The Silent Patient is a psychological thriller.

The key to writing a great psychological thriller is to build slowly toward a big surprise, leaving clues along the way but without revealing what’s really going on. Gillian Flynn famously achieved this with Gone Girl, just as Alfred Hitchcock had done so many times on film decades before her. There are many such examples. But a recent standout bestseller, The Silent Patient by Alex Michaelides, isn’t one of them. As Kirkus noted in its review, the book is “Amateurish, with a twist savvy readers will see coming from a mile away.”

Thirty-three-year-old London artist Alicia Berenson is the Silent Patient. She has been confined to a high-security psychiatric facility following the murder of her husband — because ever since that moment Alicia has remained mute. Alicia hasn’t spoken a word, not in her own defense, and not in response to six years of effort by the psychiatric staff at The Grove. But a forensic psychotherapist, newly arrived there, believes he can reach her.

The Silent Patient by Alex Michaelides (2019) 297 pages @@@½ (3½ out of 5)

Theo Faber “thought it obvious that she had suffered a severe trauma surrounding Gabriel’s death; and this silence was a manifestation of that trauma.” And it’s not long before Theo manages to get a rise out of her. However, as his treatment of Alicia proceeds, it quickly becomes clear that Theo has problems of his own. Since this is, indeed, a psychological thriller, expect a big surprise at the end — assuming you haven’t figured it out long before then. It may not be exactly what you thought it was, but close enough.

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