The Silent Patient

by Alex Michaelides

Once you name something, it stops you seeing the whole of it, or why it matters. You focus on the word, which is just the tiniest part, really, the tip of an iceberg.

I didn’t want to die. Not yet; not when I hadn’t lived.

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. 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.

Psychotherapy had quite literally saved my life. More important, it had transformed the quality of that life.

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.

we are made up of different parts, some good, some bad, and that a healthy mind can tolerate this ambivalence and juggle both

Mental illness is precisely about a lack of this kind of integration—we end up losing contact with the unacceptable parts of ourselves.

Murderous rage, homicidal rage, is not born in the present. It originates in the land before memory, in the world of early childhood, with abuse and mistreatment, which builds up a charge over the years, until it explodes—often at the wrong target.

her eyes so close they were out of focus. I gazed into a hazy green sea.

I felt an unfamiliar happiness just being in her company, as though a secret door had been opened, and Kathy had beckoned me across the threshold—into a magical world of warmth and light and color, and hundreds of orchids in a dazzling confetti of blues and reds and yellows.

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. 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.”

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

Camden

sixteen-year-olds, embracing the sunshine, sprawled on either side of the canal, a jumble of bodies—boys in rolled-up shorts with bare chests, girls in bikinis or bras—skin everywhere, burning, reddening flesh. The sexual energy was palpable—their hungry, impatient thirst for life. I felt a sudden desire for Gabriel—for his body and his strong legs, his thick thighs lain over mine. When we have sex, I always feel an insatiable hunger for him—for a kind of union between us—something that’s bigger than me, bigger than us, beyond words

the truth is he’s a deeply romantic man—in his heart if not his speech. Actions speak louder than words, don’t they? And Gabriel’s actions make me feel totally loved.

“Therapy isn’t just about talking,” Indira said. “It’s about providing a safe space—a containing environment. Most communication is nonverbal,

“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.”

once I was secure and happy, the habit fell away from me quite naturally, like dry caked mud from a boot.

I broke with therapeutic tradition. I stopped treading softly and got directly to the point:

Her silence was like a mirror—reflecting yourself back at you.

I held my hand above my head, watching blood stream down my arm in tiny diverging rivulets, mimicking the pattern of veins beneath my skin.

This whole mythology of us that I had built up, our hopes and dreams, likes and dislikes, our plans for the future; a life that had seemed so secure, so sturdy, now collapsed in seconds—like a house of cards in a gust of wind.

“Choosing a lover is a lot like choosing a therapist. 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?”

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.

one of the hardest things to admit is that we weren’t loved when we needed it most.

grief for everything I never had

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

I wanted to weep and howl and bury myself in her arms.

I wanted to reach out and pull her close. I wanted to hold her. But I couldn’t. Kathy had gone—the person I loved so much had disappeared forever, leaving this stranger in her place.

I wasn’t condemned to repeat the past. I could change the future.

“I see.” But I didn’t see.

This morning we had sex and made up. 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 defenses and bullshit justifications are discarded, lying in a heap on the floor with our clothes.

He wouldn’t meet my eyes at first. Or was it me, not looking at him?

The walls were overgrown with ivy, and the garden had been overtaken by plants, weeds mostly. I got the sense of nature encroaching, reclaiming territory that had once been hers.

Within these walls her personality had been formed: the roots of her adult life, all causes and subsequent choices, were buried here.

This doesn’t mean that all abused children go on to become abusers, but it is impossible for someone who was not abused to become an abuser. No one is born evil.

As babies, we are innocent sponges, blank slates, with only the most basic needs present: to eat, shit, love, and be loved.

A tormented, abused child can never take revenge in reality, as she is powerless and defenseless, but she can—and must—harbor vengeful fantasies in her imagination. Rage, like fear, is reactive.

you sound more like a detective than a psychiatrist.”

at the heart of all art lies a mystery.

someone real, as solid and true as the others were false.

All this time I really believed in something, you know, in you and me—and now you’ve decided it was nothing. Just like that.

Trust, once lost, is hard to recover.”

She spoke hesitantly at first, tentatively—trying to walk on legs that hadn’t been used in a while. She soon found her feet, picking up speed and agility, tripping through sentences as if she had never been silent,

it’s an incredible story—of that there is no doubt. Whether you believe it or not is up to you.

choosing each phrase with care, as if cautiously applying brushstrokes to a canvas.

I didn’t kill Gabriel. He killed me. All I did was pull the trigger.

a surprise is all very well, but it is a momentary pleasure; whereas suspense can go on indefinitely.

her silence allows her to be a blank canvas on which we can project our fears.