FX’s The Patient Is Depressing, Overly Introspective, and Worst of All… Not About Serial Killers

The 10-episode FX series The Patient is the story of a serial killer, Sam (Domhnall Gleeson), who kidnaps his therapist Dr. Straus (Steve Carell).

When you read that premise you, like me, might think “Hey, this show will probably be aware of the humor in that idea. Surely The Patient understands it’s kind of funny, and explores the absurdity of such an out-there premise.” Well, I regret to inform you that The Patient might be one of the most deathly serious television shows ever made. It has a level of somberness and sustained depression that will put critiques of the first season of The Leftovers to shame.

The Patient is about death: thinking about death, thinking about who you’d like to be when you die, and coping with the eventual death you will face. But it’s also about fractured father-son relationships, whether it’s possible to change, and coming to an understanding with your Jewish faith. The Patient is, rather surprisingly, not about serial killers at all.

I first understood The Patient, created by Joe Weisberg, as The Americans meets Mindhunter. That’s the closest comparison that can be made, with The Patient focusing on the realistic clinical psychology of serial killers rather than the academic approach Mindhunter takes. Weisberg, co-creator of The Americans, already wrote a show that masqueraded as one thing (a series about Cold War-era spies) but really found its substance in another (dissecting marriage and familial roles).

But The Patient feels more like a show whose story was never broken. There’s a division between the premise and the product. Sometimes The Patient features phenomenal conversations between Carell and Gleeson, who are both completely immersed in this dreary world. Sometimes The Patient is reaching for deeper themes on faith and change. But these aspects never come together into one cohesive show.

For all my criticism, I don’t think The Patient is a bad show. It is technically very well done, with a perfectly unsettling score and excellent sound design. By mostly taking place in one room, The Patient is able to achieve an eerie comfortableness in such a mundane environment. Gleeson is the highlight of the series; his portrayal of serial killer Sam manages to rise above many exaggerated takes on a twisted mind to make a man who is genuinely terrifying.

The only small bits of levity and humor in The Patient come from Sam. While a serial killer, Sam is also a foodie and enjoys describing all the wonderful dishes he gets from restaurants. He’s also a major fan of Kenny Chesney and interacts on fan forums. Sam also has a strange fixation on Judaism, acknowledging he specifically looked for Jewish therapists, and seems to long for the solid religious grounding and community the religion would give him (although this idea, like many others, is not explored very much as the series progresses). It’s these little oddities that make Sam a bit more than just a generic serial killer, something the show desperately needs.

The Patient is also fairly revolutionary for its depiction of Orthodox vs. Reform Judaism. In the series, Dr. Strauss’s son converts to Orthodoxy, creating a rift between him and his Reform family. Orthodox Judaism has garnered a poor reputation in media, often harping on the extremely conservative or restricting aspects of the religion (seen in TV shows like Unorthodox or films like Disobedience). But The Patient manages to be critical of Orthodoxy without associating it with evil or abuse. Some of the best scenes of the series feature Dr Strauss and his wife, a cantor (a person who sings and leads prayer in a synagogue), wrestling with their own interpretations of their religion versus their son’s.

There is one very intense aspect of The Patient’s exploration of religion that is important to dissect, though. While Dr. Strauss is Jewish, actor Steve Carell is not. This is a controversial subject, and Weisberg commented on the casting by saying “I think our feeling has always been, as television writers, that we’re kind of in an area where people are pretending to be other people. That’s what everyone does all the time.” While I don’t believe that only Jewish actors can play Jewish characters, Dr. Strauss is not just a character who is Jewish. While chained up in Sam’s basement there are frequent illusions of Dr. Strauss imagining himself as a prisoner at Auschwitz. He’s seen in the barracks and even in the gas chambers. The extent to which Dr. Strauss is tied to his religion and the ancestral trauma of the Jewish people is extreme. So while Carell is a strong performer in the role, there is a prevailing uneasiness that comes from inhabiting this narrative. It’s a line crossed that makes Carell playing pretend by sitting in the gas chambers feel just plain wrong.

Here and elsewhere, there is a prevailing sense of missed opportunity in The Patient. The show’s heaviness is what makes it occasionally interesting, making therapy sessions a life or death affair. I’m a fan of any show that can really dive into the narrative potential of simple conversation. There are glimpses of this ability throughout The Patient, but it ultimately seems afraid to embrace this narrative challenge. When the show’s heaviness is used effectively there are some inspired emotional character beats. Dr. Strauss tries to recite the Kaddish, the Jewish prayer for the dead, but he can’t remember the words. That desperation for a way to grieve properly is powerful, but moments like that are lost in a show that never brings its warring parts together.

Unfortunately the release scheme for The Patient will likely set it up to fail. While there are some cliffhangers in the first half, by Episode 6 the show doesn’t escalate enough to keep people watching each week. The Patient is described as a thriller but it has all the thrills of slowly sinking in a bog. Given the pure depression of each episode, I doubt many people will stick with the show all the way to its conclusion.

That said, there was a moment around Episode 5 where the show started to follow me. I started to internalize my own fears of death as just another idea I have to process. I thought of the last thing I would ever hear, the last thing I would ever want to say. I started to think about if I would want a closer bond with religion at the end. I thought of looking through a window and wanting to see hope in the trees. The Patient managed to spur a lot of thinking—just not about the show itself.

The truth is The Patient won’t work for everyone, or even probably most people. If you want a serial killer show, you will be disappointed. If you want a true successor to The Americans, you will also be disappointed. The Patient takes you somewhere complicated, and it is not an easy watch. It doesn’t always work, it’s underdeveloped, and it’s often a profound bummer. But it’s been weeks since I first watched the series and I still think about Dr. Strauss trying to recite the Kaddish but not knowing the words. Not a lot of shows come around with a moment like that.

The Patient will premiere on Hulu with two episodes Tuesday August 30th, followed by weekly release.

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