(Spoiler Alert) Is the mini-series “The Patient” realistic?

(Spoiler Alert) My husband asked me this question after we watched the first episode of “The Patient” together. He was curious because I endured a similar situation, albeit in much different circumstances and outcome. My response was “we’ll see”, as my opinion at the time was that often creators get characteristics of a psychopath down, but generally the story line demands logic and reason to draw a conclusion and those things are not compatible with serial killers or psychopaths. If you haven’t seen the show but intend to, please stop reading.

Quick disclaimer: I am no expert in mental health/serial killers/psychopaths and do not claim to have any authority about what I am about to write. This is my opinion based SOLEY on my personal experience. I also have no connection whatsoever to the show itself, so any bias is mine alone.

Now that the series’ first season is complete, I can confidently say that yes, the mini-series “The Patient” is a very accurate depiction of what not only being held captive feels like but also how disorientating it is to spend any significant amount of time with a psychopath.

The first thing is to break down is what I think the differences are between a psychopath and sociopath. There is a lot written about this subject and I’m going to ignore all of that and give my opinion. Psychopaths don’t experience empathy; sociopaths have a lack of it. In my experience, a sociopath is less predictable, more emotional, and has a general sense when they are doing something that hurts other people. Psychopaths do not experience empathy at all. They may be aware that they lack something, as portrayed in the show, but they do not understand what exactly it is.

A therapist once told me that a psychopath will cut open a puppy to see what is inside, whereas, a sociopath, knowing that he could get in trouble, will try to convince someone else to do it.

In the show, the patient, Sam, is reaching out to his therapist because he has become aware that killing people is something that is undesirable in our society, and he wants to “change”. I do believe this is a “feeling” (thought) a psychopath, especially one that has already killed many people, could have. The premise of the show, Sam wanting to stop killing people, is, in my opinion, realistic.

Then there is the small detail of Sam kidnapping his therapist to “make” him get better. This also seems very plausible.

Next, is the perceived loyalty Sam has to his ex-wife and mother. A diagnosed, but not violent psychopath, mother once told me that although “she doesn’t believe she can love her children; she is instinctually protective over them.” That is as close to love as she will ever get. I believe this is what drove Sam’s loyalty to the two women in life, a desire to “protect” them. However, it is not comparable to love.

One thing about the show that I really appreciated were the details of the character Sam. I think his focus on food with the multiple examples of Sam bringing Alan different types of food from different cultures, highlights something I believe to be true with people who lack empathy. They have one or two culturally appropriate things to focus their efforts on, to better conceal their darker impulses.

The second thing was Sam marriage. The couple had “adopted” (sponsored) a child in Africa and talked about her as if they were actively involved in her life. They “built” an imaginary life together with a child that lived in another country.

Another example of this type of masking was Sam’s obsession over Kenny Chesney. I think the creators really hit this example of masking out of the park. Sam was able to blur his identity into this mask because it came complete with a separate little niche society. Concerts, and outings with other fans allowed Sam to “feel a part” of something social.

Sam’s character makes for a very believable psychopath. One thing I think society has trouble understanding is that most people know, probably personally, someone that is a psychopath, or sociopath. Or at the very least, someone that falls on the spectrum of anti-social behavior. Albeit, not as many people have the experience of personally knowing a murder, the leap isn’t as wide as most people think it is. More simply put, Sam is generally a likeable character who no one suspects to be a serial killer. In my experience, psychopaths are generally likable people. Sociopaths, not as much because their behavior is more erratic and unpredictable.

There is one thing that “The Patient” does better than any show I’ve seen, is to visually show the internal disorientation that occurs when someone is trapped and the gradual process of accepting one’s death. To a lesser extent, this is demonstrated in “Handmaid’s Tale”, but it is too artistic and drawn out to be realistic.

Alan the therapist, is seen having lapses of disassociation with delusions where he is talking with his dead therapist and having other delusions including the holocaust. While the viewer may be tempted to think that this was just a way to give context and back story to Alan, it was, at least in my experience, one of the stages I went through. For me, I was able to look at my life and my relationships in their entirety. I experienced it in short rushes of memories and experiences that didn’t feel that meaningful at the time but were heavy with emotion when I thought death was coming at any minute.

The next stage is hope. This was portrayed in the show with Alan shoving a note asking for help in a dead man’s mouth with hopes that someone would find the body. Alan spends the next day sitting starring at the patio door imaging the police busting through to rescue him. In the show it was shown as short bursts followed by dialogue with his dead therapist that show he was vaguely aware that it was unlikely that anyone would come for him and that he needs to think more proactively.

In my personal experience, it was reasonable to think the police were coming, as I was successful in getting communication out. However, they did not come. After several hours of waiting in anticipation, thinking that I could hear sirens in the distance, I fell into a state of mind that I can only describe as fragmented and terrified. Hope disappeared and I struggled to accept that I need to take some sort of action or surely be killed.

Like the show, I too experienced some sense of calmness as I accepted my demise. I had to totally come to terms with my own death before I could attempt to do anything to try and save my own life. Seeing the parallels in the show was strangely comforting. Knowing that other people have survived a similar terrible experience is comforting in itself; but seeing it accurately portrayed so someone who hasn’t experienced something similar can gain some insight, impacted me in an unexpected way. I found myself very grateful for the creators of “The Patient” for not giving into the Hollywood pressure of producing for the masses.

Alan’s acceptance of death is highlighted by a note he writes to his family. He then takes a weapon he had fashioned out of a foot cream container and threatens to kill Sam’s mother if Sam doesn’t call the police and turn himself in. Alan had come to a breaking point and was done with being confined. His actions were very well thought through as he knew that he would activate Sam’s protective instinct over his mother, and he also knew that once this happened, Sam would not be able to control his impulse to kill – thus validating that despite his best efforts he cannot control his impulses and that may be enough to convince him turn himself in.

Alan was right in his expectation and is finally released from his confinement by death. There is a sense that there is no anger or suffering, only acceptance. Although, my escape was anti-climactic, it was paired with a calmness and acceptance of all things, even death. I can’t speak to being murdered but I think the show was about as accurate as one could imagine.  

My personal reflections on “The Patient” are that it is a very powerful, and accurate, depiction of both predator and prey. It serves as a reminder that no single event defines anyone, and that life is but an accumulation of choices. It also highlights the fragility of the human condition and the strength of the human soul. Two thumbs up.

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