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
For the next couple days, Theo avoids Kathy; he is “in shock” from the betrayal, a shock he tries to deal with by smoking more. While high, he shatters a wine glass, cutting himself badly. The only thing he can think to do to feel better is call Kathy, but that no longer feels like an option. In a moment of panic, all Theo’s old self-loathing comes rushing back: he tells himself that he is ugly, “worthless,” and unlovable.
Though Kathy is in every way temperamentally different from Theo’s father, the lasting trauma of his childhood—in which he felt unloved—inflects his current romantic relationship. And again, psychic pain has physical consequences, as Theo is now literally bleeding from his emotional hurt.
Active
Themes
Obsessively, Theo begins going over his relationship with Kathy, recalling both strange fights and unexplained absences, but also affectionate moments between the two of them. He thinks about his dislike for her friends, but also knows that “nothing could have prevented our union: from the moment I saw Kathy, my fate was written.”
Theo now wonders what parts of his relationship with Kathy are tied up in her lies. But it doesn’t matter—like famous heroes Oedipus or Antigone or Alcestis herself, Theo feels that his tragic “fate” has been “written” for him, and he is only a passive player in his own destiny.
Active
Themes
As Theo wonders whether or not he should confront Kathy, he realizes that he has inadvertently walked to Ruth’s house. Despite the late hour, she opens the door, taking in Theo’s distress and his bandaged finger. Concerned, Ruth invites him inside.
Again, Theo paints himself as lacking agency: instead of deciding to walk to Ruth’s door, he believes that he has been brought there by some fate, a power outside of himself.