The Silent Patient by Alex Michaelides: Book Review

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Featured Image for The Silent Patient Book Review.  Text contains the blog post title above the author's name: Alex Michaelides and icons indicating a two-point-five-star rating.

Hello, friends! Today I’m sharing my thoughts on Alex Michaelides’s The Silent Patient. Despite the writing showing clear signs of being a debut novel and side characters who fade in and out of existence as needed, Michaelides’s debut infuses a fresh perspective to a familiar kind of thriller.


Book Cover for the Silent Patient by Alex Michaelides

The Silent Patient by Alex Michaelides

Rating: 2.5 out of 5 stars

Year Published: 2019

Genres: Mystery | Thriller

Buy The Silent Patient on Amazon or support a local bookstore by purchasing it on Bookshop.org.


I read this book as part of my 2021 Reading Challenge. Check out all the books I’m reading for the challenge here.


Alicia Berenson was thirty-three years old when she killed her husband... The facts, such as they were, were simple: Alicia was found alone with Gabriel's body; only her fingerprints were on the gun.  There was never any doubt she killed Gabriel.  Why she killed him, on the other hand, remained a mystery.

so, what is The Silent Patient about?

The Silent Patient is Alex Michaelides’s 2019 debut about psychotherapist Theo Faber’s attempt to uncover what motivated his new patient, Alicia Berenson, to murder her husband. And, uh, that’s it. That’s the plot, really. Theo toes the line — and eventually just obliterates the line — between mental health professional and armchair detective.

There was (and still is) a lot of hype around The Silent Patient, but to be honest, I live under a rock when it comes to most popular things. I just can’t keep up with what the kids are reading these days! So, unfortunately, in this review, I won’t necessarily be able to speak to whether this book lives up to its hype. That said, I do have some thoughts & feelings about what The Silent Patient gets right, and what it gets… well, wrong.

So let’s talk about that!

As you will see, it's an incredible story -- of that there is no doubt.  Whether you believe it or not is up to you.

what The Silent Patient gets right

so i heard y’all like greek mythology

In case you couldn’t tell by his surname, Alex Michaelides is Greek. Even if you didn’t know it by his surname, you might figure it out by reading The Silent Patient. Greek mythology comes into play in the story, particularly Euripides’s play: Alcestis. After Gabriel’s death, the first painting Alicia creates features herself, caught naked, standing before a blank canvas, with her lips parted as if to speak. She titles the painting Alcestis.

In Euripides’s play, Alcestis volunteers to die in place of her husband, Admetus. All Alcestis asks of her husband is that he not remarry and lead a life of solemnity to honor her memory. Shortly after Alcestis departs for the land of the dead, Heracles shows up at their home. At this point, Admetus disregards his promise and parties with his guest. Upon learning of Alcestis’s passing, Heracles takes it upon himself to ambush Death at Alcestis’s tomb and bring her back home.

Alcestis wears a veil to conceal her identity, and Heracles urges Admetus to look after this mysterious woman. Admetus eventually lifts the woman’s veil to discover it is his wife, back from the dead. Alcestis cannot speak for three days, after which she will be wholly alive again. Is Alcestis a tragedy, or is this a happy ending? Well, just like the stories of Theo and Alicia, that’s up for interpretation.

An unsettling myth of self-sacrifice, it was unclear how it related to Alicia's situation.  The true meaning of the allusion remained unknown to me for some time.

y’all gat any more of them unreliable narrators?

The Silent Patient primarily follows psychotherapist Theo Faber, who has just started working at an inpatient facility called The Grove. He may sound like a nice guy, but he’s not in the “unreliable narrators” section for nothing. You see, Theo waited six years for a job opening at this facility specifically because he wanted to treat Alicia. Now that he’s here, he supplements his time treating his patients with hours playing amateur detective. His motivations may be in the right place, but to what lengths is he willing to go to get the answers he seeks from his silent patient? (See what I did there?)

Nearly six years after Alicia was admitted, the position of forensic psychotherapist became available at The Grove... I followed my gut -- and applied for the job... In this case, there would be no talking.  No listening.  The information I needed would have to be gathered through nonverbal clues, such as my countertransference... and whatever information I could gather from outside sources.

In addition to the chapters we get from Theo’s perspective, we are also treated to sporadic passages from Alicia’s diary in the days leading up to her husband’s murder. Alicia has her own secrets to keep, and whether her secrecy is well-founded or not is up for debate. However, that doesn’t change the fact that she frequently stops herself from writing about things she doesn’t want to think about. What is Alicia hiding? Or, equally pressing, what information does she fear being discovered by her diary’s potential reader?

I mustn't put strangeness where there's nothing.  I think that is the danger of keeping a diary: you exaggerate everything, you are on the lookout, and you continually stretch the truth.

Jean-Paul Sartre, as quoted in The Silent Patient

what i wish The Silent Patient did better

side characters acting like NPCs who only exist when they’re on screen

One of my major criticisms of The Silent Patient is that pretty much every side character is kind of a bad person. On its own, this wouldn’t be a bad thing. However, none of them have any motivation for doing the things they do, and they suffer no consequences after the fact. The primary example of this is difficult to discuss without spoilers. Suffice it to say that I find it incredibly hard to believe that two people could keep such big secrets from each other for as long as they do in this story.

The less-spoilery examples of side characters who only exist in service to the main character’s plotline all involve The Grove’s employees. The Grove is run by Dr. Lazarus Diomedes. Dr. Diomedes not only has a great Greek name but also a great investment in the success of his clinic. As The Grove is being threatened with closure, Dr. Diomedes is willing to do whatever it takes to manifest a patient success story. This apparently includes turning a blind eye to blatant violations of a doctor’s ethical responsibilities toward their patients and feeling emboldened by a patient’s violent outburst.

"It hasn't put you off... what happened?" [Dr. Diomedes asked.] / "On the contrary, I'm encouraged." / "Good.  I agree, such an intense reaction... is certainly worth investigating.  I think you should keep going."

Then, a therapist is discovered to have (1) previously treated a patient they now treat at The Grove — which is a massive conflict of interest; and (2) failed to report the income from treating that patient — which is literally a crime!!! Another staff member is discovered selling drugs to the patients. Nothing comes of either of these situations because… you know… we gotta have someone to suspect… until we have someone new to suspect!

dear diary, today i wrote a rough draft for my novel… in my diary

Hands down, my biggest gripe with The Silent Patient is the writing. For starters, there’s a line from Theo at the beginning of the book where he cuts himself off from revealing something too soon. This is obviously meant to entice the reader to keep reading. But, like, this is on page nine! I don’t need the bait; just get to the story!

Until one day, the truth came to light-- But I'm going too fast, I'm getting ahead of myself.  I must start at the beginning and let the events speak for themselves.

As I mentioned above, Alicia’s diary entries are used to give us insight into her life in the days leading up to Gabriel’s murder. Unfortunately, these diary entries are so poorly-written that they took me out of the story on several occasions. Alicia writes dialogue on separate lines (which nobody does), and she writes herself… stopping herself… from saying (writing?) things… in her diary… Confused? Yeah, me too. Here’s an example:

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 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.

Someone get this woman an eraser! Also, this is not a diary entry, but it must needs be remarked that an actual character in this book says they no longer felt compelled to do drugs because they were “high on love.” I just–.

There are some very nice quotes and lines in The Silent Patient, but I’d be lying if I said there was more good than bad.

should you read The Silent Patient?

The short answer is… it depends. As someone who doesn’t read many thrillers because I find much of the genre to be derivative of itself, I thought The Silent Patient was just fine! I didn’t predict the twist as far ahead as some other readers, and I was pretty invested in learning how the story would end for the two main characters. However, the book does rely heavily on its twist, and not everything gets wrapped up as neatly as I might’ve liked.

If you do read a lot of thrillers, I could see this going one of two ways. First, it could be right up your alley. A lot about The Silent Patient is similar to other well-received thrillers, so you might like it if those similarities are things you’ve enjoyed. On the other hand, if you read thrillers often, you might find this predictable and not very complex.

All in all, The Silent Patient is a pretty solid debut thriller. At only 325 pages, with most chapters under ten pages each, it’s a pretty quick read. So, if you’re on the fence, I’d say give it a shot! You’ll probably finish it in a few hours anyway. That said, in my opinion, you’re definitely not missing anything groundbreaking if you choose to skip this book. To conclude, here’s my absolute favorite quote from the book… which might not be saying much, now that I think about it.

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... Somehow grasping at vanishing snowflakes is like grasping at happiness: an act of possession that instantly gives way to nothing.

You can also read my reviews on Goodreads. Check this one out here.


now it’s your turn!

So, there you have it, my thoughts on The Silent Patient. Have you read this thriller? If so, what did you think? Will you be reading Michaelides’s next book, The Maidens (due out June 2021)? I know I might have been a bit harsh on The Silent Patient, but I’m probably still going to pick his next one up. If you haven’t read The Silent Patient, what thriller(s) do you like?

No matter what you want to talk about, I’d love to hear your thoughts. Sound off in the comments below!

As always, thanks for reading!