Thanks to NetGalley and to Orion for providing me an ARC copy of this book that I freely chose to review.
Being a doctor (although I’d always had the same interest, even before studying Medicine), I’m always intrigued by books with the word “patient” (or doctor, hospital, or similar healthcare-related terms) in the title. Being a psychiatrist and having worked in forensic psychiatry in the UK, the description of this book seemed right up my alley. (And yes, in case you’re curious, I have treated patients who presented as temporarily mute, more than once, although not in circumstances quite as shocking as those in the book. Even one of the characters in one of my own thrillers is totally unresponsive after she is accused of a crime, but that’s another story). So I requested this book and it went into my very long list of books to read and review. Then, I started seeing great reviews, recommendations, etc., and grew curious, to the point where it jumped up to the top of my list.
Now, it’s quite difficult to review this book without revealing any spoilers, and this is a book where the twists in the plot are quite important, so I won’t be able to say much, as I’m sure many people will enjoy it and I don’t want to ruin it for them.
What can I tell you? What did I think? Well, I know this is a work of fiction, rather than a treatise in psychiatry or psychotherapy. (Theo Farber, one of the main characters, is a psychotherapist, a psychologist by training, not a medical doctor and, let’s say, he is not too enamoured with psychiatrists, anyway). But still, having work experience in high secure units in the UK, and also in low and medium secure units, both NHS and private, I couldn’t help but find so many things wrong with the characterisation of the professionals involved in the care of the other main character, Alice Berenson —the silent patient of the title— and also with the procedures followed and the way the unit is run, that it shattered my suspension of disbelief and made the rest of the book difficult to judge in its own right, for me. Despite the great reviews the book has had, I’ve noticed some other people have also had issues with the characterisation of the therapist and with other details of the novel, so if you are somebody who likes mysteries and thrillers to be realistic and tight when it comes to details, I’d say you should give it a miss.
The actual mystery side of the story… Well, as I said there are twists, more than one, red herrings, and some people have described it as original. Others, not so much. How well the twists work depends on how much you engage not only with the story, but also with the main characters. The story is narrated from two points-of-view, both in the first person, one the therapist’s, and one the patient’s, although, as must be evident from the title, the patient mostly does not talk, and what we get are entries from her diary, the diary she wrote before the events that landed her in the psychiatric unit. I like unreliable narrators, and they can work very well for mysteries, indeed. Here we have two. If Alice might be seen as an unreliable narrator due to her mental state, Theo seems to be very good at not applying his therapeutic insights (such as they are, but I’ve already said my piece on that and won’t insist) to himself and his own situation. But, I’m sure you won’t be surprised if I tell you that things are not quite as straightforward as they seem, even if you suspect they are far from straightforward.
My inkling is that people who don’t read tonnes of thrillers or mysteries are likely to enjoy this book more than people who mostly read thrillers and are used to smelling a rat from afar. Because of the issues I had with the novel, I included the editorial reviews, so you can get a sense of what the official line is on it. When I read the negative reviews I saw that some readers felt cheated by the twist (and yes, I understand that point of view, although, as I said, I had other issues with the book); there were complaints about not liking any of the characters (other than the two main characters, none of the rest are drawn in much detail, I agree); some readers found the descriptions of therapies and the use of psychotherapeutic terms over the top (too much telling and not enough showing, and some complained they slowed the action); some reviewers objected to the use of swear-words (as this was mostly by one of the patients, from personal experience I’d say that bit is not unrealistic); and also some comments about a somewhat prejudiced depiction of a couple of characters (the Greek professor running the clinic comes out of it much better than the Turkish patient, it’s true). I mention those as a warning for people who are thinking about reading it and the concerns might resonate with them.
After reading the whole book, and with the caveats I’ve mentioned, personally, I was intrigued by the reference to a play by Euripides I hadn’t heard about, Alcestis, and I want to explore it further. I also enjoyed the references to Alice’s paintings and her creative process.
If you aren’t familiar with psychiatric care (particularly forensic psychiatric care in the UK), don’t regularly read tonnes of mysteries, and prefer books with enticing plots rather than those focused on a strong and psychologically consistent depiction of, you are likely to enjoy this book. Otherwise, my recommendation would be to check a sample of the book and see if it hooks you and you feel compelled to keep reading.