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.

Alicia never spoke again. Her enduring silence turned this story from a commonplace domestic tragedy into something far grander: a mystery, an enigma that gripped the headlines and captured the public imagination for months to come.

ALCESTIS IS THE HEROINE OF A GREEK MYTH. A love story of the saddest kind. Alcestis willingly sacrifices her life for that of her husband, Admetus, dying in his place when no one else will. An unsettling myth of self-sacrifice, it was unclear how it related to Alicia’s situation.

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 profession because we are damaged—we study psychology to heal ourselves.

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

Somehow grasping at vanishing snowflakes is like grasping at happiness: an act of possession that 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.

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

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.

I ARRIVED AT THE GROVE pursued by an icy January wind. The bare trees stood like skeletons along the road. The sky was white, heavy with snow that had yet to fall.

The only hint of its dangerous occupants was the line of security cameras perched on the fences like watching birds of prey.

I thought of my old therapist, Ruth. What she would do? She used to say 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 felt desperately sorry for her, and those like her—for all of us, all the wounded and the lost.

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.

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

“I want to help you, Alicia. I need you to believe that. The truth is, I want to help you see clearly.” At this, Alicia looked up. She stared at me—right through me.

“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?”

“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.

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.”

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

Sometimes it’s hard to grasp why the answers to the present lie in the past.

Rage, like fear, is reactive.

Though I am not naturally honest, I am sometimes so by chance. —WILLIAM SHAKESPEARE, The Winter’s Tale

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.

His words came back to me: “Borderlines are so seductive.” I looked into Alicia’s eyes. They weren’t seductive; they weren’t even friendly. A fierce mind was behind those eyes, a sharp intelligence that was only just waking up. She was a force to be reckoned with, Alicia Berenson. I understood that now.

For a second I thought Alicia was going to cry. I fought a sudden desire to hold her, take her in my arms, kiss her, reassure her, promise her she was safe. I restrained myself.

As I watched, I felt increasingly sure I had to do something to help her. She was me, and I was her: we were two innocent victims, deceived and betrayed.

I had no choice. I had to help her.

It swung open and I stepped into the garden. I felt a sudden rush of adrenaline. An illicit thrill at being an intruder on someone else’s property.

“I want to help you—I want to help you see clearly.” Well, now I saw. I saw clearly. I wanted him to know that I knew.

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.

I opened the window and reached out my hand. I caught a snowflake. I watched it disappear, vanish from my fingertip. I smiled.