Editor’s note: The below contains spoilers for Episodes 1-5 of The Patient.In a crime-obsessed era of television, the 10-episode limited seriesThe Patient,starringSteve CarellandDomhnall Gleeson, ventures to explore a different approach to the story of a serial killer. Sam (Gleeson) initially seeks out a therapist, Dr. Alan Strauss (Carell), in the hopes of addressing somecompulsionsthat make it incredibly difficult for him to interact with others in his day-to-day life. He dutifully attends week after week but grows increasingly irritated over his lack of progress. He decides on behalf of the pair that the only way for him to receive proper help is if Dr. Alan is made available to treat him around the clock… so he takes him hostage.
After Alan wakes up chained to the floor in Sam’s basement is when co-creatorsJoel FieldsandJoe Weisberg(ofThe Americansfame) really start flexing their creativity within an increasingly over-saturated genre. Sam is an especially interesting antagonist; even though he is depicted as someone who wants to change his ways, his stubbornness and temper make it incredibly difficult for him to garner sympathy. He remains a looming, intimidating threat despite his decently commendable goals. Through Sam and Alan’s unstable dynamic,The Patientsolidifies itself as a high-octane crime thriller. What sets it apart from other series in this genre is that the piecing together of clues is done from a psychologist’s perspective as opposed to law enforcement.
Over the first few episodes of the series, Alan learns that Sam’s inclination towards violence has a more extensive history than he thought. Sam presents proof of having targeted multiple people and often delves into how his compulsions make him think and feel. Ultimately, he wants to be understood, but only on his terms. He steers the conversation away from the details of his family life that can anddocontain important hints to the development of his behavior. Dating back to the sessions in his office, Alan has begun collecting clues as to what the source of Sam’s anger might be. In this way, audiences are given the same breadcrumbs that might be left behind in a traditional catch-a-killer drama.
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From the moment Alan arrives in Sam’s basement, he is confronted with a specific problem: Sam has his next victim in mind, and for months he has been able to restrain himself with a great deal of difficulty. He believes that with intense therapy, he can keep these urges at bay until they eventually subside. In practice, however, he inches closer and closer to the act of murder. Alan helps to slow that process, and as a result, the episodes break down the elongated steps of his escalation. From stalking his victim to playing out the fantasy of the kill in his mind, his rationale and motivations are examined one step at a time in his therapy sessions.
There comes a point when Sam is almost unable to resist his homicidal impulses and brings the man he’s been stalking, Elias, back to the basement bound and blindfolded. Though he’s never been able to pause a murder once he’s started, everyone is now caught in a freeze-frame moment in which Sam has given himself a buffer to resist. The only thing separating him from Elias now, after months of premeditation, is physical distance. Alan insists that Sam put as much space between himself and Elias as possible in an attempt to buy time. It is only when he runs out of ways to delay him that Alan creates the opportunity to pinpoint the true source of Sam’s rage. Alan encourages him to look inward instead of acting out, “part of therapy is to look beyond what you are experiencing in the moment and to search more deeply.” This request causes Sam to confront some uncomfortable connections to his abusive father, and his aggression boils over when Elias is brought into the room.
Despite Sam’s reluctance, Alan uses what information he has available to him to try and initiate a breakthrough. Much like a police officer would piece together the evidence of a crime scene to stay one step ahead of a killer, Alan is forced into a similar situation. Now that Elias is in immediate danger, his need to achieve some sort of progress is much more urgent. At this point in the series, there has been no intervention from the police even though both Alan and Elias suspect their loved ones have reported them missing. Without much linking them to Sam, Alan bears the responsibility of keeping them both safe until Sam is caught. Because of this, he, like a detective, must collect clues to find out what makes Sam tick, and what drives his need to “teach a lesson” to those who mistreat him. Because so few people know the truth about Sam’s past, only Alan will be able to utilize this information to best maneuver his way out alive. Instead of a physical chase between police and criminal, there is a mutual pursuit of understanding, and it requires both parties to give and take.
Alan is obviously not in the position of power here, and yet he is the only thing standing between Sam and his potential victims. He has to ensure Sam’s rehabilitation without any tools, backup, or any way to protect himself. There is a huge disparity between what Alan, as a psychiatrist, has at his disposal versus what an officer would have, and yet the end goal would be the same for both: to save others from being harmed by this individual. Because Sam is, to a degree, compliant, they are put in the unique position of having to work together to prevent any more damage. This angle hasn’t been explored in this type of series nearly as often, and it is interesting to observe how police drama tropes are subverted by eliminating the “task force” aspect of stopping a killer. Typically, when cops are portrayed on television in their pursuit to catch a murderer, they are pretty far removed from certain psychological or sociological root causes of a crime. Psychiatrists are trained to examine those aspectsfirst. Without sacrificing suspense, Alan’s perspective allows a more cerebral approach to a topic that a sudden influx of content has desensitized many viewers to. While Sam is seeking help and wants to change, it is Alan’s unique perspective that constantly reminds us of the reality of the situation: there is little hope that he actuallycan.
From the beginning, Alan insists that he will be of little help to Sam while he is chained to the floor. In order to effectively do his job, he needs to feel safe and comfortable. His words have little bearing, and it looks like Alan won’t be going anywhere until Sam is satisfied with the results. What might not occur to Sam at this time is that he is asking Alan to treat thesymptomsof his psychopathy. What makesThe Patientso captivating is that, while we hope that Sam is eventually caught and Alan can be freed, the premise nor the tension rely on that moment to remain compelling. So instead of the question beingcan the killer be caught?it becomescan the killer be cured?
Research on the subject points to no, as many true-crime aficionados will tell you.Updated publicationsmake note that the idea of a serial killer simply lacking empathy is an outdated outlook on psychopathy. Many other traits factor into one’s inclination towards acting out in violent ways. They include deceitfulness, irritability or aggressiveness, lack of remorse, and failure to conform to social norms. Sam states in his first session with Alan that he’s generally unhappy, doesn’t have a good social life and is frequently angry. He also describes his feelings post-kill as “dead” — not remorseful, just not elated or energized. New research also suggests that the decision-making part of the brain is increasingly rewards-driven in serial killers. It is incredibly hard to treat someone whose brain only sees the value in their harmful actions with little regard for consequences, whether that be upon themselves or the fact that they are hurting others. For someone like Sam, hunting his next victim is all about how that can positively affect him. He will feel better knowing that he’s punished someone who he feels deserves it. All that being said, Alan’s safety or the amount of time left on his clock becomes the real point of contention. How much time can he buy drilling an empty well?
The point of view of a therapist in this suspenseful, dramatic crime thriller has unlocked so much untapped potential within the genre. The characters are vastly more enriched when we are able to dig into the innermost secrets behind their behaviors. Sam’s mother, for example, claims that his intensity may have less to do with his father than Alan might think and that he has always shown signs that this is his true nature. This foreboding statement alludes to a darker truth that despite Alan’s extensive expertise, his training may be of little help to him here. It does help the audience understand that within the mind of a killer, things aren’t always as they appear. More than an evidence board weaved together with red yarn,The Patientprovides a compelling insight into the mind of a serial killer that wants to be saved from himself.
New episodes ofThe Patientpremiere weekly each Tuesday on FX on Hulu.
