The Silent Patient

Alicia Berenson is the mute heroine of the novel. Her actions, starting with killing Gabriel, drive the narrative. When the narrative opens, Alicia is 39. She murdered her husband six years earlier, when she was 33. She has not spoken since then. Tried for the murder, the court deemed her unstable and committed her to the mental institution The Grove instead of giving her prison time.

Alicia has not spoken for six years, and her silence aligns her with the Greek heroine Alcestis, who sacrifices her own life for her husband’s. Alicia clearly identifies with the character, naming her self-portrait after her. The reasons for Alicia’s identification with Alcestis ultimately come clear: Vernon’s “psychic infanticide” of Alicia, and Gabriel’s choosing his own life over Alicia’s, both play a role. Alicia truly is Alcestis, mute with rage and hurt, having the men who should have loved and protected her betray her instead.  

Alicia’s character emphasizes the significance of non-verbal communication. The fact that Alicia doesn’t speak makes her actions all the more significant. Although she doesn’t speak for the majority of the novel, her diary serves as her voice, giving insights into her mind and personality. Her paintings likewise are a means of communication. Through her work, she addresses her relationships with Eva, Lydia, Gabriel, and, ultimately, Theo.

Theo’s wife, Kathy has an affair with Alicia’s husband, Gabriel. In her late 30s or early 40s, she is an actress. Kathy is American, but her mother is English. Bold, confident, and loud, Kathy is the polar opposite of Alicia and offers a counterpoint to the “insane” silent patient: “Kathy did that a lot, protesting her insanity—‘I’m crazy’, ‘I’m nuts’, ‘I’m insane’—but I never believed her. She laughed too easily and too often for me to believe she suffered the kind of darkness I had experienced” (54). After Gabriel’s death, Kathy becomes a shadow of her former self, quiet and withdrawn.

Theo idolizes Kathy—much in the same way Alicia seems to have idolized Gabriel—as someone who rescued him. He describes her a “Greek goddess come to life” (55) on their first night together. For Theo, Kathy’s love for him is proof that he’s worthy of love—something his parents never instilled in him—and that he escaped his childhood trauma and achieved normalcy, complete with a successful, intimate, romantic relationship. The discovery of Kathy’s betrayal thus shatters not only Theo’s illusions regarding their marriage but also his self worth.

Alicia’s husband, Gabriel has an affair with Theo’s wife, Kathy. Murdered at age 44, Gabriel’s death takes place six years before the novel’s narrative begins. He was also a successful photographer. In Alicia’s diary entries, she depicts Gabriel as the sane rock contrasting her insane self. It’s Gabriel who suggests she write. He is the problem-solver in this instance, presenting a proactive solution in the face of Alicia’s wallowing. The couple’s dynamic of “sane” versus “insane” also receives affirmation by the two portraits the reader becomes acquainted with: Alicia’s self-portrait, showing her nude and vulnerable, and her portrait of Jesus—with Gabriel’s face—aligning Gabriel with a religious leader. Religious allusion appears not only in the Jesus portrait but also in Gabriel's name. Gabriel is one of the archangels, a heavenly messenger who announced the birth of Jesus to the Virgin Mary.

From Theo’s view, Gabriel is a sort of cool guy, perhaps obnoxiously so. Theo describes Gabriel’s photography as “slick and shallow,” photographs of “semi-starved, semi-naked women at strange unflattering angles” (7). Even on the day of his murder, Gabriel was living the life of the cool, successful fashion photographer, shooting models for Vogue magazine in the hip Shoreditch neighborhood of London. Jean-Felix likewise sees Gabriel as full of himself.

Alicia’s solicitor, Max is Gabriel’s adopted brother. He and Gabriel were close, although Max admits that Gabriel was always the star between the two siblings. When Theo goes to see Max, Max confesses that he hated Alicia. As the reader and Theo will learn, however, Max was in love with Alicia—although Alicia, in her diary, notes that Max is likely just jealous of Gabriel and wants everything Gabriel has. The reader briefly believes that Max might have something to do with Gabriel’s death—Alicia believes momentarily that Max is her stalker, for example, and Theo reveals the fact that Gabriel’s will left everything to Max. These prove to be red herrings and Max ultimately appears to have had genuine feelings for Alicia, as he shows up in tears at The Grove when learning of her coma. 

Alicia’s parents. Eva killed herself when Alicia was just a child, driving her car into a wall with Alicia inside of it. Her mother’s suicidal-homicidal history left Alicia afraid to have children of her own, convinced she might harm them. Vernon killed himself a few years prior to the novel’s narrative, and Alicia attempted suicide shortly after. While Theo initially assumes Alicia must have loved her father dearly and that her suicide attempt was due to grief, he later learns that Alicia hated her father. Theo identifies Vernon’s wishing death upon his daughter as Alicia’s psychological death, a transformative childhood moment that resulted in her hatred of her father and in her subsequently being capable of murdering a man—Gabriel.

Alicia’s cousin. The son of Lydia, Vernon’s sister. Paul provides the missing piece of the puzzle in terms of Alicia’s formative childhood trauma. Paul is about the same age as Theo and represents what Theo might have become if he had not escaped his parents’ home. Paul is an alcoholic and a gambling addict, chained to his tyrannical mother, still living in his childhood home and caring for her.

Alicia’s aunt, who raised Alicia following her mother’s death. Lydia is mentally ill, another character supporting the theme of mental illness. Lydia is belligerent and angry, and expresses a strong dislike for Alicia—claiming she was always a “little bitch” (148). She says she took care of Alicia after Eva’s death and that Alicia was ungrateful, even creating an unflattering portrait of Lydia, which Lydia calls an “obscene mockery” (149). 

Professor of Forensic Psychiatry at Imperial College and clinical director at The Grove. In Theo’s narration, Lazarus appears as an almost God-like character—comparable to the Gods who often control the lives and situations of mortals in Greek tragedies. During Alicia’s trial, Theo describes how Lazarus’s testimony sways the Judge and allows Alicia to avoid jail time. Lazarus also sets the deadline that drives the novel’s narrative forward, giving Theo only six weeks to get Alicia talking. The name Lazarus affirms a reading that aligns the character with god-like or heavenly beings, thanks to the biblical allusions it carries. In the New Testament, Lazarus is a figure raised by Jesus from the dead. Lazarus also serves as a replacement father figure to Theo, who seeks approval from the older man that his own father could never provide. 

The head psychiatric nurse at The Grove. Yuri moved to England from Latvia seven years ago—so, just one year before Alicia murdered Gabriel. He didn’t speak English at all when he arrived. Now he’s fluent. He comes across as friendly and relaxed, and his character offers a counterpoint to Theo’s obsessive and addiction-driven nature. Even Yuri has a dark side, however, as it’s ultimately discovered that he deals drugs to patients at the clinic. Yuri is one of the many characters who warn Theo against pursuing Alicia’s case. 

Another patient at The Grove. She killed her mother and sister, suffocating them in their sleep. Her loud and overtly aggressive nature is a counterpoint to Alicia’s. Elif serves as the instigator for Alicia’s rages on two occasions. First, a few weeks after Alicia’s admission, Elif accosts Alicia in the canteen asking her if Gabriel deserved to die and asking what he looked like after someone shot him in the head. Alicia becomes violent, smashes a plate, and tries to slash Elif’s throat with the shards. Elif is again an instigator when she daubs the word “slut” on Alicia’s painting and suggests that Theo is in love with Alicia. In response, Alicia stabs Elif in the eye with a paintbrush. 

Max Berenson’s receptionist and wife. When Theo goes to see Max, Tanya catches him for a moment alone and secretly suggests he go see Paul, Alicia’s cousin, if he wants to know more about Alicia. Tanya is nervous and afraid of her husband. Tanya’s character serves as a valuable plot tool, alerting the reader to the fact that Max’s comments on Alicia (which paint her as a mentally unhinged woman with a violent past) should not summarily dismissed. Tanya plays a small but important part as her brief interference in the narrative points Theo towards Paul and deepens the complexity of the mystery surrounding Alicia and Gabriel’s relationship. 

A psychiatrist at The Grove who Theo is already acquainted with from a previous job—and dislikes. Christian is an old school friend of Gabriel’s and to have secretly treated Alicia after Vernon’s suicide in exchange for under-the-table cash payment. He also treated her in the weeks prior to Gabriel’s murder—both Christian and Gabriel assumed that Alicia was being delusional when spoke of a stalker. At the time, Christian prescribed Alicia antipsychotic medication. His tendency to simply medicate Alicia into a stupor is a commentary on mental health treatments that overly rely on pharmaceuticals. Theo’s approach, investigating Alicia’s childhood to identify a root cause—a reason for her transformation into a killer—in her past trauma, serves as a counterpoint. 

The manager of the gallery representing Alicia as a painter. Originally from France. Early 40s. He and Alicia originally met in art school. He adores Alicia as a painter first and foremost—more so than as a person. He displayed her self-portrait while she was on trial and it attracted crowds of people. Jean-Felix shows Theo four of Alicia’s paintings at the gallery and encourages Theo to read the Euripedes play that Alcestis comes from. His character thus serves, like Tanya’s, as a valuable plot tool, providing the “detective” Theo with information and guidance that will help elucidate the mystery surrounding Alicia’s silence and Gabriel’s murder. Jean-Felix also urges Theo to give Alicia painting supplies, which she uses to create the painting of her and Theo in front of The Grove as it burns. 

Theo’s old therapist. He first went to see her after his suicide attempt in his first year of university. Using talk therapy, Ruth encouraged Theo to open up about his traumatic childhood and he credits her with his improved mental health. No longer Theo’s therapist, Ruth remains in his memory as a figure of comfort—perhaps even a replacement mother figure, providing comfort and guidance in a way that his own mother never could. When Theo discovers that Kathy is having an affair, he turns to Ruth. Her maternal role comes up again in the last chapter when Theo reflects on how she would react if she knew the truth: “Even worse than the shock or repulsion, or possibly even fear, in Ruth’s eyes as I told her would be the look of sadness, disappointment and self-reproach” (335).

Theo’s parents are only alluded to in the story. By the time of the novel’s telling, his father is dead and his mother in a care home. His father was abusive and left Theo with crippling self-esteem issues. His mother was depressed and offered no protection against his father. Theo sees his ability to get out of his parents’ clutches as a triumph. When he and Kathy get engaged, he brings her to their home in Surrey for a visit, wanting to prove to them that he’s “made it”—achieved a normal life, complete with intimacy. Ironically, he ends up moving back to Surrey with Kathy by the novel’s end—even living in his childhood home. 

A psychiatrist at The Grove. Indira is a motherly figure and reminds Theo of his old therapist, Ruth. She does motherly actions like baking cakes, and Theo describes her as radiating “a kind of maternal calm” (77). Indira takes a motherly interest in Alicia and Theo, and is a cheerleader for their relationship. She seems to believe that Theo can truly help Alicia: When Alicia first attacks Theo, she frames the interaction positively, saying “In a way, Alicia has begun to talk. She’s communicating through Theo—her advocate. It’s already happening” (88).

The woman living next door to Alicia and Gabriel at the time of the murder, Barbie still visits Alicia every couple months at The Grove. She describes herself as a good friend and confidante of Alicia’s but Barbie is a narcissist who mostly talks about herself. Alicia did confide in Barbie on one occasion, telling her about her stalker. She also shows Barbie a photo of the man following her but it’s just a blur. In the investigation that ensues following Gabriel’s murder, Barbie shares Alicia’s fears and the photo with the police.