The Silent Patient

The overall narrative of The Silent Patient and many of the characters’ individual narratives demonstrate the dangers of unresolved or improperly treated mental illness. Alicia clearly never resolved the trauma of Vernon’s destructive comment that psychologically “killed” her; Theo’s assault on Alicia and Gabriel was thus able to reawaken this trauma, with deadly results. Theo likewise has unresolved issues related to his abusive upbringing, which make his unhealthy attachment to Kathy so strong that he can’t leave her after discovering her adultery—again, with harmful results to himself and others. Then there is Alicia’s mother, Eva, who presumably struggled with mental health issues that led to her suicide (and/or Alicia’s attempted murder—the novel never makes her intent clear) and Theo’s father, whom he believes had an undiagnosed personality disorder.

The novel’s setting of The Grove medical facility and Theo’s profession highlights the theme repeatedly, as even secondary characters exhibit struggles with mental health issues. The violent patient Elif, for instance—but also the nurse Yuri—describes a history of troubling stalking behavior to Theo. By depicting characters at both ends of the spectrum (patient versus caregiver/doctor/nurse) with mental health issues, the novel makes it clear just how universal these problems are. The blurry line between patient/caregiver and mentally unstable/stable reappears in Christian’s comment to Theo: “She’s the patient, you know—not you” (186). Similarly, the description of the nurse’s station at The Grove reinforces the blurred lines of patient/caregiver: “the patients hovered restlessly outside, staring in, watching us, so we were the ones under constant observation” (77).

Questions also come up about mental health problems and the best way to treat them. For example, when Christian privately treats Alicia, he prescribes antipsychotics. What if the doctor had instead engaged in talk therapy? Could Gabriel’s death have never taken place? Then there is Theo’s final view on Kathy, which leaves no doubt as to his therapeutic method of choice: “Her doctor wanted to put her on antidepressants but I discouraged it. I advocated getting a therapist and talking through her feelings […] But Kathy doesn’t want to talk, it seems” (334).