Hulu's The Patient could be accurately categorized as a psychological thriller, but it often comes across as a taut stage play thanks to its minimal sets, strong performances, and engaging dialogue. It's mostly a two-hander led by Steve Carell as Dr. Alan Strauss and Domnhall Gleeson as Sam, his obstinate patient who believes that by kidnapping him, he'll be able to stop him from committing murders.
While the two engage in a cunning game of cat and mouse, the stakes increase as Sam struggles to curb his impulses, and Alan's terrifying circumstances force him to confront certain uncomfortable moments of trauma from his own past. The dialogue not only provides insight and perspective into the topic of mental health, but it reflects on thought-provoking and dynamic drama.
"You Have To Fix Me."
Sam to Dr. Strauss During Therapy
After Strauss first meets Sam, it becomes readily apparent that it's going to take time to get him the open up. While he's glib with the abuse he suffered as a child at the hands of his father, he's only willing to stick to surface-level details, yet the events clearly resonate with him decades later and are a driving force behind his violent impulses.
"You have to fix me," he says during one of their sessions, seemingly getting impatient about how long it's taking for him to "get better." As the series focuses on mental health and the "small daily experiences that can alter people's states" to an overwhelming degree, it also isn't afraid to showcase what happens when the responsible accomplishment of seeking counsel becomes a means to justify bullying a therapist into premature recovery.
"He Was Always Just Sam."
Sam's Mother To Dr. Strauss
Dr. Strauss eventually realizes he's not alone in the house with Sam, and that the upstairs is occupied by Sam's mother, Candace, who wants her son to be in therapy but also doesn't think it'll do any good. No matter what he suggests, such as discussing Sam's traumatic childhood, doesn't give her confidence that Sam will be able to get any better.
Dahmer Story attempt to explore the things that contribute to their psychosis, such as childhood environmental factors and their relationship to figures of authority in their lives. Candace dismisses such options, insisting that talking about his childhood won't reveal any truth about his impulses because "he's always been Sam."
"You're Just Looking For People Who Will Serve As An Excuse To Act Out Those Feelings."
Dr. Strauss To Sam During Therapy
The Patient has dialogue that will very possibly make viewers question the motivations behind their own actions, particularly because Dr. Strauss forces Sam to take a hard look at why he feels he needs to punish people around him for "being rude." When he gets angry enough about perceived slights, he believes the violence he inflicts is justified because they brought it on themselves with their unconscionable behavior.
As Dr. Strauss probes deeper into Sam's childhood, he begins to see that whenever Sam's father punished him for even the smallest transgression, it made it okay for him to do the same to others, perpetuating a cycle of abuse.
"Look Beyond What You're Experiencing In The Moment."
Dr. Strauss To Sam During Therapy
By now, there are many TV characters who accurately portray mental illness, with conscientious efforts to convey what it's really like to be bipolar, clinically depressed, or sociopathic. Sam's mental health is precarious, but Dr. Strauss believes if he can give him appropriate coping mechanisms, Sam won't have to use violence as a means to address how negatively he feels.
As Dr. Strauss points out, Sam interprets people behaving rudely who are just going about their business. It's clear some part of Sam holds external factors able for his reactions, and Dr. Strauss is trying to give Sam some agency back. Instead of projecting his feelings of inadequacy onto them, and punishing them for being "wrong" the same way his father could find fault with him, he is removing his culpability in their demise.
"I've Never Started On Absolute Zero."
Dr. Strauss To His Therapist In Episode 6
In order to cope with his harrowing predicament, Dr. Strauss finds himself seeking counsel from his own therapist, who's been dead for several years. These "sessions" occur in his mind as a way for him to ruminate on Sam's therapy and his own method of escape, but in puzzling out Sam's problems, they also serve as catharsis for his own trauma.
He explains that empathy is the key to building strong interpersonal relationships which help people like Sam feel more tethered to his community, and therefore unwilling to perform acts of violence against its citizens. His Herculean task is therefore to make Sam see his victims as human beings by putting himself "in their shoes" and identifying with them on some level, but he's never "started from absolute zero."
"Now I'm One Of Those Guys Who Buries People In His Basement."
Sam To Dr. Strauss In The Basement
If TV serial killers were ranked from lowest to highest kill count, Sam wouldn't be one of the most prolific, but that doesn't make his crimes (nor the reasoning behind them) any less vicious. Sam is highly unpredictable and erratic, and at the slightest provocation will justify his need to get release from the overwhelming urges he feels.
In a terrifying display of dominance, Sam kills another prisoner in his basement, which Dr. Strauss must witness firsthand without being able to prevent it. When the deed is done, Sam makes this offhanded quote followed by a "thanks a lot," essentially blaming Strauss for what he did.
"Therapy Is Not An Exorcism."
Dr. Strauss to Sam
The best fictional TV serial killers often feel glamorized in some way, and are either seen as brilliant and sophisticated operators like Hannibal Lecter, or charming and confident tricksters like Dexter. Both of these characters can easily blend into society, and even be well-liked by people around them, but not Sam.
Sam is, by contrast, of average intelligence and emotionally stunted. He isn't particularly well-liked by his coworkers. He's petulant and childish and acts on impulse, and though he is capable of forethought (such as how he chooses to dispose of his victims' bodies), he expects immediate results from his therapy. As Dr. Strauss explains, he can't force progress, and he can't pull anything out of him like an excised demon.
"Don't You Want To Take The Veils Off?"
Charlie To Dr. Strauss
The Patient's cast is found extensively in film and television, including lauded character actor David Alan Grier who has been known for his comedy sketches as part of the cast of In Living Color but here flexes his dramatic muscles. In several therapy sessions that take place in Dr. Strauss's mind, he plays his long-deceased therapist Charlie.
Charlie is both a person to seek solace and comfort with, as well as a means to challenge Strauss's own thoughts. He is his inner critic, and helps him to realize certain things about himself even as he's trying to discuss things about Sam. At one point, Charlie asks Strauss if he wants to "take the veils off," which seems to imply that his best bet of helping Sam and ensuring his own survival may be being vulnerable with him about his own problems.
"I've Been More Comionate To A Serial Killer Than My Own Son."
Dr. Strauss To Charlie
One of the biggest points of contention in Dr. Strauss's own life involves his son Ezra who became Orthodox and distanced himself from his already Jewish (albeit liberally so) family. That it happened at the same time his mother developed cancer made the ime even worse.
Strauss eventually realizes that as much as he detests Ezra's "holier-than-thou" attitude, he cannot remove his own ability in raising him to be so firm and obstinate in his convictions that he disregards all other perspectives. Strauss believes himself to be enlightened because he can see things from everyone else's point of view — everyone else, except Ezra's, and he projects his own inadequacies onto his son, mirroring in a minor way what occurred with Sam and his own father, making him appalled.
"Just Kidding. I'm Not Gonna F*** His Skull."
Sam To Dr. Strauss
In the penultimate episode of the series, Sam appears to have a breakthrough; based on Dr. Strauss's assessment that he's really mad at his father and not the people he hurts, he decides to kill his father and therefore stop the urges once and for all. In Sam's mind, he's just like Edward Kemper, an infamous serial killer who, due to abuse by his mother at a young age, killed several young women before finally killing his mother, at which point he claimed his urges stopped.
Kemper also violated his mother's corpse in certain ways which Sam makes light of, revealing a rare moment for The Patient's dark humor to emerge. It's difficult to laugh at Sam's attempt at a joke, but at the same time, the levity adds a much-needed break from the tension.
