REVIEW: The Silent Patient – Alex Michaelides

Author: Alex Michaelides (twitter)

UK Publisher: Orion

Genre: Psychological thriller, crime

Alicia Berenson lived a seemingly perfect life until one day six years ago.

When she shot her husband in the head five times.

Since then she hasn’t spoken a single word.

It’s time to find out why.

The premise of this book fascinated me when I heard about it – a murderer who was unquestionably guilty, but who has been completely silent since the murder. No-one can understand her motivations, no-one knows what prompted it. When a job opening comes up at the institute she is being held at, Theo, a psychologist who has been following her case, truly believes he can help her. 

He seems strangely obsessed with her, but the explanation given is that his own marriage – which he had assumed was perfect – is falling apart since his discovery of his wife’s infidelity, so he focuses on work as a way to handle his personal situation. There’s certainly something to be said about the mirroring in the storylines too. The two narratives we are given are Alicia’s diary leading up to the events of the murder, and Theo’s inner monologue some time after the fact, trying to deduce what drove her to killing her husband. Both provide suggestions of seemingly perfect marriages gone awry – Theo’s because he has discovered his wife is cheating, and Alicia’s because we know she murders her husband. Interestingly, Theo’s narrative bookends Alicia’s, as his investigations lead him to dig more into her early life, while her diary entries only give the immediate history of the situation in the weeks prior to the event.

There are other, mini-mysteries to be solved too. Why is Theo’s old colleague so hostile toward him when he joins the team? Who is giving one of the patients access to drugs so she can sell them to other patients? Something doesn’t seem quite right about most of the other characters you encounter in the book, and it adds to the sense of narrative unease until you realise exactly why that’s the case.

I found the whole thing very well done, and perfectly chilling. It wasn’t a novel designed to keep you at ease. I think this is to do with the very clever juxtaposition of narratives between the voice of the calm, in-control and self-aware psychologist, and the anxious artist with a history of mental illness, who appears to be on the verge of a breakdown. A breakdown we are led to believe is at least her second, and one we know will drive her to murder.

For all it wasn’t a comfortable read – deliberately so – it was a nice fast one, and perfect for holidays. It’s clever, and extraordinarily executed, but not dense or inaccessible. While there is some psychobabble, it’s kept to a minimum and didn’t become overly complex or mind-boggling, which was something of a relief. I thought the cast of characters were great as well, and Alicia was fantastic as a focus of sympathy – you knew she had done it, but even as you were reading you wondered if there was some way that she hadn’t. 

There is some very clever work done with timelines in this, to keep you guessing. When the final reveal came, the seeds had been sown but I still found it compelling and effective. The ending as a whole was wonderfully sinister, and left me with the most chilling feeling.

If you love dark crime books, you’ll really enjoy this. The approach of a psychologist unpicking the reasoning behind every action and interaction is really fascinating, and would work well for fans of The Sinner. Rather than disputing guilt, the book instead seeks to investigate what would drive someone to murder, can these factors be used as mitigation for their crimes? Is it just one trigger, or are there cumulative events that build up until a person snaps? The psychological examination was really well done, and it was interesting seeing the narrator apply that to himself as much as his patient.


  • A psychological novel that gives you the murderer at the very beginning, and instead works to unpick her motivations and what drove her to kill, through the guise of a psychologist trying to break her muteness.
  • The split timelines of Alicia’s diary in the weeks leading up to the murder, and Theo dealing with the aftermath and investigating the context make for a brilliant pace and reveal.
  • There’s something very sinister about the book, and I think a lot of that is the intimacy of the setting – psychologists are supposed to be safe people, almost blank slates to help your treatment, but having the narrative voice be the psychologist and getting insight into his own inner thoughts as he treats her creates something of a cognitive dissonance. The boundaries between the professional and the personal are blurred because you’re seeing it through his thoughts. How much else is blurred? What other boundaries are being crossed?

Rating: 5/5 – it’s a dark and creeping look into the mental state that drives someone to murder, blurring the lines between patient and psychologist as Theo tries to get inside Alicia’s head.

If you enjoyed this, and love crime and thriller fiction, I have written reviewed it again, and other titles at

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s