The Silent Patient

Use this activity to engage all types of learners, while requiring that they refer to and incorporate details from the text over the course of the activity.

Activity 1: “Missing Journal Pages”

In this activity, students will write journal pages in the voice of one of the characters to reveal something about the other characters in the story.

Alicia’s journal demonstrates her voice at different places in the novel, even when she cannot speak aloud. Pretend the police have discovered two new journal pages. Choose a character, and then write a journal entry from their perspective. As you write, adopt the style of their voice and provide details that reveal important aspects of their relationship with at least one other character. Follow these steps as you begin:

• Re-read and review sections that depict the character’s voice you will be adopting.
• Identify the important relationships between this character and others in the novel.
• Brainstorm topics the character might have written about in a journal.
• Write a two-page draft in first person and in a style that reflects the character’s voice.
• Exchange your draft with a partner and review for content, clarity, and style.
• Revise and prepare the final version.

Once students have completed all journal entries, you will share your work in an informal presentation and reflect on the work of your peers. Afterward, discuss with the class the power of perspective and how different points of view affect the novel.

Teaching Suggestion: To prepare for this Activity, students might discuss unique elements of different characters’ voices and how they could apply these observations to their writing. The assignment could remain open-ended; the journals might be from any point in the novel, even red herrings that have no real bearing on Theo’s arrest. Alternatively, the focus could be narrow, with students writing journals the police might use as evidence.

Differentiation Suggestion: Students with musical talents and creative learning styles might create songs or poems from the perspective of a character instead of journals. Students with interpersonal learning styles might dramatize their journals in the form of a play, while those with artistic talents could create visual artifacts—like one of Alicia’s paintings—from a character’s perspective.

Activity 2: “Illuminating Allusions”

In this activity, students will present an allusion to another text that could connect to the characters, plot, or ideas in The Silent Patient.

The novel alludes to Othello, Alcestis, and religion. Reflect on other texts, such as films, books, or songs, and then choose one and analyze how it could connect to the novel.

• Take notes on any parallels between the texts.
• Identify related messages, themes, ideas, characters, and/or plot details.
• Create an artifact in the form of a poster, song, poem, or video to depict the allusion.
• Title your artifact in a way that reflects the novel’s title, The Silent Patient (The + Adjective + Noun).

Share and display your artifact, and then participate in a gallery walk. Afterward, compose a journal entry of your own in which you consider how the allusion you presented fits into the novel.

Teaching Suggestion: It may be helpful to review allusions with the class and discuss one or more examples already in the novel. Some ideas for discussion could be how the allusions are referenced, what they add to the novel, and/or their cultural contextual factors. It could also help to brainstorm texts together that might address one or more of the novel’s themes: The Dangers of Unresolved or Improperly Treated Mental Illness, The Destructive Force of Betrayal, and/or The Human Instinct to Hide Weakness and Present a Favorable Façade to the World. This activity focuses on a complex form of figurative language and requires high levels of critical thought. It could be beneficial to have a think-aloud where the class builds meaning together before students work individually. Students could also apply another text studied in class to this project.

Use these essay questions as writing and critical thinking exercises for all levels of writers, and to build their literary analysis skills by requiring textual references throughout the essay.

Differentiation Suggestion: For English learners or struggling writers, strategies that work well include graphic organizers, sentence frames or starters, group work, or oral responses.

Scaffolded Essay Questions

Student Prompt: Write a short (1-3 paragraph) response using one of the bulleted outlines below. Cite details from the text over the course of your response that serve as examples and support.

1. Most of the story is told through Theo’s voice and perspective.

• How reliable is Theo as a narrator? (topic sentence)
• As you craft your response, include at least three quotations or specific details to support your analysis. Cite your evidence with page numbers.
• In your concluding sentence or sentences, explain how the novel would be different if told entirely from Alicia’s perspective.

2. Author Alex Michaelides incorporates multiple allusions throughout the novel. Choose one of these allusions as the basis for your response.

• How does the allusion parallel events in the novel? (topic sentence)
• As you write your analysis, explain the significance of the allusion and identify at least three moments in the text that connect to it.
• In your concluding sentence or sentences, discuss the author’s purpose in including this particular allusion and the overall effect it has on the reader’s interpretation of the text. 

3. As a thriller novel, The Silent Patient is full of mystery and suspense and is designed to keep the reader guessing.

• How does the author build suspense? (topic sentence)
• As you write your essay, identify and analyze at least three of the author’s suspense-building techniques. Explain your ideas carefully.
• In your concluding sentence or sentences, discuss how the book’s genre directly relates to one or more of its themes: The Dangers of Unresolved or Improperly Treated Mental Illness, The Destructive Force of Betrayal, and/or The Human Instinct to Hide Weakness and Present a Favorable Façade to the World.

Full Essay Assignments

Student Prompt: Write a structured and well-developed essay. Include a thesis statement, at least three main points supported by text details, and a conclusion.

1. Consider the differing perspectives and overall format of the novel. From what point of view is the novel primarily told? How do the style choices affect the reader’s interpretation of the characters and events? Where does the perspective shift, what different text formats are included, and how does time factor into the story? Write an essay explaining how style choices affect the novel’s meaning.

2. Reflect on the different forms of betrayal in the novel. How does The Destructive Force of Betrayal act in a cyclical way? Where do characters deceive others? What are examples of characters harming people they were trusted to protect? When does a character who was harmed betray another? Write an essay analyzing the role of betrayal in the characters’ lives and discuss a related lesson the novel teaches.

Multiple Choice and Long Answer Questions create ideal opportunities for whole-text review, exams, or summative assessments.

Multiple Choice

1. How are Kathy and Alicia different?

A) Kathy loses job after job, while Alicia gets promoted several times.

B) Kathy is talkative and self-assured, while Alicia is often silent and doubts herself.

C) Kathy prefers to be alone, while Alicia surrounds herself with people.

D) Kathy enjoys being in The Grove, while Alicia wants to escape it.

2. What is symbolic about the way Alicia paints Gabriel?

A) Gabriel is depicted as smaller than her, demonstrating how little she thinks of him.

B) Gabriel is depicted as the only one in red, revealing her plan to murder him.

C) Gabriel is depicted as a bird, which highlights her inability to fly to freedom.

D) Gabriel is depicted as Jesus on the cross, which positions him as her leader.

3. In what ways does Theo play detective?

A) Tracking down his wife’s lover and clues to Alicia’s past

B) Finding who really injected Alicia with morphine and alerting authorities

C) Searching for Alicia after she flees Gabriel’s murder

D) Meticulously researching Kathy before beginning a relationship

4. Why is painting important to Alicia?

A) Painting is how she connects to Gabriel.

B) Painting provides her with a break from her job.

C) Painting helps her make friends.

D) Painting gives her a voice.

5. What is significant about where Theo is living at the end of the novel?

A) The new condo looks over the city as he holds things over others.

B) The farm he has bought gives him an escape from all his demons.

C) He is stuck in his childhood home and in trauma that began in his childhood.

D) He buys Alicia’s house, taking over her space as he has stolen her voice.

6. How does Kathy’s role in Othello foreshadow events to come?

A) Kathy plays Iago, who pretends to be friends with Othello, foreshadowing Theo pretending to be friends with Alicia.

B) Kathy plays Desdemona, killed by her husband’s jealousy, which foreshadows Theo’s pending violence fueled in part by jealousy.

C) Kathy loses her role in the play after Theo exposes her affair, which foreshadows Theo losing Kathy and Alicia.

D) Kathy shifts from the role of a priest and a policeman, foreshadowing different roles Alicia tries to play in her husband’s life.

7. What literary strategy does the following quotation include: “Alicia’s blue eyes remained as clear and cloudless as a summer’s day”? (Part 2, Chapter 4)

A) Imagery

B) Simile

C) Hyperbole

D) Irony

8. What is symbolic about the character Alcestis?

A) Like Alicia, Alcestis does not speak after someone she trusted chose for her to die instead of another.

B) Like Theo, Alcestis hides her struggles from everyone around her, but the truth is eventually discovered.

C) Like Gabriel, Alcestis turns to art to heal after learning of the infidelity of her spouse.

D) Like Kathy, Alcestis is viewed as a maternal figure trying to help others and failing to help herself.

9. What can be inferred about why Alicia gives her diary to Theo?

A) She wants him to read it and understand the destruction of his actions.

B) She needs him to hide it from the police so that she does not have to leave.

C) She hopes he will give it to Gabriel, who refuses to see her.

D) She wishes he would publish it for others to learn from.

10. Which of the following misleads the reader away from Theo’s revelation of how he met Alicia?

A) Gabriel’s job as a painter and journalist

B) Christian arguing for less medication for her

C) Ruth’s harsh treatment of Theo

D) Alicia believing Max is her stalker

11. What is the best example of The Human Instinct to Hide Weakness and Present a Favorable Façade to the World and the harm it poses?

A) Theo marrying Kathy so quickly

B) Ruth retiring and only treating Theo in her home office

C) Gabriel’s insistence on Alicia seeing Dr. West as her therapist

D) The board of The Grove choosing to close the facility

12. What can be inferred about why Alicia begins speaking when she does?

A) Alicia is exhausted by others getting the facts incorrect.

B) Alicia believes they will release her if she speaks.

C)    Alicia does not have what she needs yet from Theo.

D) Alicia needs to hear more about Kathy and her cousin.

13. Which one of the following best describes Ruth’s role?

A) Foil for Alicia

B) Maternal figure for Theo

C) Antagonist for Jean-Felix

D) Confidant for Max

14. What might Alicia’s painting of The Grove symbolize?

A) The male figure represents Theo either rescuing Alicia or about to kill her.

B) The rose in front shows Alicia’s surviving love for Gabriel.

C) The fiery colors suggest Alicia’s glee about murder.

D) The collapsing building indicates its weakened state.

15. How do the novel’s events unfold?

A) Chronologically from beginning to end

B) Through flashbacks until the final three chapters

C) Jumping between time periods in different ways

D) In reverse chronological order except for Alicia’s diary entries

Long Answer

Compose a response of 2-3 sentences, incorporating text details to support your response.

1. How is Alicia’s childhood connected to her killing Gabriel?

2. What is Theo’s reaction when he realizes his guilt has been discovered?