The Silent Patient

1. General Impressions

Gather initial thoughts and broad opinions about the book.

• Which of the novel’s twists did you find most surprising? If you saw any of the twists coming, what clues led you to your conclusion?
• How did you feel about the novel’s epistolary structure? Have you read other novels that use this technique? How does this one compare? 
• Based on your experience with this novel, would you be interested in reading other works by Alex Michaelides? Why or why not?

2. Personal Reflection and Connection

Encourage readers to connect the book’s themes and characters with their personal experiences.

• Before learning of Theo’s involvement in Gabriel’s death, did you relate more to Theo or to Alicia as a narrator? Why?
• A major subplot in the novel concerns Theo’s wife’s infidelity. How would you respond if you found out someone close to you had betrayed you? Would you be able to forgive them?
• How responsible do you believe Alicia is for Gabriel’s death? Did her fate feel like justice or like a final instance of victimization?
• Have you ever kept a diary or journal? What did you get out of the experience?

3. Societal and Cultural Context

Examine the book’s relevance to societal issues, historical events, or cultural themes.

• Consider the novel’s depiction of the doctor-patient relationship. What potentials for abuse does it locate within this dynamic? How might that abuse play out in a more realistic setting?
• What do you make of the novel’s depiction of mental illness? To what extent does it perpetuate harmful stereotypes about people with mental illness? To what extent does it challenge them?
• Although men are statistically more likely to commit violent crimes, The Silent Patient focuses heavily on female violence—for example, Alicia’s murder of her husband, Elif’s murder of her mother and sister, and Eva’s attempted murder-suicide. What does the novel suggest about the root causes of this violence? How does it compare or relate to the male violence that the novel portrays?

4. Literary Analysis

Dive into the book’s structure, characters, themes, and symbolism.

• What tropes does The Silent Patient borrow from the detective fiction genre? In what ways does it subvert that genre’s conventions?
• What parallels does the novel suggest between Alicia’s childhood and Theo’s? What function do these parallels serve?
• Consider the name of the psychiatric hospital where the novel takes place: The Grove. What is the significance of this name? 
• What is the significance of Alicia’s silence, beyond indicating the depth of her trauma? How does Theo’s decision to tell her story, and the inclusion of Alicia’s diary, complicate this depiction?
• The novel alludes to several plays, including Alcestis, Othello, The Mourning Bride, and The Winter’s Tale. What unites these works or makes them relevant to The Silent Patient? Beyond these specific plays, what is the thematic significance of theater itself?

5. Creative Engagement

Encourage imaginative and creative connections to the book.

• Alicia’s self-portrait as Alcestis is a central symbol in the novel. If you were creating a self-portrait in the guise of a literary or historical figure, whom would you choose as your alter ego, and why?
• Suppose one of the novel’s secondary characters also kept a diary. What secrets could their diary reveal that would be in keeping with the novel’s themes and atmosphere?

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