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
A blonde woman in her mid-60s, decked out in perfume and plastic surgery, is complaining to Stephanie that she has been waiting in the Grove’s reception area. Theo recognizes the woman as Barbie Hellman, Alicia’s neighbor who heard the gunshots on the night of the murder. Theo assesses that Barbie is spoiled and wealthy, and he feels a pang of sympathy for Stephanie.
If Theo prides himself on a great deal of empathy, he has no patience for self-involvement: and Barbie, with her money and her plastic surgery, is almost a comical stereotype of a narcissistic woman. Moreover, since Barbie and dishonest, self-involved Kathy are the only Americans in the story, there is now a repeated, light-hearted critique of Americans throughout the novel.
Active
Themes
Hoping to relieve the tension, Theo introduces himself to Barbie as Alicia’s therapist. Immediately, Barbie explains that she and Alicia were “best friends”; though she has been in the U.S. visiting family, she frequently visits Alicia at the Grove. After threatening to scream, Barbie gets her way: Yuri brings her back to see Alicia.
By now, anyone who claims to have an easily-defined connection to Alicia—whether it is Jean-Felix pretending to adore her or Max Berenson pretending to hate her—has been shown to be lying. And based on Alicia’s quiet, anxious temperament in her diaries, it is unlikely that she and Barbie were nearly as close as Barbie says.
Active
Themes
Alicia shows no sign of emotion at seeing Barbie, though Barbie immediately launches into a long monologue about her family and friends. Barbie prepares to leave, but before she does so, she tells Theo that she was one of Alicia’s closest confidantes (“she told me things you wouldn’t believe”). Theo wants to know more, but Barbie refuses to tell him in the hospital, instead inviting him over to her house for drinks that evening.
Whereas Theo sees Alicia’s silence as an invitation to interpret her inner life, Barbie only seizes on Alicia’s lack of response as an opportunity to monologue about herself. It is hard to trust, then, that Barbie was actually a meaningful confidante for Alicia.