The Silent Patient

by Alex Michaelides

The author

It’s hard to believe that it’s been a little more than two years since The Silent Patient first appeared in bookstores. Now, millions of copies have been sold worldwide, and I wanted to take a moment to thank all of you who have read, reviewed, and recommended The Silent Patient to your friends and family. Your support was so encouraging as I worked on my follow-up story, The Maidens, and I really don’t think I could have written that book without your kind words in the back of my mind. I’d like to take the opportunity to give some heartfelt encouragement to any aspiring writers or creatives out there: It’s clear to me now that my biggest obstacle was always myself. It took me years to finish writing my book because I kept giving up on it. If I could speak to my younger self, I would say, “Please believe in yourself and pay no heed to negative voices, inside or outside your head. And keep going.” If you haven’t yet read The Silent Patient, I hope you’ll have a chance to pick up a paperback copy on May 4. And I hope you will all love The Maidens, coming on June 15. Thank you from the bottom of my heart! https://www.goodreads.com/book/show/45892184-the-silent-patient https://www.goodreads.com/book/show/45300567-the-maidens

The painting was a self-portrait. She titled it in the bottom left-hand corner of the canvas, in light blue Greek lettering. One word: Alcestis.

The Greek myths are hard to escape, growing up in Cyprus, as I did ― you are taught Homer from the age of 13 in school ― and the tragedies are constantly being performed and reimagined. I came across the tragedy Alcestis by Euripides when I was 13. In it, Alcestis dies to save her husband, Admetus ― and then is brought back to life by Heracles at the end of the play. But when Alcestis is reunited with her husband, she refuses to speak. It’s a problematic play for all kinds of reasons. It’s not often performed largely, I think, because of this silence. Is she overjoyed to see him? Or is she furious he allowed her to die for him? Something about this refusal to conclude, to explain, haunted me for years, as well as something about Alcestis herself ― she was sacrificed, deemed disposable by the man she loved most in the world. This sense of being made to feel unworthy struck a chord with me. I searched for a way to update it and tell that story for years ― but it was only after I worked in a secure psychiatric unit that I had the idea of setting the story inside a psychiatric hospital with the structure of a detective story. And instead of a detective, I would have a psychotherapist. But it was a real challenge, having a mute heroine. At some point in the book, her silence is described like a mirror, reflecting yourself back at you. Silence is her only weapon; she has no recourse other than silence, because no one will believe her story. I think a lot of people ― particularly women ― can relate to that.

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.

I’m very fond of Theo, as troubled as he is. Early on in the book, he says he became a psychotherapist because he was messed up. That was certainly my experience ― and I believe a lot of therapists are drawn to the profession because on some level they feel damaged and wish to heal themselves. Whether they are prepared to admit this or not is another question. I feel that Theo, like all of us, tries to justify himself ― everyone is the hero of their own story, after all. I think Theo’s motives, at least in his own mind, were benign: a wish to help Alicia heal, as he says. In a sense that is no different to the motive of any therapist, even if his methods were a little different.

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.

I studied psychotherapy at a postgrad level, although I didn’t graduate, as I decided I was a writer, not a therapist. But I had a lot of therapy myself ― 10 years or so ― and felt I had never really seen a therapy session in a book that resembled my own experience. I was very keen to explore trauma in the novel and to ask the question of whether we can recover from a traumatic childhood or not. My own personal opinion is that it’s possible to recover from a traumatic childhood if you hold it in awareness ― and understand what happened to you and why. But if you are in denial about it, or lying to yourself, then you are more likely to be condemned to reenact and repeat it. We need to understand not only what happened to us when we were children but also what happened to our parents when they were children. Only by understanding can we forgive others ― and ourselves.

Somehow grasping at vanishing snowflakes is like grasping at happiness: an act of possession that instantly gives way to nothing.

The end of the novel links up with this. People often ask me why the end of the book references snowflakes. It’s because in the final moments of his story, Theo thinks back to a brief moment in his childhood when he felt free and life was full of possibility.

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 used to work at a secure psychiatric unit for teenagers, and it became an increasingly important part of my life. I would probably still be there now if the unit had not been closed down when all the National Health Service cuts were made after the 2008 banking crisis. It was a Therapeutic Community, which is a highly powerful but not particularly cost-effective form of therapy. For example, a group of adolescents will stay for a period of up to four years, immersed in the community, which includes therapists, doctors, nurses, and where all activities and therapies are group-based and all decisions regarding a patient’s care are made by the group. It’s a powerful healing process for these damaged young people, who suddenly find themselves, after so much abuse, in the bosom of a highly functioning and caring family. It’s an increasingly rare form of therapy, unfortunately, and it was a privilege to experience it. It changed me on a very deep level. I didn’t know I was going to write The Silent Patient then, and I never used any of the stories or people I encountered there, but I kept a record of the atmosphere and my own emotional reactions. I used them in the novel, and that was very helpful. But I must say, I have an ambivalent relationship to therapy. The problem is it all comes down to the skill of the individual therapist, and I encountered some very bad therapists, with precious little empathy or insight; I even witnessed elements of sadism. That was another reason why I quit my training: I don’t care how many letters you have after your name or how many books you have written; if you know nothing about compassion or humility, then you have nothing to teach me.

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

Again, this comes back to the importance of holding your own story in awareness ― before you can heal the damaged parts of yourself, you must get them into the light and have a good look. Repression and denial never bring anything good.

I know now that when I have an agenda for a picture, a predetermined idea how it should turn out, it never works. It remains stillborn, lifeless. But if I’m really paying attention, really aware, I sometimes hear a whispering voice pointing me in the right direction. And if I give in to it, as an act of faith, it leads me somewhere unexpected, not where I intended, but somewhere intensely alive, glorious—and the result is independent of me, with a life force of its own.

This is a very personal passage for me ― this is very much my voice speaking through Alicia. I’m not a painter, so I transposed what it feels like for me as a writer. The more I meditate and operate in a state of awareness when I write, the more likely I will catch that whispering voice of inspiration pointing me in the right direction. Unless you are very quiet and still, it’s often easy to miss it.

ACKNOWLEDGMENTS

I never would have written The Silent Patient without Agatha Christie. She made me into a writer ― or, more importantly a reader ― when I was 13 years old and I discovered her books. They became a compulsion for me that summer ― the first adult books I had ever read ― and I would devour one after the other, on the beach, wriggling my toes in the sand with sheer pleasure, an ice cream in one hand and an Agatha Christie in the other. It was as happy as I have ever been, a magical reading moment, happily lost in the world of a book ― and one that I have always sought to re-create. That’s why I wrote The Silent Patient ― with no more Christies forthcoming and having reread them all so many times, I wanted to see if I could try and write something like it myself; in homage to her, that I might read on the beach, and re-create that early magical experience. It was important that it was a detective story ― a great deal of my love for Christie is for the form itself, which she perfected and exploited to the full. Beginning to read a detective story, for me, is to know that I am embarking on an adventure ― and there will be murder, betrayal, many twists and turns, possibly a hint of romance, definitely an investigation, and ultimately a surprising solution. That is the unspoken pact Agatha Christie makes with you when you pick up one of her books, and I tried to keep the same bargain with The Silent Patient. Every time I got lost or strayed from the path, I asked myself what Christie would do ― and pretty quickly found my way back again. When it was finished, I read The Silent Patient over a few days on the beach in Spain. And magically enough, I caught a glimpse of that first happy reading experience. I felt satisfied ― but not for long. As Christie knew, it turns out writing thrillers is just as addictive as reading them. As soon as it was done, I thought, “I want to do that again.” Another adventure, another investigation, more twists and turns, and another big surprise. And so I began work on The Maidens ― and I hope you have as much fun reading it as I had writing it. https://www.goodreads.com/book/show/45300567-the-maidens