The Silent Patient Book summary

The Silent Patient is the debut novel of Alex Michaelides, and it was published in 2019. It is a contemporary psychological thriller that explores the mystery of the brutal murder of Gabriel Berenson, a photographer. The novel uses an epistolary technique with Alicia Berenson’s journal entries interspersed throughout her Psychotherapist’s narrative. Alicia Berenson is Gabriel’s wife and his convicted murderer, but she hasn’t spoken since the night of the murder. The book garnered significant commercial and critical success. It rose to the top of the New York Times Bestseller list and won the Goodreads Choice Award for Best Mystery & Thriller of 2019.

Alicia Berenson, a reputed painter, is convicted of murdering her husband, Gabriel Berenson, by shooting him several times in the head. She is found with slit wrists, sitting in a pool of her blood right across from her dead and tied-up husband. The police conclude that she is responsible for the murder, and attempt to uncover the motivations for the crime. Alicia becomes completely silent and refuses to answer any questions about her true motivations for the crime. During the trial, she draws a self-portrait and labels it Alcestis. The case causes a great stir in the media, as journalists try to uncover the real reasons behind the crime, while Alicia is sentenced to receive psychiatric help at the Grove, after the testimony of Professor Lazarus Diomedes, the director of the Grove.

Theo Faber is a forensic Psychotherapist who wishes to help people much like his psychotherapist had helped him in overcoming the trauma of growing up with a mentally unstable father. Six years after Alicia’s trial, Theo arrives at the Grove with the intent of helping her overcome her silence. He receives support from the director Diomedes, but Alicia attacks Theo with surprising ferocity at the end of their session together. Rather than be discouraged by this violence, Theo sees it as a means of communication. Since Alicia continues to remain mute after that first outburst, Theo begins to interview members of her inner circle to better understand her history.

On the personal front, Theo faces calamity as he discovers that his wife, Kathryn, whom he loves with all his heart, is cheating on him with another man. Theo is unable to gather the courage to confront her because he is so afraid of losing her, but the knowledge of her betrayal slowly begins to eat at his already compromised mental health. On the other hand, Alicia’s diary entries reveal that her marriage with Gabriel had been quite alright in the weeks leading up to the murder. Yet, Alicia had struggled with her mental health, particularly because of how her mother had tried to kill the both of them by crashing their car into a wall. Alicia had survived, but her father’s death had caused her to spiral again. A few weeks before Gabriel’s death, Alicia had begun to believe that she was being stalked by someone, but she could not prove this to anyone. Given her history with mental illness, Gabriel had dismissed these claims as being delusions.

Through a series of interviews with Alicia’s friends and family, as well as Alicia’s diary, Theo is able to uncover the source of Alicia’s silence. Alicia had suffered a psychological death right after her mother’s suicide because her father had told her that he wished Alicia had died in the accident rather than his wife. He understands that this trauma and her experience of the play, Alcestis had caused her to become silent. He reveals this information to Alicia and successfully manages to make her speak. Alicia gives Theo a false account of how she murdered her husband.

Theo reveals that his wife had been cheating on him with Gabriel Berenson and that Theo had followed him home and observed his life. He had gone into the Berenson home with the intent of revealing Gabriel’s true nature to Alicia. He had taken them both hostage and forced Gabriel to choose between his death and Alicia’s. Gabriel had chosen to kill Alicia, and this triggered Alicia’s old childhood trauma. So when Theo untied Alicia and left her to deal with Gabriel as she pleased, Alicia killed him. 

Theo realizes that Alicia has recognized him to be the masked man who had entered her home that day. He decides to kill her and gives her a lethal dose of morphine. Alicia uses her last minutes of consciousness to record a final entry in her diary about Theo’s involvement. The diary is eventually found by the police, who are investigating Alicia’s overdose, and it leads to Theo’s capture.