The Silent Patient

The Prologue is an excerpt from Alicia Berenson’s diary, dated July 14th—five weeks before Gabriel Berenson’s murder. Alicia has been feeling depressed. A painter, her emptions weight her down so much that she has been unable to create. Gabriel, a photographer who understands her creative struggles, encourages her to write and gives her a notebook to use as a diary. She writes that she loves Gabriel.

Alicia expresses embarrassment at the thought of keeping a “diary,” writing that people like Anne Frank “not someone like me” would keep a diary (1). She resolves, “This is going to be a joyful record of ideas and images that inspire me artistically, things that make a creative impact on me. I’m only going to write positive, happy, normal, thoughts. No crazy thoughts allowed” (3).

A quotation from Sigmund Freud’s Introductory Lectures on Psychoanalysis prefaces Part 1: “He that has eyes to see and ears to hear may convince himself that no mortal can keep a secret. If his lips are silent, he chatters with his fingertips; betrayal oozes out of him at every pore” (5).

The novel's first-person narrator, Theo Faber, is a 42-year-old forensic psychotherapist living in London. He does not disclose these details or even his name in Chapter 1. Instead, he launches directly into an account of the day Alicia murdered Gabriel—a case that has fascinated him for years. On August 25th, six years earlier, Alicia (33 at the time) murdered Gabriel (44). Gabriel, a photographer, came home late from a photo shoot for Vogue in London’s Shoreditch neighborhood. Half an hour later, Barbie Hellmann, a neighbor, heard gunshots and called the police.  

The police discovered Gabriel’s body, in a chair with wire wrapped around the wrists and ankles. He had been shot five times in the face. Alicia was standing in the room and had deep cuts (self-inflected) across both her wrists. Taken to the hospital, she survived. She never spoke again. Her only “statement” was a self-portrait, which she created in the days after her discharge from the hospital. In the bottom corner of the canvas, she signed it “ALCESTIS.”

Theo explains that Alcestis is a heroine of Greek myth and describes her “unsettling myth of self-sacrifice” as “a love story of the saddest kind” (11). Theo ponders revealing his identity—at this point he’s still a nameless narrator—but instead concludes, “I am not the hero of this tale. It is Alicia Berenson’s story, so I must begin with her—and the Alcestis” (11). Theo describes the self-portrait, which shows Alicia in her painter’s studio, standing before an easel and a canvas, holding a paintbrush. She is naked. The painting even shows the scars on her wrists. The paintbrush is dripping red paint—or blood. The manager of the gallery representing Alicia, Jean-Felix Martin, displayed the self-portrait during her trial and people lined up out the door to view it.

During the trial, Alicia remained silent. The judge took her muteness as a sign of guilt. The defense cited Alicia’s history of mental health problems, dating back to childhood, and entered a plea of “diminished responsibility” (a criminal defense that absolves an accused person of the liability for a criminal act by arguing they were mentally impaired). Professor Lazarus Diomedes, clinical director at The Grove, a secure mental health facility in north London, argued that Alicia’s silence was a sign of profound psychological distress. As a result, Alicia didn’t go to prison but ended up at The Grove. Six years later, Theo sees a forensic psychotherapist position available at The Grove and applies for the job.

The narrator finally introduces himself: “My name is Theo Faber. I’m forty-two years old. And I became a psychotherapist because I was fucked up” (16). Born in Surrey, outside of London, Theo grew up with his mother and abusive father (whom Theo now suspects had an undiagnosed personality disorder). When he left home at 18 for university, he thought he was free. However, he struggled with mental health issues, having internalized his father’s abuse: “I was pursued by an infernal, relentless chorus of furies, all with his voice—shrieking that I was worthless, shameful, a failure” (19). After an unsuccessful suicide attempt during his first semester, he started therapy. Theo’s therapist, Rush, helped him through talk therapy.

Now a fully trained and experienced psychotherapist, Theo wants to work with Alicia—which means working at The Grove. He describes his interview for the position at The Grove. When asked why he became a psychotherapist, he doesn’t delve into the real reason (his own difficult past). Instead he tells the interview panel, led by Indira Sharma, a present employee of The Grove, that he wanted to help people. Theo gets the job.

Theo arrives at The Grove. It’s January. He made a new year’s resolution to quit smoking—however, before he enters The Grove, he smokes a cigarette. He’s annoyed by his behavior because “psychotherapists tend to view smoking as an unresolved addiction—one that any decent therapist should have worked through and overcome” (23). He doesn’t want people to smell cigarettes on him and pops a mint to cover up the stink.

Theo meets Yuri, head psychiatric nurse. Yuri comes across as friendly and relaxed. He introduces Theo to Stephanie Clarke, the manager of The Grove, who comes across as strict and cautious. She gives Theo a personal attack alarm, which he’s to carry with him at all times. Yuri notes that it’s quiet at the moment because the patients are in a “community meeting.” Theo asks if he can join the meeting.