The silent patient by alex michaelides

She didn’t respond. 

“Won’t you come in?” 

Yuri leaned forward as if to nudge her, but he didn’t actually touch her. Instead he whispered, “Go on, honey. Go in and take a seat.” 

Alicia hesitated. She glanced at him, then made a decision. She walked into the room, slightly unsteadily. She sat on a chair, silent as a cat, her trembling hands in her lap. 

I was about to shut the door, but Yuri didn’t leave. I lowered my voice. “I can take it from here, thanks.” 

Yuri looked worried. “But she’s on one-on-one. And the professor said—”

“I’ll take full responsibility. It’s quite all right.” I took my personal attack alarm out of my pocket. “See, I have this—but I won’t need it.” 

I glanced at Alicia. She gave no indication she had even heard me. 

Yuri shrugged, obviously unhappy. “I’ll be on the other side of the door, just in case you need me.” 

“That’s not necessary, but thanks.” 

Yuri left, and I closed the door. I placed the alarm on the desk. I sat opposite Alicia. She didn’t look up. I studied her for a moment. Her face was expressionless, blank. A medicated mask. I wondered what lay beneath. 

“I’m glad you agreed to see me.” I waited for a response. I knew there wouldn’t be one. “I have the advantage of knowing more about you than you do about me. Your reputation precedes you—your reputation as a painter, I mean. I’m a fan of your work.” No reaction. I shifted in my seat slightly. “I asked Professor Diomedes if we might talk, and he kindly arranged this meeting. Thank you for agreeing to it.” 

I hesitated, hoping for an acknowledgment of some kind— a blink, a nod, a frown. Nothing came. I tried to guess what she was thinking. Perhaps she was too drugged up to think anything at all. 

I thought of my old therapist, Ruth. What she would do? She used to say we are made up of different parts, some good, some bad, and that a healthy mind can tolerate this ambivalence and juggle both good and bad at the same time. Mental illness is precisely about a lack of this kind of integration—we end up losing contact with the unacceptable parts of ourselves. If I was to help Alicia, we would have to locate the parts she had hidden from herself, beyond the fringes of consciousness, and connect the various dots in her mental landscape. Only then could we put into context the

terrible events of that night she killed her husband. It would be a slow, laborious process. 

Normally when beginning with a patient, there is no sense of urgency, no predetermined therapeutic agenda. Normally we start with many months of talking. In an ideal world, Alicia would tell me about herself, her life, her childhood. I would listen, slowly building up a picture until it was complete enough for me to make accurate, helpful interpretations. In this case, there would be no talking. No listening. The information I needed would have to be gathered through nonverbal clues, such as my countertransference—the feelings Alicia engendered in me during the sessions—and whatever information I could gather from other sources. 

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