The Silent Patient

by Alex Michaelides

I don’t know why I’m writing this. That’s not true. Maybe I do know, and just don’t want to admit it to myself. I don’t even know what to call it – this thing I’m writing. It feels a little pretentious to call it a diary. It’s not like I have anything to say. Anne Frank kept a diary, or Samuel Pepys – not someone like me. Calling it a ‘journal’ sounds too academic, somehow. As if I should write in it every day, and I don’t want to – if it becomes a chore, I’ll never keep it up. Maybe I’ll call it nothing. An unnamed something that I occasionally write in. I like that better. Once you name something, it stops you seeing all of it, or why it matters. You focus on the word; which is just the tiniest part, really, the tip of an iceberg. I’ve never been that comfortable with words – I always think in pictures, express myself with images –

‘Talk to me,’ he said. ‘There’s nothing to say. I just get so stuck in my head sometimes. I feel like I’m wading through mud.’

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.

One word: ALCESTIS. 2 Alcestis is the heroine of a Greek myth. A love story of the saddest kind. Alcestis willingly sacrifices her life for her husband, Admetus, dying in his place when no one else will. An unsettling myth of self-sacrifice,

As a psychotherapist, it was obvious to me that she had suffered a severe trauma surrounding Gabriel’s death; and this silence was a manifestation of that trauma. Unable to come to terms with what she had done, Alicia stuttered and came to a halt, like a broken car.

And I became a psychotherapist because I was fucked up.

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.

As human beings, our earliest years reside in a land before memory. We like to think of ourselves as emerging from this primordial fog with our characters fully formed, like Aphrodite rising perfect from the sea foam. But thanks to increasing research into the development of the brain, we know this is not the case. We are born with a brain half-formed – more like a muddy lump of clay than a divine Olympian. As the psychoanalyst Donald Winnicott put it: ‘There is no such thing as a baby.’ 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. This is frightening, for obvious reasons – who knows what indignities we suffered, what torments and abuses, in this land before memory? Our character was formed without us even knowing it.

grasping at vanishing snowflakes is like grasping at happiness; an act of possession which instantly gives way to nothing.

It reminded me that there was a world outside this house: a world of vastness and unimaginable beauty; a world that, for now, remained out of my reach. That memory has returned repeatedly to me over the years. It’s as if the misery that surrounded it made that brief moment of freedom burn even brighter; a tiny light surrounded by darkness.

I left that semi-detached prison in Surrey – and I thought was free. I was wrong. 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.

And as I talked, I found that no matter how distressing the details I related, I could feel nothing. I was disconnected from my emotions, like a hand severed from a wrist. I talked about painful memories and suicidal impulses – but couldn’t feel them. I would, however, occasionally look up at Ruth’s face. And to my surprise, tears would be collecting in her eyes as she listened. This may seem hard to grasp, but those tears were not hers. They were mine.

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. And then, ever so slowly, she feeds his feelings back to him.

The hateful internal chorus never entirely left me – but I now had Ruth’s voice to counter it, and I paid less attention. As a result, the voices in my head grew quieter and would temporarily vanish. I’d feel peaceful – even happy, sometimes.

It’s odd how quickly one adapts to the strange new world of a psychiatric unit. You become increasingly comfortable with madness – and not just the madness of others, but your own. We’re all crazy, I believe, just in different ways.

The patients were all women – and most had coarse features, lined, scarred. They’d had difficult lives, suffering from horrors that had driven them to retreat into the no man’s land of mental illness; their journey was etched into their faces, impossible to miss.

tried to contain my nerves and prepare myself. I tried to silence the negative voices in my head – my father’s voice – telling me I wasn’t up to the job, I was useless, a fraud. Shut up, I thought, shut up, shut up –

we are made up of different parts, some good, some bad; and that a healthy mind can tolerate this ambivalence and juggle both good and bad at the same time. Mental illness is precisely about a lack of this kind of integration – we end up losing contact with the unacceptable parts of ourselves.

I experienced a sudden and unexpected wrench of sadness. I felt desperately sorry for her, and those like her – for all of us, all the wounded and the lost.

I never seemed to find the special connection I longed for. I had believed I was too damaged, too incapable of intimacy.

I felt desperately sad. When Kathy and I left the house, part of me hadn’t left, I knew, but had remained behind – forever a child, trapped. I felt lost, hopeless, close to tears. And then Kathy surprised me, as always. She threw her arms around me, pulling me into a hug. ‘I understand now,’ she whispered in my ear. ‘I understand it all. I love you so much more now.’

I silently thanked Him for giving me such unexpected, undeserved happiness. I saw things clearly now, I understood His greater purpose. God hadn’t abandoned me during my childhood, when I had felt so alone and so scared – He had been keeping Kathy hidden up His sleeve, waiting to produce her, like a deft magician.

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

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

but how can Alicia benefit from therapy if she doesn’t talk?’ ‘Therapy isn’t just about talking,’ Indira said. ‘It’s about providing a safe space – a containing environment. Most communication is non-verbal, as I’m sure you know.’

‘In order to be a good therapist, you must be receptive to your patients’ feelings – but you must not hold on to them – they are not yours – they do not belong to you.’ In other words, this thump, thump, thumping in my head wasn’t my pain; it belonged to Alicia. And this sudden wave of sadness – this desire to die, die, die – did not belong to me either. It was hers, all hers. I sat there, feeling it for her, my head pounding, my stomach churning,

You can’t help me, her eyes shouted. Look at you, you can barely help yourself. You pretend to know so much and be so wise, but you should be sitting here instead of me. Freak. Fraud. Liar. Liar –

It’s hard to put into words, but a psychotherapist quickly becomes attuned to recognising mental distress, from physical behaviour and speech and a glint in the eyes – something haunted, afraid, mad.

‘Rage is a powerful communication. The other patients – the zombies who just sit there, vacant, empty – they’ve given up.

But our ability to contain ourselves directly depends on our mother’s ability to contain us – if she had never experienced containment by her own mother, how could she teach us what she did not know? Someone who has never learned to contain himself is plagued by anxious feelings for the rest of his life; feelings that Bion aptly titled ‘nameless dread’. And such a person endlessly seeks this unquenchable containment from external sources – he needs a drink or a joint to ‘take the edge off’ this endless anxiety

My addiction had been waiting for me patiently all this time, like a faithful dog.

Time caught up with itself with a jolt. Suddenly I was no longer stoned. I was horribly, painfully sober.

intimacy requires the repeated experience of being responded to – and that doesn’t happen overnight.’

an image of someone biting their fist, holding back a yell, swallowing a scream. I remember when I first started therapy, I found it very hard to cry. I feared I’d be carried away by the flood, overwhelmed. Perhaps that’s what it feels like for you. That’s why it’s important to take your time to feel safe, and trust that you won’t be alone in this flood – that I’m treading water here with you.’

I don’t believe a therapist can ever really be a blank slate, as he intended. We leak all kinds of information about ourselves unintentionally – by the colour of my socks, or how I sit or the way I talk – just by sitting here with you, I reveal a great deal about myself. Despite my best efforts at invisibility, I’m showing you who I am.’

this had to happen, it was inevitable – I was never good enough for her, I was useless, ugly, worthless, nothing – she was bound to tire of me eventually – I didn’t deserve her, I didn’t deserve anything – it went on and on, one horrible thought punching me after another.

How could she help me? How can one drowning rat save another?

‘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 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 imagine you do give Kathy love – in the true sense of the word. Whether or not she is capable of giving it back to you is another question.’

don’t know if persistent sexual and emotional betrayal with another human being is on the same level as getting stoned every now and then. I think it points to a very different kind of individual – someone who is able to lie repeatedly and lie well, who can betray their partner without feeling any remorse—’

‘I know how sad you feel. But I want you to consider the possibility that you felt this sadness long before you met Kathy. It’s a sadness you’ve been carrying around for many years.

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.’

I had been groping for the right words to express that murky feeling of betrayal inside, the horrible hollow ache; and to hear Ruth say it – ‘the pain of not being loved’ – I saw how it pervaded my entire consciousness, and was at once the story of my past, present, and future. This wasn’t just about Kathy: it was about my father, and my childhood feelings of abandonment; my grief for everything I never had and, in my heart, still believed I never would have. And Ruth was saying that was why I had chosen Kathy. What bet...

‘So all this was inevitable? That’s what you’re saying – I set myself up for this? It’s fucking hopeless?’ ‘It’s not hopeless. You’re not a boy at the mercy of your father any more. You’re a grown man now – and you have a choice. Use this as another confirmation of how unworthy yo...

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

We always seem to resolve our problems in bed. It’s easier, somehow – when you’re naked and half-asleep under the covers, to whisper ‘I’m sorry’, and mean it. All defences and bullshit justifications are discarded,

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.

I feel better for having written this down. I feel safer, somehow, having it on paper. It means I have some evidence – some proof.

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