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Get The Silent Patient summary with the jaw-dropping ending explained here. Learn what happens in Alex Michaelides’s instant #1 New York Times bestselling debut book. You’ll get all your questions answered and get a printable PDF to take away with you, so let’s get literary!

the silent patient by alex michaelides.

The Silent Patient Summary (With Spoilers)

Genre: Psychological Thriller

The Silent Patient by Alex Michaelides is a psychological thriller. Psychological thriller books are a genre that contains mystery, suspense, and unexpected plot twists. They most often include crimes, especially murder. The narrators may be unreliable, immoral, or suffer from mental illness or substance abuse.

Here, the psychological thriller genre has especially unique elements: the female lead is a psychotherapy patient and the male lead is her psychotherapist. At issue is why she killed her husband.

Main Characters

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

Full Synopsis

Alicia Berenson is a famous painter who has been found guilty of murdering her husband. He was 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.” 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 paint, 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, Paul Rose, to learn more about her. Alicia’s cousin recounts the impact of Alicia’s mother Eva’s suicide when she was a child, and how Alicia’s grieving father, Vernon, said he wished Alicia to be dead instead.

Theo talks about this traumatic childhood event with Alicia.

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 Explained: A Plot Twist!

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 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. He chose himself.

However, Theo then left the Berenson house without shooting either Alicia or Gabriel. In reality, his only intent was to expose Gabriel’s selfishness to Alicia.

But, this intimate betrayal reminds Alicia of her father’s betrayal after the death of her mother, and her darkest emotions and impulses overwhelm her. 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. He sought to help her recover from the murder in his capacity as her therapist.

But, when Alicia finally speaks, 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 West, had treated Alicia before Gabriel’s death in an unlicensed practice. Theo blames Christian, and he is arrested.

Unbeknownst to Theo, however, Alicia revealed 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 did not occur in the present but rather in the past, before Gabriel’s affair.

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


  • effects of marital betrayal and psychological disorders
  • betrayal
  • guilt
  • drug use
  • communication
  • inner workings of the medical profession

Printable PDF of The Silent Patient Summary

Book Review and Analysis: Is This Story Worth Reading?

the silent patient book review infographic.

My Review: ★★★★☆

The Silent Patient is worth reading if you like thrillers that are quick, engaging, and/or have big plot twists.

The shocking twist in the mystery The Silent Patient makes it a book you have to read. This debut novel is a hit with millions of 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 that was unique, engaging, and most 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?!” (After all, that was exactly my own reading experience.)

It’s a great book like Verity, beach read, Fall thriller, and book to start a reading habit.

The Silent Patient Movie Updates

The feature film movie adaptation of The Silent Patient was optioned by Annapurna and Plan B in 2019. At the time of posting, lMDB still listed it as “in development.”

Fun Fact: Author Alex Michaelides himself was a former screenwriter!

Frequently Asked Questions

How does The Silent Patient end?

At the end of The Silent Patient by Alex Michaelides, 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.

What is the summary of The Silent Patient?

The Silent Patient by Alex Michaelides is about a woman named Alicia, who murders her husband and then becomes completely silent through psychological treatment. Her doctor, Theo, is obsessed with uncovering her motive, and the reveal comes with a plot twist.

Who was the killer in The Silent Patient?

Alicia is the killer in The Silent Patient by Alex Michaelides; 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 is the main message of The Silent Patient?

The Silent Patient by Alex Michaelides is a bestselling psychological thriller book in which a woman named Alicia murders her husband and then becomes completely silent through psychological treatment. Her doctor, Theo, is obsessed with uncovering her motive. Essentially, it’s a book about concealing the truth.

What is the twist in The Silent Patient?

The twist in The Silent Patient is that Theo, in fact, was the “masked man” who prompted the murder committed by Alicia.

What happens to Theo at the end of The Silent Patient?

Alicia’s diary reveals Theo as the “masked man” who prompted the murder committed by Alicia. The police arrive at Theo’s home and read him Alicia’s diary. Theo feels a sense of relief that he has been caught.


The Silent Patient by Alex Michaelides is a masterclass in psychological suspense, taking readers deep inside the main characters’ psyches. As the reader unravels Alicia Berenson’s chilling silence and the events that led to it, the reader learns that things are not as they seem. It’s the kind of book you can read about in a day, then still think about years later.

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