The Silent Patient

This last section of the novel reveals the truth about Theo, concluding with Inspector Allen showing up at his home—presumably to arrest him. Despite his transgressions, Theo is convinced that he rescued Alicia by helping her identify her formative childhood trauma and, with it, the reason for her mental break on the night she killed Gabriel. Theo thus still feels justified as a psychoanalyst—but he has in the process condemned himself.

Part 5 sees Theo brought to justice—all thanks to Alicia’s diary. Although the “silent patient” is again without a voice, she still has found another way to communicate. In the end, her non-verbal communication proved just as valuable as any verbal communication.

Theo’s circumstances by the novel’s end reiterate the fact of his mental illness. He feels little remorse for what happened to Alicia and still sees himself as having helped her in a way by identifying her childhood trauma. He also absolves himself of any guilt by stating that he had no idea of Alicia’s troubled past: “I want to be clear—I never thought Alicia would shoot Gabriel” (328). The only figure in Theo’s life who seems to be able to spark some sort of regretful emotion is Ruth. Her maternal role again appears in the last chapter when Theo reflects on how she would react if she knew the truth: “Even worse than the shock or repulsion, or possibly even fear, in Ruth’s eyes as I told her would be the look of sadness, disappointment and self-reproach” (335).

Meanwhile, Theo’s father has died and his mother is in a care home. Theo and Kathy moved to Surrey, back into his childhood home, one year ago. They planned to renovate the house and make it their own but haven’t managed to make significant changes. This geographic detail reflects Theo’s own personal tragedy—his inability to escape his own childhood trauma. Alicia was not able to escape the influence of hers. While Theo thought for some time he had escaped, he hasn't either. He displayed violent behavior, similar to his father’s, and now has, in terms of location at least, come full circle—right back in the childhood home in Surrey.

The novel’s conclusion thus drives home an overarching message encapsulated in its theme of mental health—the danger of failing to address psychiatric issues. One can treat trauma, but one has to address it, recognize it, and—in one way or another—communicate it. Failing to take these steps allows the trauma to fester and potentially, as evidenced in both Theo’s and Alicia’s cases, lead to self-destruction.