The Silent Patient Book Club Questions & Discussion Guide

If you wanted to shake your book club up with a psychological thriller that will keep you reading late into the night, The Silent Patient by Alex Michaelides was the choice for you. Not only does this book deliver the shady characters and hairpin plot twists characteristic of the genre, it also raises important questions about human society and psychology. 

Can we ever be free from the trauma of our pasts? How do our economic priorities affect society’s most vulnerable populations, such as those being treated in mental health institutions? What are the consequences when we voice our deepest, darkest wishes–and are there some wishes best kept in silence?

As usual, we’re here to help you start the conversation with these The Silent Patient book club questions!

The Silent Patient book club questions, Alex Michaelides

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Our The Silent Patient discussion guide is formatted to launch you deep into conversation. First, we’ve provided a synopsis of The Silent Patient, in case you missed any beats in that head-spinning plot. (We wouldn’t blame you!) Next, we’ve provided 10 The Silent Patient book club questions you can pick apart with your friends. Finally, we’ve curated some provocative quotes from book reviews, which you may or may not agree with!

And don’t forget to read to the end. We’ve got you covered with suggestions for 3 books like The Silent Patient. Where one book closes, another opens!

The Silent Patient Synopsis

(We always chose to provide the publisher synopsis because we feel that it’s worthwhile to discuss whether the official book description actually squared with your experience of the book.)

The Silent Patient, by Alex Michaelides

Alicia Berenson’s life is seemingly perfect. A famous painter married to an in-demand fashion photographer, she lives in a grand house with big windows overlooking a park in one of London’s most desirable areas. One evening her husband Gabriel returns home late from a fashion shoot, and Alicia shoots him five times in the face, and then never speaks another word.

Alicia’s refusal to talk, or give any kind of explanation, turns a domestic tragedy into something far grander, a mystery that captures the public imagination and casts Alicia into notoriety. The price of her art skyrockets, and she, the silent patient, is hidden away from the tabloids and spotlight at the Grove, a secure forensic unit in North London.

Theo Faber is a criminal psychotherapist who has waited a long time for the opportunity to work with Alicia. His determination to get her to talk and unravel the mystery of why she shot her husband takes him down a twisting path into his own motivations—a search for the truth that threatens to consume him….

10 The Silent Patient Book Club Questions

  1. Jean-Felix and his art gallery profit from the notoriety surrounding Alicia’s paintings after she murders her husband. How do you feel about the painting “Alcestis” being exhibited publicly? Do you think Alicia intended for the painting to gain fame? What do you know about the Alcestis myth?
  1. During Alicia’s trial, Theo notes that “while everyone was talking, writing, arguing about Alicia, at the heart of this frantic, noisy activity there was a void–a silence.” What risks do you think we take when we generate noise around a silent figure? 
  1. Theo claims that most people who go into mental health professions do so because they are “damaged” and seeking a way to “heal” themselves. Do you think this might be true? In what way might you be seeking to heal yourself through your own profession?
  1. When Theo finds out Kathy is cheating on him, his therapist, Ruth, counsels him, “Real love is very quiet, very still. It’s boring if seen from the perspective of high drama. Love is deep and calm and constant.” Do you think any of the characters in this novel exhibit that kind of love? If not, what keeps them together?
  1. Alicia stabs Elif in the eye with a paintbrush after Elif claims that Theo is in love with Alicia. Why do you think Alicia reacted so violently to this claim?
  1. When Alicia overhears her father wishing that she had died in the car crash instead of her mother, she responds by whispering, “He killed me…Dad just–killed me.” Is it fair to judge a person’s wishes as seriously as their actions? In what situation might this judgment be fair?
  1. Theo and Alicia both feel that, despite his sympathetic gestures, Jean-Felix loves Alicia’s artwork more than he loves Alicia herself. Is it appropriate to separate an artist from his or her art? Can you love one and not the other?
  1. Theo attempts to frame Christian for Alicia’s murder, stating, “I had no qualms about framing him. Christian had failed Alicia when she needed him the most; he deserved to be punished.” What do you think about Theo’s rationale? How responsible is Christian for Alicia’s fate?
  1. Shortly before he is arrested, Theo reflects that “no therapist ever had a better shot at (healing someone) than Ruth” and wonders if his immoral behavior disproves the effectiveness of talk therapy. Do you think Theo’s therapist failed him or that he failed his therapist? Both? Neither?
  1. From the beginning to the end of the book, Theo insists that he only ever intended to help Alicia. Do you think this claim is sincere? If so, why did his “help” have such disastrous consequences?

Selected Reviews for The Silent Patient

“This is a novel that depends on you being fooled by the twist…Unfortunately, I’ve seen this particular twist done numerous times, so I was clued in fairly early to what the big twist would be…It was too neat and tidy to end any other way.”

“Although Alicia is silent, the narrative speaks to us in a way that she can’t or won’t, throwing the spotlight on the minutiae of her life as a talented artist, and ultimately what led to the events of that fateful night. Theo’s own personal life is laid bare too, and he’s also a very complex character – indeed not unlike Alicia. If Theo’s attempts to encourage Alicia to speak are successful, will it be something he wants to hear?”

“The author also examines some hard truths about institutions that rely on funding, which leads to money and power taking precedence over the welfare and health of the patients. Adding in yet another rich layer is the unique and quite interesting mythological parallel woven into the story.”

“I had so many questions about what was happening and what had happened with both Alicia and Theo. Theo is so ready to lie, manipulate, and use people and even though Alicia was the murderer, think I felt more danger from Theo and his shady practices.”

“The author had unabashedly mentioned some things about Psychotherapy in which some are true in some rare cases while some have unfortunately gone entirely wrong. The author has no right to generalise about the health sector as a whole based on some scrupulous activities done by some individuals. You can’t even see such a shady Psychiatric institution in any dystopian world.”


Use our guide to find dozens of book ideas for your group.

3 Books Like The Silent Patient

In addition to the suggestions below, we have an even bigger list of books like The Silent Patient if you want more for your TBR list.

If your book club is looking for more thrillers, you can check out our guides for A Flicker in the Dark, Into the Water, The Last Thing He Told Me, The Perfect Marriage, The Guest List, or The House in the Pines. Or try Verity, if you really want to lean into the whole messed up marriage thing.

Gone Girl Gillian Flynn book cover

Gone Girl, Gillian Flynn

If you enjoyed the enigmatic character of Alicia Berenson in The Silent Patient, you will be sucked in by Gone Girl’s Amy Dunne. Like Alicia, Amy communicates the chilling events leading up to her disappearance through the journal she left behind. Meanwhile, Amy’s husband, Nick, fumbles to prove his own innocence in Amy’s disappearance by putting together the pieces of Amy’s case before the police do. 

Throughout the book, Amy and Nick remain locked in a struggle to control their rapidly unfolding story, and as a reader, you will find yourself questioning the reliability of both narrators–as well as various other creepy characters lurking in the shadows!

The Witch Elm Tana French book cover

The Witch Elm, Tana French

Like The Silent Patient, Tana French’s The Witch Elm is narrated by a “nice guy” who is forced to turn amateur detective after his life is interrupted by the discovery of a disturbing skeleton in his past: the skeleton of a young man buried inside an elm tree in his beloved uncle’s backyard. 

The Witch Elm surrounds readers in a cast of characters who are at once familiar and vaguely sinister and invites everyone to join in investigating these characters. The novel also takes time to explore its own psychological underpinnings, like The Silent Patient, as Toby wrestles with the medical implications of a traumatic brain injury he suffered shortly before the skeleton was discovered in his uncle’s elm tree.

The Girl with the Dragon Tattoo book cover

The Girl With the Dragon Tattoo, Stieg Larson

Steig Larson gave the literary world a shock when he conjured up Lisbeth Salander, the titular character in The Girl With the Dragon Tattoo, just as Alex Michaelides later gripped our attention with Alicia Berenson in The Silent Patient. Like Alicia, Lisbeth is a brilliant and misunderstood woman, largely because of her tight-lipped response to trauma. 

But while The Silent Patient only offers us a glimpse of the power of an intelligent and passionate woman like Alicia, Lisbeth Salander allows that power to come to full fruition. If you found yourself dissatisfied with Alicia’s resignation to her fate, you will be cheering for Lisbeth as she dares to take full control of her story and delivers darkly poetic justice to her would-be oppressors. 

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