Parts of the book are set in a recognisable Hampstead, other parts around Southern England.

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