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Can You Help the Madwoman In the Asylum?

Updated: Oct 23, 2020

The Silent Patient and Female Insanity in Fiction

Madwoman, eyes rolling, head on green chair
Madwoman in the asylum

Ophelia and Bertha were just the beginning

Shakespeare showed us Ophelia blabbering madcap snippets of song and manically plucking flowers before throwing herself into a stream. Charlotte Bronte created “the madwoman in the attic” when Jane Eyre discovers that her husband has barricaded Bertha, his crazy, first wife, in an upstairs room. Charlotte Perkins Gilman depicted the horrible mental demise of a woman locked away in her bedroom and subjected to the “rest cure” in The Yellow Wallpaper.

Wilkie Collins got a letter from a woman in an insane asylum in 1858 begging him to use his legal expertise to get her out. Louisa Nottidge claimed she was perfectly sane and wrongfully imprisoned. In an era when women could be institutionalized if a man in the family wanted it, women were accused of lunacy and put away for the sake of monetary gain. That letter was the impetus for the novel, The Woman in White, the “first madwoman in the asylum” novels. Wilkie Collins dedicated his book, The Woman in White to the Commissioner for Lunacy, as a statement against the malicious lunacy incarceration phenomenon of England in the 1850s.

For hundreds of years, we’ve been reading about women locked away in dingy rooms with little dignity and questionable sanity.

Why do we love reading about crazy women in asylums?

Three reasons exist for the perennial popularity of a good read about damaged women locked away:

1) The setting of the story

Isolated buildings. Locked doors. Weird noises. Chains and restraints. Drugs. Doctors. Incoherent conversations. Furtive looks and professions of innocence. Let’s face it. Asylums are way up there on the scale of settings that intrigue us.

Carolyn Kirby, the author of The Conviction of Cora Burns, says that we are drawn to the tension that builds around the facility itself. Is the asylum a place where decent doctors are dedicated to healing injured minds, or are they corrupt and uncaring, doing nothing but drugging patients to a zombie-like state?

“The tension between these two visions of the mental institution / psychiatric hospital continues to be irresistible to thriller writers. A novel’s perspective on the merits of the ‘asylum,’ whether repellent, intriguing or therapeutic, depends very much on the point of view from which the story is told.”

Dingy asylum room with empty wheelchair
Empty Room in Asylum

2) The sanity of the patient

The asylum may be a point of interest, but the mental state of the patient creates the most tension for readers and writers. Is she sane and falsely accused? Does she think she’s sane but is, in truth, a raving lunatic? Is she acting crazy, hiding a logical mind with a reason for faking it? Does she wobble between rational thought and irrational fantasy? Is it even possible to help her?

3) The motivation of the doctor

In “asylum” novels, the motivation of the doctor who’s treating the patient is tantamount to the plot. Is he honorable? Is he driven by greed, intellectual concern, genuine compassion, or some hidden agenda? Is he skilled, certified, or a wacko with his own crazy treatment ideas?

(Consider, trepanation which believed that you could cure mental illness by taking out a piece of skull to allow the evil to escape. Or rotational therapy which meant being spun around in a special chair as fast as possible until “brain congestion” was reduced. Or Henry Cotton’s idea that toxins in certain body parts were infecting the brain…so he surgically removed uteri, teeth, spleens, and other organs with a mortality rate of 45%.)

The Silent Patient as a “collision”

The Silent Patient by Alex Michaelides is a debut novel for the Greek-born writer who said that this book was

“the collision between Agatha Christie and Euripides.”

He wanted to write a detective story that people would read on the beach like he did when he discovered Agatha Christie as a teenager. He threw in an obscure story by Euripides, the Greek philosopher of his homeland, and then mixed that with the basics of psychotherapy he studied as a post-graduate student only adds to the novel’s authenticity.

Little did he know that the book would end up on the New York Times bestseller list for 22 weeks. Michaelides commented,

“When my editor called me to tell me that it had gone into the NYT Times bestseller list at number one, I thought he was joking. It was probably the best experience of my life, certainly the most thrilling.”

Alex Michaelides knew how to make people want to read about crazy women in asylums

From the very beginning of the book, the author utilizes the three techniques writers often use to crank up tension and make the readers want to read.

He creates the perfect setting for suspense

The Silent Patient by Alex Michaelides uses the tension created by an asylum on the verge of being shut down. Inadequate funding, non-existent maintenance, and isolation from other buildings, The Grove creates an emotional tension for the reader right away. No legitimate asylum should be a chronic state of disrepair:

“It was obvious not much had been spent on the upkeep of the building in several years: paint was crawling away from the walls, and a faint musty smell of mildew and decay permeated the corridors.” (22).

He emphasizes the questionable sanity of the patient, artist, Alicia Berenson

  • She didn’t show remorse.

  • She had a history of mental illness from childhood.

  • She didn’t cry once after the death of her husband or throughout her trial.

  • She had not uttered one word, not one syllable, since the night of her husband’s murder.

Alex Michaelides describes Alicia through the eyes of Theo Faber, the doctor who treats her. Theo describes her as troubled, but he also points fingers at ineffective treatment by her current doctor who simply medicates her until she’s compliant:

“I hadn’t expected her to be in such bad shape. There were some echoes of the beautiful woman she had once been: deep blue eyes; a face of perfect symmetry. But she was too thin and looked unclean. Her long red hair was hanging in a dirty, tangled mess around her shoulders. Her fingernails were chewed and torn. Faded scars were visible on both her wrists — the same scars I’d seen faithfully rendered in the Alcestis portrait. Her fingers didn’t stop trembling, doubtless a side effect of the drug cocktail she was on — risperidone and other heavyweight antipsychotics. And glistening saliva was collecting around her open mouth, uncontrollable drooling being another unfortunate side effect of the medication.” (25).

He ratchets up the tension by suggesting multiple motivations on the part of Alicia’s doctor, Theo Faber

Michaelides is skilled in getting us to question what kind of doctor Theo Faber was and why he was so intent on helping Alicia above everyone else.

“Some people — myself included — continued to be fascinated by the mystery of Alicia Berenson and her enduring silence. As a psychotherapist, I thought it obvious that she had suffered a severe trauma surrounding Gabriel’s death; and this silence was a manifestation of that trauma. Unable to come to terms with what she had done, Alicia sputtered and came to a halt, like a broken car. I wanted to help start her up again — help Alicia tell her story, to heal and get well. I wanted to fix her” (12).

While Theo professes his desire to help, he also admits,

“…I became a psychotherapist because I was fucked up. That’s the truth- though that’s not what I said during the job interview…” (13).


“I mean, of course I wanted to help people. But that was a secondary aim — particularly at the time I started training. The real motivation was purely selfish. I was on a quest to help myself. I believe the same is true for most people who go into mental health. We are drawn to this profession because we are damaged — we study psychology to heal ourselves” (13–14).

Can Theo Faber help the silent, crazed Alicia Berenson?

The Silent Patient and the long tradition of female insanity in fiction

Multiple sleazy characters, intertwined plots, the diary of a madwoman, and the questionable intent of the doctors. Every element adds to the dramatic suspense of The Silent Patient and its popular success.

Ultimately, the sanity of Alicia Berenson — locked away in an asylum, driven mad by circumstances beyond her control, and facing treatment from a male doctor with ulterior motives — is not so very different from that of Bertha Rochester, driven crazy by isolation and anger and the betrayal of her husband. Or from Ophelia, reeling from the loss of her father at the hands of her lover. While Ophelia plucks flowers and jabbers songs before committing suicide, Alicia says nothing but grabs pen and paintbrush to explain her own madness.

Hand with brush painting on canvas
Artist painting

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