The Silent Patient

by Alex Michaelides

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. Sigmund Freud, Introductory Lectures on Psychoanalysis

I mean, of course I wanted to help people. But that was a secondary aim – particularly at the time I started training. The real motivation was purely selfish. I was on a quest to help myself. I believe the same is true for most people who go into mental health. We are drawn to this particular profession because we are damaged – we study psychology to heal ourselves. Whether we are prepared to admit this or not is another question.

The development of our personalities doesn’t take place in isolation, but in relationship with another – we are shaped and completed by unseen, unremembered forces; namely our parents.

I didn’t know it then, but it was too late – I had internalised my father, introjected him, buried him deep in my unconscious. No matter how far I ran, I carried him with me wherever I went. I was pursued by an infernal, relentless chorus of furies, all with his voice – shrieking that I was worthless, shameful, a failure. During my first term at university, that first cold winter, the voices got so bad, so paralysing, they controlled me. Immobilised by fear, I was unable to go out, socialise or make any friends.

No one paid me the least attention; I was clearly as invisible as I felt.

At the time I didn’t understand. But that’s how therapy works. A patient delegates his unacceptable feelings to his therapist: and she holds everything he is afraid to feel, and she feels it for him.

Alicia made no effort to interact with patients or staff, remaining withdrawn and isolated; and, for the most part, the other patients had left her alone. If someone doesn’t reply when you speak to them and never initiates conversation, you soon forget they’re there. Alicia had quickly melted into the background, becoming invisible.

Unexpressed emotions will never die. They are buried alive, and will come forth later, in uglier ways. Sigmund Freud

Tears collected in my eyes as I walked up the hill. I wasn’t crying for my mother – or myself – or even that poor homeless man. I was crying for all of us. There’s so much pain everywhere, and we just close our eyes to it. The truth is we’re all scared. We’re terrified of each other. I’m terrified of myself – and of my mother in me. Is her madness in my blood? Is it? Am I going to

Between the two of us, I had most to lose, that was obvious. Kathy would survive – she was fond of saying she was tough as nails. She’d pick herself up, dust herself off and forget all about me. But I wouldn’t forget about her. How could I? Without Kathy, I’d return to that empty, solitary existence I had endured before. I’d never meet anyone like her again, never have that same connection, or experience that depth of feeling for another human being. She was the love of my life – she was my life – and I wasn’t ready to give her up. Not yet. Even though she had betrayed me, I still loved her. Perhaps I was crazy, after all.

‘Choosing a lover is a lot like choosing a therapist,’ Ruth had said. ‘We need to ask ourselves, is this someone who will be honest with me, listen to criticism, admit making mistakes, and not promise the impossible?’

‘About love. About how we often mistake love for fireworks – for drama and dysfunction. But real love is very quiet, very still. It’s boring, if seen from the perspective of high drama. Love is deep and calm – and constant.

‘I think her behaviour suggests she is quite damaged – lacking in empathy and integrity and just plain kindness – all the qualities you brim with.’

‘Trying to please someone unpredictable, someone emotionally unavailable, uncaring, unkind – trying to keep them happy, win their love – is this not an old story, Theo? A familiar story?’

one of the hardest things to admit is that we weren’t loved when we needed it most. It’s a terrible feeling, the pain of not being loved.’

‘But you think I should leave, don’t you?’ ‘You’ve come too far, and worked too hard, to return to a life of dishonesty and denial and emotional abuse. You deserve someone who treats you better, much better—’

Remember, love that doesn’t include honesty doesn’t deserve to be called love.’

I’m writing this in Caffe dell’Artista. I come here most days now. I keep feeling the need to get out of the house. When I’m around other people, even if it’s only the bored waitress in here, I feel connected to the world somehow, like a human being. Otherwise I’m in danger of ceasing to exist. Like I might disappear.

‘A baby cannot hate the mother, without the mother first hating the baby.’

‘It’s a shame you didn’t know her then. She was the most interesting person I’ve ever met. Most people aren’t alive, you know, not really – sleepwalking their way through life.

cities. I stopped listening after a while. He went on, complaining, self-justifying, self-pitying, boring me to death. He never asks me anything. He doesn’t have any actual interest in me. Even after all these years, I’m just a means to an end – an audience of the Jean-Felix Show.

Trust, once lost, is hard to recover.’

I mustn’t put strangeness where there’s nothing. I think that is the danger of keeping a diary: you exaggerate everything, you are on the look-out, and you continually stretch the truth. Jean-Paul Sartre

The aim of therapy is not to correct the past, but to enable the patient to confront his own history, and to grieve over it. Alice Miller

I saw it now. I would never be safe. Never be loved. All my hopes, dashed – all my dreams, shattered – leaving nothing, nothing – my father was right – I didn’t deserve to live. I was – nothing. That’s what Gabriel did to me. That’s the truth. I didn’t kill Gabriel. He killed me. All I did was pull the trigger.