The Silent Patient

by Alex Michaelides

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.