The silent patient by alex michaelides

I found it—in the form of Ruth, a psychotherapist referred to me through the university counseling service. Ruth was white-haired and plump and had something grandmotherly about her. She had a sympathetic smile—a smile I wanted to believe in. She didn’t say much at first. She just listened while I talked. I talked about my childhood, my home, my parents. As I talked, I found that no matter how distressing the details I related, I could feel nothing. I was disconnected from my emotions, like a hand severed from a wrist. I talked about painful memories and suicidal impulses—but couldn’t feel them. 

I would, however, occasionally look up at Ruth’s face. To my surprise, tears would be collecting in her eyes as she listened. This may seem hard to grasp, but those tears were not hers. 

They were mine. 

At the time I didn’t understand. But that’s how therapy works. A patient delegates his unacceptable feelings to his therapist; and she holds everything he is afraid to feel, and she feels it for him. Then, ever so slowly, she feeds his feelings back to him. As Ruth fed mine back to me. 

We continued seeing each other for several years, Ruth and I. She remained the one constant in my life. Through her, I internalized a new kind of relationship with another human being: one based on mutual respect, honesty, and kindness— not recrimination, anger, and violence. I slowly started to feel differently inside about myself—less empty, more capable of feeling, less afraid. The hateful internal chorus never entirely left me—but I now had Ruth’s voice to counter it, and I paid less attention. As a result, the voices in my head grew quieter and would temporarily vanish. I’d feel peaceful—even happy, sometimes.

Psychotherapy had quite literally saved my life. More important, it had transformed the quality of that life. The talking cure was central to who I became—in a profound sense, it defined me. 

It was, I knew, my vocation. 

After university, I trained as a psychotherapist in London. Throughout my training, I continued seeing Ruth. She remained supportive and encouraging, although she warned me to be realistic about the path I was undertaking: “It’s no walk in the park” was how she put it. She was right. Working with patients, getting my hands dirty—well, it proved far from comfortable. 

I remember my first visit to a secure psychiatric unit. Within a few minutes of my arrival, a patient had pulled down his pants, squatted, and defecated in front of me. A stinking pile of shit. And subsequent incidents, less stomach-churning but just as dramatic—messy botched suicides, attempts at self harm, uncontained hysteria and grief—all felt more than I could bear. But each time, somehow, I drew on hitherto untapped resilience. It got easier. 

It’s odd how quickly one adapts to the strange new world of a psychiatric unit. You become increasingly comfortable with madness—and not just the madness of others, but your own. We’re all crazy, I believe, just in different ways. 

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