LitCharts assigns a color and icon to each theme in The Silent Patient, which you can use to track the themes throughout the work.
Empathy, Identification, and Boundaries
Tragedy and Destiny
Honesty vs. Deception
Childhood Trauma
Silence vs. “The Talking Cure”
Summary
Analysis
With dread, Theo climbs the steps to Lydia’s room. The first thing he notices is that she is obese, nearly crushing the bed she lays on. Everything in the bedroom is old and tattered, including a scarred cat near Lydia’s feet. At first, Lydia panics, thinking Theo is a journalist, but Paul reassures her that he is not. Lydia relaxes just enough to declare that Alicia is “a little bitch. She always was, even as a child.”
Lydia is not written as a sympathetic character, so her hatred of Alicia may well be unwarranted. But it does show, one more time, that everyone in the novel links adulthood to youth (Lydia resented Alicia “even as a child”).
Active
Themes
When Theo is surprised, Lydia explains that her anger stems from Alicia’s decision to paint an unflattering picture of her. Lydia also feels that she took care of Alicia after her mother Eva died, and that Alicia never repaid her for that favor. Shaken by the memory, Lydia gets upset, and Paul urges Theo to go home.
Two major themes from Alicia’s life surface here. Her painting, though it is wordless, is always a form of communication—in this case, she uses it to get revenge on Lydia. And second, Lydia’s transactional view of her relationship with Alicia further hints at the scale of the trauma Alicia has been through; no adult in her life, not even her aunt, was truly there for her.
Active
Themes
As he travels back to London, Theo decides that the whole experience has been a waste. Lydia is clearly deranged, and he feels strongly that Alicia must have been running away from her. He also pities Paul, forced to live his life as an overgrown child, always in service to his bullying mother.
Paul’s stunted growth is a distorted mirror image of what could have happened to Alicia (or to Theo): unable to get away from his horrific childhood, Paul is doomed to repeat it forever, living out his life as a little kid in an adult’s body.