Motifs are recurring structures, contrasts, and literary devices that can help to develop and inform the text's major themes.


Addiction in various forms serves as a notable motif in the novel, generally indicating personal distress or unresolved struggles with mental health. At the very beginning of the novel, Theo notes that psychotherapists generally regard smoking as a form of addiction that has not yet been resolved. Theo reflects upon his own habit of smoking, which he has failed to quit despite several attempts. After a week of abstaining from cigarettes, he smokes one to ease his nerves prior to his interview at The Grove, feeling annoyed with himself for doing so. A good therapist, he claims, should be able to overcome this form of addiction. Ashamed, he attempts to disguise the smell with breath mints, but he smokes with increasing frequency as his personal and professional life unravel throughout the events of the novel, using language that indicates emotional dependency. “I desperately needed a cigarette,” he states after several failed attempts to reach out to Alicia’s family. In their most intimate conversation, Theo and Alicia, both of whom struggle with mental health, smoke cigarettes together in a scene of mutual understanding.  

Cigarettes are not Theo’s only addiction. While attending college and suffering deeply from depression, Theo developed a dependent relationship to marijuana. He first began smoking while feeling socially ostracized at a party, and soon begins smoking weed every day. For Theo, marijuana offered him the comfort that he was not receiving from others, serving as his best friend, his “inspiration,” and his “solace.” He stops smoking marijuana when he begins to date Kathy, but the obsessive behavior he exhibits later suggests that he has replaced smoking with Kathy, a new addiction of sorts. He begins to smoke again only when she ignores him at a party and resumes smoking later when he is home alone, hiding his marijuana from her to conceal his behavior. The novel suggests that Theo’s inclination towards addiction and dependency is a sign of his ongoing psychological struggles, which, like his illness, he struggles to conceal from others.  


The nature of Alicia’s refusal to speak is the subject of curiosity and debate throughout The Silent Patient. The novel uses her silence as a key motif in order to reflect upon the silencing of women by men and the need to make meaning out of confusion. Before she fell silent, the men in her life, including her husband, Gabriel, and her therapist, Christian, failed to take her reports of being stalked seriously. Weaponizing her past struggles with mental health against her, they push aside her worries and make her doubt her own senses. Similarly, Jean-Felix speaks over her, holding one-sided conversations, and her brother-in-law Max makes threats to silence her from reporting his inappropriate behavior to Gabriel. A central irony in the novel is that nobody listens to Alicia until she stops talking. Once she falls mute, however, her silence seems to invite interpretation from others. The public, convinced of her guilt, interprets her silence as guilt, as does the judge at her trial. For the employees at The Grove, her silence reflects the shock and trauma of Gabriel’s murder, and Theo takes her silence as tacit approval of his actions. Her silence allows others to more easily project their own thoughts and feelings onto her, most notably Theo, who struggles to delineate his emotions from hers after their therapy sessions.  

Greek Tragedy and Mythology 

The Silent Patient draws numerous references to Ancient Greek tragedy in order to reflect upon the role of fate or destiny in shaping an individual’s life. Most prominently, the novel engages extensively with Alcestis, a play by Ancient Greek tragedian Euripides. After the murder of Gabriel, Alicia entitles a self-portrait Alcestis, though the connection between Gabriel’s murder and the ancient play is not immediately clear. At the suggestion of Alicia’s former friend Jean-Felix, Theo buys and reads the play, though its meaning is equally puzzling to him. In the play, the fates, figures from Greek myth, condemn a man named Admetus to death, though he is offered a deal: if he can convince someone else to take his place, Admetus will be spared. He readily accepts the sacrifice of his wife, Alcestis, though she is later miraculously rescued from the underworld. Theo is confused by the ending of the play, as Alcestis is silent and offers no comment on the events of the story. With the help of Diomedes, who was educated in Ancient Greek theater in his native Greece, Theo interprets her silence as a quiet fury at her husband, who was willing to let her die in his place.  

This play becomes the key that helps Theo to unlock the mystery of Alicia’s trauma, which mirrors the events of the play. This is, however, not the novel’s only reference to Greek drama and myth. Diomedes, for example, characterizes Alicia as a “silent siren” whose helplessness offers a seductive threat to Theo, and in the fateful moment when Theo spies his wife Kathy and Gabriel kissing by the entrance to a park, he describes himself as “staring at a Medusa, turned to stone.” Theo’s references to Greek myth highlight the prominent role that destiny plays in many of these stories. Repeatedly, his invocations of Greek tragedy and fate minimize his own agency and culpability in the tragic events of the novel.