Summary: Part 2, Chapters 1-6

This chapter is composed of a series of short diary entries written by Alicia throughout the month of July, the month prior to the murder of Gabriel. She describes the unusually severe heatwave that afflicts London that month, which causes her to spend time outside, as her home has no air conditioning. In the first entry, she writes from Hampstead Heath, a grassy public space at one of the highest points in London. As she observes other visitors to the park, she reflects upon the summer that her mother died. She remembers her mother playing the radio and dancing along to pop songs and realizes that she is now older than her mother was when she died. She also notes that on her way to the park, she found a small bird lying on the ground. When she reaches down to help it, she finds that the bird is already dead and full of maggots, which disgusts her. She writes her next diary entry from an air-conditioned café, where she begins sketching. As she reflects upon the difficulty she’s had completing a painting of Jesus Christ, Alicia realizes that the painting isn’t really of Christ, but rather of Gabriel. In her third diary entry, she visits a popular market in Camden, London, where she hands a few coins to a mentally ill homeless man.

She reflects upon her mother and theorizes that the car accident in which her mother died, which she used to believe was an act of suicide, was actually a deliberate attempt to murder her, as she was a passenger in the car. She begins to cry as she reflects upon the homeless man, her mother’s mental illness, and all the pain she sees around her in the world. In her next entry, she goes on a dinner date with Gabriel and asks him to sit for a painting, which he agrees to reluctantly. In the last entry, Gabriel sits for her painting despite his discomfort with being portrayed as Jesus. Within 20 minutes, he grows impatient and the two have sex in her studio.  

Chapter 2 

Chapter 2 is narrated by Theo. He reports to Diomedes about his first session with Alicia and admits that she didn’t respond to him. Theo feels that he can’t reach Alicia because she is too heavily medicated and requests that her dosage be reduced. Diomedes notes that Christian is responsible for Alicia’s dosage and suggests that Theo speak to Christian about it. However, Theo is reluctant to speak with Christian and states that the request to lower Alicia’s dosage would “sound better” coming from Diomedes, who notes the clear tension between the two colleagues. Though Theo insists that he bears Christian no ill will, Diomedes advises him that the staff of The Grove need to work together on their common goal of treating patients. Further, Diomedes reminds Theo that Alicia was suicidal when she first arrived at The Grove, and lowering her dosage might trigger a crisis if she is “overwhelmed” by the flood of feelings that have been held at bay by her sedatives. Theo weighs the risk but ultimately concludes that Alicia will never be treated if she cannot access her emotions. Diomedes concedes, agreeing to ask Christian to lower her dosage. He offers a cigar to Theo, who turns it down.  

Chapter 3  

At The Grove, Theo chats with Indira in the “Goldfish Bowl,” the staff nickname for the nurse’s station. The walls of the station are made of glass so that staff can observe patients, but it also means that the patients can see the staff at work. Indira hands Theo some cake, which she has smuggled into the facility against the orders of Stephanie, who considers outside food a health hazard. Theo realizes that he likes Indira because she reminds him of Ruth, who had a similarly maternal personality. Theo also has a tense and awkward conversation with Christian, which is cut short by Elif, who bangs on the glass walls to complain about her medicine. When she leaves, they chat about Elif, who was institutionalized after murdering her mother and sister, and then about Alicia. Christian tells Theo to come to him directly in the future if he has an issue with how Christian medicates patients and adds that Alicia won’t respond to any form of therapy because she has Borderline Personality Disorder. Indira disagrees with Christian and offers her support to Theo.  

Chapter 4 

In his second one-on-one session with Alicia, Theo finds that the lowered medication is already having an effect, as she appears less clouded and a bit more deliberate in her movements. He asks Yuri to leave the room and then sits with Alicia in silence for 50 minutes, resisting the temptation to fill the silence by talking. Instead, he tries to pay attention to minor, nonverbal cues from Alicia, and to build her trust in him. At the end of their session, he finally breaks the silence by speaking, telling her that he wants to help her. Alicia suddenly looks up, and while Theo attempts to interpret the meaning of this surprising gesture, she leaps on him and, knocking him off the chair, bangs his head repeatedly into the ground. She knocks the attack alarm out of his hand and begins to choke him. Finally, he is able to reach and press the alarm, and after a loud, wailing noise, staff rush into the room and hold down Alicia. While she fights them in a frenzied fashion, Christian sedates her.  

Chapter 5 

Yuri tends to Theo’s minor injuries in the goldfish bowl and tells him that Diomedes has called an emergency meeting. Theo walks to the meeting and wonders if he is going to be fired. Christian, Stephanie, and Indira are also present. Stephanie demands to know why he was in the room alone with Alicia, against safety protocol, and Theo takes full responsibility. Theo explains what happened during the session and interprets her attack as a form of communication. Christian sneers at this and insists that the attack was a result of the lowered medication, but Theo argues that the attack should be thought of as a sign of progress. Against Stephanie’s protests, Diomedes allows Theo to continue working with Alicia, giving him six weeks to make a breakthrough in the case.  

Chapter 6 

Theo is home alone while Kathy is out rehearsing for a play. Alone and tired, Theo finds his secret stash of marijuana and begins to smoke. He explains that he became emotionally dependent upon weed at college, as it helped him to manage his difficult emotions. He claims that marijuana was like a lover to him at that time in his life, though through Ruth, he begins to think of his relationship to the drug as an addiction. Ruth advises him not to quit, but rather, to acknowledge his dependence on substances. Ultimately, she counsels, Theo will not need marijuana when he finds something else in his life to take its place. As Ruth predicts, Theo stops smoking when he meets Kathy, as she helps him to feel the security and contentment that marijuana once brought him. However, he begins smoking again one night at a party when he feels that Kathy is ignoring him. Searching for the remote control, he knocks over Kathy’s laptop, which turns on, the screen displaying her email inbox. He sees multiple sexually explicit conversations with a user named BADBOY22. The emails to and from Kathy range from sexually obscene to emotional, and Theo sees that they have arranged to meet up after Kathy’s rehearsal. Theo is horrified by what he sees and vomits into a toilet.  


Alicia’s diary entries reveal her tortured emotional state in the hot summer weeks preceding Gabriel’s murder. Seasons are a significant motif in The Silent Patient, creating continuities with the past. Just as Theo’s childhood memories are dominated by winter snow, the historic heatwave triggers Alicia’s memories of childhood, some of which are pleasant and others very difficult for her. In particular, Alicia thinks about her late mother, who she regards as having been lovely but frail. Reflecting on the car accident that led to her mother’s death, Alicia wonders if she meant to kill herself in an act of suicide, or rather, if the accident was intended to kill Alicia in an attempted murder. Haunted by the possibility that she has inherited her mother’s mental illness, Alicia wonders if she is destined to lose the battle with her own personal darkness. Her feeling that madness is in her blood is an important aspect of the novel’s exploration of mental illness and fate. Whenever she finds herself dwelling on her anxieties, she forces herself to switch to a new topic, but it is clear that she cannot entirely repress the despair that visits her again and again.  

Her diary entries also reflect thoughtfully on art and artistic representation, another important theme in the novel. As an artist, she feels that she needs to trust her own instincts and allow the artistic impulses to guide her, without planning everything out in advance. Whenever she begins painting with a preconceived notion of the end-result, the painting is “stillborn,” just a copy of an image in her head that never takes on a life of its own. Instead, she thinks of art as a process that she must surrender to as an act of faith. Still, she struggles to give in to this process, creating numerous sketches before beginning a new painting, which gives her a sense of control. She credits Gabriel with her success as an artist, as she feels that he lifted her from her previous partygoing life and gave her the sense of safety and security that allowed her to paint.  

In his psychotherapy sessions, Theo also struggles to surrender control. In his second session with Alicia, he finds it difficult not to speak even though he knows that he must sit in silence with Alicia to better understand her. When he gives in to the temptation to speak, this triggers a violent reaction in Alicia. While Theo believes that this is a sign of progress, and an attempt to communicate nonverbally, Christian instead feels that it was a mistake to lower her medication. Theo and Christian represent very different approaches to treating patients. A psychiatrist, Christian places his faith in medication, dismissing the psychodynamic approach used by Theo, which foregrounds communication and emotion. Theo believes that his session was successful because he was able to sense her feelings through “countertransference,” the process by which a therapist feels for a patient who cannot express their own feelings. During their second session, Theo feels what he believes to be Alicia’s own feelings, including a strong suicidal impulse and a skepticism of Theo’s own attempt to treat her. However, it is also possible that these are Theo’s own feelings, incorrectly projected onto the silent Alicia.