Book Club Discussion Questions and Guide for The Silent Patient by Alex Michaelides

1. Who do you think is to blame for Gabriel's death?
2. When did you figure out the twist, and what were the clues that led you there?
3. Much of this story takes place inside a psychiatric hospital. How did this setting impact your perception of the characters—both inside and outside The Grove—and what effect did it have on the atmosphere of the book?
4. This book plays with the idea of trustworthiness, with characters seeming reliable one moment and unreliable the next. What were the elements that made you trust certain characters or not?
5. What is the meaning of the Alcestis? Why do you think the author included this reference to Greek mythology, and what does it add to your experience of the story?
6. How did you feel about the dynamic between Theo and Alicia and between Theo and Ruth as therapist and patient? What lines should or shouldn't be crossed in these relationship? What power dynamics are at play here?
7. How did you feel about Theo and Kathy's marriage? What are your thoughts on how their relationship is resolved?
8. This book includes many different types of communication: conversation, diary entries, art, and even silence. How are each of these used to progress the story line and character development?

Unless otherwise stated, this discussion guide is reprinted with the permission of Celadon. Any page references refer to a USA edition of the book, usually the trade paperback version, and may vary in other editions.