The following version of this book was used to create this lesson plan. Michaelides, Alex. The Silent Patient. Macmillan Publishers. 2019. 1st Edition. Hardback.

The novel begins with the first entry from the diary of Alicia Berenson. She professes her love for her husband Gabriel, as well as her desire to please him by writing in the diary to figure out her emotions. She promises that she will only write normal things.

Six years later, a currently unknown narrator says that Alicia killed her husband Gabriel six years prior for reasons unknown. When she was found in her house with the gun, she refused to speak to anyone and tried to kill herself. From then on, she never said anything to anyone, and only painting a single painting of herself naked in her studio with the word Alcestis. The media tried to figure out her motive as she was found guilty of the murder. Thanks to Diomedes, however, Alicia was found insane and put into an asylum called the Grove.

Our narrator, however, is still fascinated by her story and decides to apply for a job at the Grove to help her. He then reveals himself as Theo Faber, a psychotherapist who suffered an abusive childhood. Because he was saved from madness by a therapist named Ruth, Theo believes he can save Alicia, as he knows he would have gone crazy like her without Ruth’s help. During their first therapy session, however, Theo is disappointed to see that Alicia is heavily medicated and unable to understand him. He tries to contact her brother-in-law Max and her aunt Lydia, but both refuse to speak to Theo. One of Alicia’s doctors, Yuri, tells Theo to return to his wife Kathy and forget about Alicia.

When Theo meets Kathy at a nearby restaurant, he explains that both of them met while dating other people and cheated on their respective partners with each other. They started dating and were married within a few months. Theo sees Kathy as the light in his life and feels that he is blessed with a love that very few of his patients ever experience.

In another diary entry from Alicia six years prior, she reveals her mother’s apparent suicide when she purposefully slammed their car into a wall with Alicia inside. Alicia wonders if she was the real target, but forces herself to stop writing about it. At home, she worked on a painting of Jesus on the cross before she realized she accidentally painted Gabriel. She asked him to pose for her, committed to the new painting, but he was hesitant. When he did reluctantly agree, Alicia struggled to paint the happiness in his eyes.

Back at the Grove, Theo asks for Alicia’s medication to be reduced and Diomedes agrees. Alicia’s doctor Christian, who Theo knows from his previous job, is not happy that Theo talked to Diomedes about Christian’s patient, but lowers the dosage anyway. During their next therapy session, Alicia attacks Theo, but he sees that as a sign of improvement as she is actually communicating an emotion.

That night, Theo discovers that Kathy is cheating on him. This revelation directly affects his next session with Alicia, as he asks if a part of her hated Gabriel like a part of him hates Kathy. Alicia storms out of the session before Theo realizes how unprofessional the question was.

At home, Theo smokes some marijuana to calm his nerves, but accidentally cuts himself on a broken wine glass. In a panicked haze, he wanders to the house of his old therapist Ruth who welcomes him inside. After he tells her what he found, she tells him that he needs to leave Kathy because Kathy is incapable of returning the same amount of love to Theo that he gives to her. He returns home with the resolve to confront Kathy. However, he decides not to after she gets angry at him for the marijuana she found in the kitchen.

Later that week, Theo receives a call from Max and goes to visit him at his office. Max reveals that he is adopted and adored his brother Gabriel. However, he says he hates Alicia for killing Gabriel. He recommends Theo talk to Jean-Felix, the manager of Alicia’s gallery. On the way out, Max’ wife Tanya tells Theo to talk to Alicia’s cousin, Paul.

The novel then shifts back to Alicia’s diary where she and Gabriel had a fight over the gun in the house. It is also revealed that Max had sexually assaulted Alicia and even declared his love for her. However, Alicia believed he was jealous of Gabrie. She was too scared to tell Gabriel about the assault, as Gabriel idolized Max.

Back at the Grove, Theo learns from Max that Alicia was treated by a private doctor after a suicide attempt. However, Diomedes tells Theo to stop contacting family members, as the Grove is struggling to stay open without angering a lawyer like Max. However, Theo decides to meet Paul anyway at Alicia’s childhood home in Cambridge. After Paul knocks Theo out because he thought he was a burglar, the two talk about Alicia’s childhood and Theo learns that her father, Vernon, committed suicide. Eventually, an angry Lydia sends Theo away. He realizes that Alicia and Paul were both abused by Lydia.

Theo heads home to learn that Kathy is planning a night out with her old friend, Nicole. Theo, however, is deeply suspicious and resolves to learn the truth himself.

Theo then goes to the gallery and meets Jean-Felix who is keeping all of Alicia’s paintings in storage. While he tells Theo that he loves Alicia and finds her artwork joyous, Theo believes that Jean-Felix is more in love with her paintings than with Alicia herself. A diary entry reveals that Alicia felt the same way and even tried to leave his gallery when Jean-Felix entered her home unannounced. This entry also reveals that Paul was in trouble and received money from Alicia a few weeks before the murder even though Paul told Theo he had not seen Alicia for many years.

Theo then, at Jean-Felix’ request, reads the Alcestis, a Greek tragedy about a woman named Alcestis who sacrifices herself for her husband and is saved by Hercules. When she returns to life, however, she is silent, just like Alicia after Gabriel’s murder. Theo goes to Diomedes who says that Alcestis felt betrayed, as she did not believe her husband would actually sacrifice her for himself. Theo believes that Alicia feels that she has died at some point in her life and they must bring her back. He asks Diomedes if they can let her paint. He and her art therapist Rowena agree, and Theo hopes Alicia will communicate through her painting.

One night during all of this, Theo follows Kathy to her supposed meeting place with Nicole. He is disappointed, however, when Nicole actually arrives and not the mysterious man that Kathy has been emailing.

Back at the Grove, Theo and Yuri introduce Alicia to her own painting space. Within a few days, she paints a picture of the Grove on fire and Theo carrying her outside. It is unclear, however, if he is carrying her to or from the flames. After this, Alicia’s old neighbor Barbie visits and eventually convinces Theo to come to her home. Once there, he learns that Alicia told Barbie she had a stalker, but never told Gabriel or the police. When

Theo returns to the Grove, he learns that Alicia stabbed another patient named Elif in the eye with a paint brush after Elif wrote the word slut on Alicia’s painting. In the emergency ward, however, Elif reveals that she told Alicia that Theo was in love with her. Theo then attends a meeting where the manager Stephanie and Christian have decided to medicate and isolate Alicia. Diomedes tells Theo that his therapy sessions with Alicia are over. Theo goes to see her to apologize and she gives him her diary.

In the journal, Alicia reveals that she was being watched by an unknown man. However, everyone she told about him - including Gabriel and Dr. West - whom Gabriel forced her to talk to after she became more paranoid - did not believe her. Dr. West even forced Alicia into accepting pills, but she only pretended to take them as she believed the man would attack her. In her very last entry, she writes that the man was inside her house.

After reading the diary, Theo realizes that Dr. West is actually Christian and goes to confront him. Terrified that Theo will tell about his secret meetings with Alicia, as they were paid and undocumented, he tells Theo about the meeting. He says that Alicia was delusional, paranoid and incapable of empathy. However, Theo believes that it is Christian who cannot understand other people and decides to ask Alicia himself. He gives back the diary, but she seems disappointed when he asks about Christian. Theo decides to look for more answers.

Back at his house, Theo decides to follow Kathy when she refuses to let him walk with her. Once at the park, he is devastated to not only see a man he does not know, but overhears them having sex. Theo fantasies about killing the man, believing that it is what this father would have done.

Back at the Grove, Theo systematically reveals the diary to every one of Alicia’s friends and family that were involved, including Max and Jean-Felix. However, Paul is the only one willing to talk to Theo. While he lies about the money, Paul takes Theo to the rooftop of the Cambridge home, as it is a place Alicia always went to. There, he reveals that this is where Vernon "killed" Alicia. After Alicia’s mother died in the car accident, Vernon had demanded to know why she died instead of Alicia. In that moment, Alicia herself said that Vernon just killed her. Theo takes this information back to Alicia who finally talks to him for the first time.

After receiving further permission from Diomedes, Theo continues to meet with Alicia. She tells him about her life and they eventually share stories from their childhood. After a few days, she tells him about the day the man broke into her home, put a knife to her neck and stole Gabriel’s gun. She says that the man tied her up and talked non-stop until Gabriel came home. Then, the man knocked Gabriel out, tied him up, and shot him in the head six times before leaving. However, Alicia’s story does not match police evidence, and both Theo and Diomedes believe she is lying.

That night, Theo follows Kathy’s lover to his house with the intent to kill him. However, when he sees a woman inside, Theo decides he needs to save her and comes up with another plan.

The next day, Theo learns that Alicia has overdosed and is in a coma. However, it is Theo who finds the prick in her wrist and reveals that someone injected morphine into her. Diomedes tells him to find Alicia’s diary as they call the police. When questioned by Chief Inspector Allen, Theo blames Christian who lied about the overdose. Outside the Grove, Theo is confronted by an angry Max who promises revenge as Theo walks away.

Theo then returns to the house of Kathy’s lover where it is revealed that every night he followed her, which the reader had been led to believe were on the same nights as his visits with Alicia, actually happened six years ago. Theo was Alicia’s mysterious stalker.

Minutes before Alicia passes out from the morphine, she writes one final diary entry telling the truth. She reveals that she suspected that Theo was the stalker when he first came to the Grove. However, it was not until much later when she purposefully told him the wrong story that she knew for certain. She allowed him to inject her with morphine because she understands her guilt in Gabriel’s murder. However, she forces herself to stay awake to finally reveal what happened. Theo did tie both her and Gabriel up. However, when Alicia begged him not to kill Gabriel, Theo asked Gabriel if he should kill him or Alicia. When Gabriel picked himself, Theo fired a shot into the ceiling and pretended to have shot Alicia. However, this was the moment Alicia broke mentally, as Gabriel killed her in the same way her father Vernon did years ago, unbeknownst to Theo at the time. When Theo left, Alicia grabbed the gun and shot Gabriel herself.

Later as Theo and another doctor Indira go through Alicia’s possessions he reveals that he never intended for Alicia to kill Gabriel. He wanted her to see the truth so she would seek out a better life and says he would have done things differently if he had known about her past. He says he came to the Grove in part to absolve himself of any guilt, but also because he truly wanted to help Alicia come to terms with what happened. He is happy that he can visit her, even if it is in a coma. However, he is frustrated when he is unable to find the diary. As he leaves the Grove, he learns that the Grove is going to be shut down and is offered a position of director at the next hospital. Theo happily agrees because he wants to help more people.

Theo returns to his old family home where he and his depressed wife Kathy moved into a year prior. He tells the reader that he constantly has to pretend with her as she has not recovered for Gabriel’s death, nor did she ever admit her infidelity. Inspector Allen then arrives with the diary and begins reading Alicia’s new and final entry. Theo calmly accepts his fate.