The Silent Patient

by Alex Michaelides

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. Whether we are prepared to admit this or not is another question.

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.

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— No. Stop. Stop— I’m not writing about that. I’m not.

“You know that joke, about why you can’t be a therapist and smoke? Because it means you’re still fucked up.” He laughed and popped one of the cigars into his mouth. “I think we’re all a bit crazy in this place. You know that sign they used to have in offices? ‘You don’t need to be mad to work here, but it helps’?”

By that I mean psychiatrists tend to be wary of psychodynamic thinking. They favor a more biological, chemical, and, above all, practical approach—such as the cup of pills Alicia was handed at every meal.

I remember the advice Ruth gave me when Kathy and I first got together: “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. 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.”

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.”