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The Silent Patient Summary + Book Club Questions You’ll Love

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Fans of twisty thrillers can read on for all the details of Alex Michaelides instant #1 New York Times bestselling debut book and finalist for The Tonight Show’s Summer Reads. This post shares The Silent Patient summary, book club questions, and answers to frequently asked questions (all WITH spoilers).

The shocking twist in the mystery The Silent Patient made it a hit with readers, and I (a harsh critic of thrillers, which can all feel the same to me), found it to be an extremely quick page-turner, engaging, and DEFINITELY thrilling. It’s the kind of book you can curl up on the couch with on a cold, dreary day, and re-emerge a few hours later, thinking, “Wow! What did I just read?!”


Frequently Asked Questions About The Silent Patient


What is the main idea of The Silent Patient?

The Silent Patient is the bestselling psychological thriller book in which a woman named Alicia murders her husband, then becomes completely silent through psychological treatment, in which her doctor, Theo, is obsessed with uncovering her motive.

Who are the main characters in The Silent Patient?

The four main characters in The Silent Patient are:

-Theo Faber: the narrator, a psychotherapist
-Alicia Berenson: a silent psychotherapy patient of Theo, who killed her husband
-Gabriel Berenson: Alicia’s husband, who she murdered
-Kathy Faber: Theo’s wife, an actress

Is The Silent Patient based on a true story?

The Silent Patient is not based on a true story. Author Alex Michaelides has credited his Greek heritage in which he consumed Greek myths throughout his life as inspiration for the novel.

For example, in the novel, Theo references “Alcestis,” a similar story of a Greek goddess who was sent to death in Hades in her husband’s place. While she was later saved from death, she never spoke again. 

Is The Silent Patient a horror story?

The Silent Patient is better described as a psychological thriller book than a horror story.

Is The Silent Patient dark?

The Silent Patient is very dark. It deals with murder, betrayal, guilt, psychological treatment, and twisted obsessions.

What are the themes of The Silent Patient?

The Silent Patient explores the effects of marital betrayal and psychological disorders. It also touches upon betrayal, guilt, drug use, communication, and the inner workings of the medical profession.

What is the conflict in The Silent Patient?

The main conflict in The Silent Patient is why Alicia killed her husband, Gabriel, and why she now chooses to be silent, which is prodded by Theo in his quest to determine her motive.

What is the twist in The Silent Patient?

The twist in The Silent Patient comes as the reader realizes that Theo, in fact, was the “masked man” that prompted the murder by Alicia.

Who is the killer in The Silent Patient?

Alicia is the killer in The Silent Patient; however, it was her doctor, Theo, who broke into her house, held her captive, and exposed her husband’s affair with his wife. This caused a dormant trauma to resurface in Alicia’s mind, which propelled her to shoot and kill her husband.

What happened to Alicia at the end of The Silent Patient?

It’s clear that Alicia is at least in a coma at the end of The Silent Patient. I am unclear whether she actually died.

What happens to Theo in The Silent Patient?

At the end of The Silent Patient, the police arrive at Theo’s home and read him Alicia’s final diary entry, which reveals him as the mas, and Theo feels an odd sense of relief that he has been caught.

Is The Silent Patient worth reading?

The Silent Patient is absolutely worth reading. It’s quick, engaging, and thrilling with a major plot twist. This is why it was an instant number-one New York Times best seller!

Is The Silent Patient being made into a movie?

Annapurna Pictures is now adapting and developing The Silent Patient.

Buy The Silent Patient:

The Silent Patient Summary

Below is The Silent Patient summary WITH spoilers!

Alicia Berenson is a famous painter who has been found guilty of murdering her husband, the famous fashion photographer Gabriel Berenson, who was tied up and shot. Because she took a plea of “diminished responsibility;” however, she is admitted to a secure forensic unit called the Grove as opposed to being sent to prison.

Six years later, at the Grove, Theo Faber is a newly hired forensic psychotherapist uniquely intrigued by Alicia’s case. He requests to be assigned to Alicia’s care.

Alicia is “The Silent Patient,” as she has not spoken since the day of her husband’s murder. She remains mute during therapy sessions but, over time, Theo reduces her medication, allows her to pain, and gives her time outdoors. She gives Theo her diary, wherein she details weeks of being watched in her home by a masked man before the murder of her husband. She suspects the brother-in-law who once assaulted her or the owner of the art gallery she had planned to leave.

Meanwhile, Theo learns that his wife is cheating on him, and he learns that her lover is also married.

Since Alicia fails to speak, Theo reaches out to her cousin to learn more about her. Alicia’s cousin recounts the impact of Alicia’s mother’s suicide when she was a child, and how Alicia’s grieving father said he wished Alicia to be dead instead.

Theo talks about this traumatic childhood event with Alicia and finally, she speaks, telling Theo that it was the masked man mentioned in her diary who entered her home and murdered Gabriel, not her.

The Silent Patient Ending


Then, the shocking twist of The Silent Patient is revealed. Theo was actually the masked man. He broke into Alicia’s and Gabriel’s home in order to confront Gabriel, who had actually been having an affair with Theo’s wife, Kathy. Theo then held Alicia and Gabriel at gunpoint, giving Gabriel the choice to save either himself or Alicia, and he chooses the former.

However, Theo then left the Berenson house without shooting either Alicia or Gabriel. In reality, his only malicious intent was to expose Gabriel’s selfishness to Alicia. But this intimate betrayal reminds Alicia of her father’s hurtful betrayal after the death of her mother, and the darkest of emotions and impulses take her over. Alicia shoots Gabriel in the face and kills him.

The news of Gabriel’s murder is what sparked Theo to apply to work at the Grove, as he sought to help her recover from the murder in his capacity as her therapist.

But, when Alicia finally spoke, telling Theo the clearly false story that the masked man killed Gabriel, he realizes that she recognizes him as the masked man.

Theo then attempts to murder Alicia by way of a drug overdose of morphine, leaving her in a coma. Theo had learned that her prior doctor, Christian, had treated Alicia before Gabriel’s death in an unlicensed practice and blames him. Christian is arrested.

Unbeknownst to Theo, however, Alicia reveals Theo as the masked man in her diary before losing consciousness. Her friend finds the diary and gives it to the police.

This twist also means that Theo’s story of his wife’s affair was not occuring in the present, but in the past, before Gabriel’s affair.

When the police then arrive at Theo’s home and read him Alicia’s final diary entry, the charade is over, and Theo feels an odd sense of relief that he has been caught.

Buy The Silent Patient:

The Silent Patient Book Club Questions


Why did Alicia stop speaking / refuse to speak?

Discuss the variety of ways the characters communicated, or failed to do so.

What were your early impressions of Theo?

How and when did your impressions of Theo change?

Is Theo a psychopath or a husband coping with betrayal?

Do you believe Theo ever wanted to help Alicia?

Should Theo have known Alicia may murder Gabriel?

Was Alicia’s killing of Gabriel justified? Why or why not?

Do you believe Alicia truly suffered from diminished capacity?

Are any of the characters trustworthy?

Why did Alicia give Theo her diary?

Did you like the use of a diary to convey information in The Silent Patient?

Discuss the role of art in Alicia’s life.

Was the Grove more helpful or more harmful to Alicia?

How does Alicia compare and contrast to the mythical character Alcestis?

Discuss the positive and negative roles of therapy in this book.

What are the themes of The Silent Patient?

Did you find the book to be more plot driven or character driven?

Did you see the big plot twist coming?

Before you knew the ending, how did you think The Silent Patient would end?

When do you think Alicia recognized Theo?

Did you suspect there were dual timelines?

Did you like the surprising use of dual timelines?

What do you think may have happened after the police confronted Theo?

Is The Silent Patient a fitting title?

Who would you cast in the movie adaptation of The Silent Patient?

For even more The Silent Patient book club questions:

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