The Silent Patient

The Silent Patient

by

Alex Michaelides

The Silent Patient: Part 2, Chapter 4 Summary & Analysis

Summary
Analysis
At Theo’s next therapy session with Alicia, she is already clearer, having started to take less of her medication. He wants to talk, but he is determined to remain silent and build trust. A few minutes in, Theo develops a headache, and he realizes that he has begun to take on Alicia’s pain. He recalls Ruth’s words: “you must be receptive to your patients’ feelings—but you must not hold onto them—they are not yours.”
First, Alicia’s improvement implies that Theo’s talking-based method is more useful than Christian’s medication-based one. Second, and more importantly, Ruth’s advice here proves a template for the entire novel. She urges Theo to empathize with his patients—but she also reminds him to draw a boundary between where his patients end and he begins. It is Theo’s failure to listen to this advice in its totality that will, like a great Greek hero, ultimately doom him.
Themes
Empathy, Identification, and Boundaries Theme Icon
Tragedy and Destiny Theme Icon
Silence vs. “The Talking Cure” Theme Icon
Quotes
After 50 minutes, Theo’s time with Alicia is up. He tries once more to get Alicia to speak: “I want to help you see clearly.” But she says nothing, though Theo believes her eyes communicate that she thinks he is a liar and a fraud. Just as Theo realizes how clear-headed Alicia’s gaze is, she pounces on him with “monstrous” vigor, trying to strangle him. Theo presses his attack alarm, and four nurses (including Yuri) come to hold Alicia down.
Something about these seven words (“I want to help you see clearly”) is what sets Alicia off, communicating in the only way she is able to—through violent attack. But what about these words makes Alicia feel that Theo is a fraud? Does something suggest that he wants to harm her instead of help?
Themes
Childhood Trauma Theme Icon
Silence vs. “The Talking Cure” Theme Icon