‘The Patient’ Walks Into the Dark Mind of a Serial Killer With Unnerving Tension

Alci Rengifo

FX’s “The Patient” gives the notion of seeking help a whole new meaning. It’s common for shows to feature self-aware killers who know they’re sick. In this series, the whole plot amounts to a 10-episode therapy session between a deranged predator and his therapist. On paper this might have the makings of a dark comedy or farcical jab at our ongoing obsession with shows about grisly crime. But it’s pulled off convincingly because the writing moves along with the confidence of imagining this scenario is possible. Another key factor is the casting of Steve Carell, who can be hilarious or powerful depending on the task at hand. Here he evokes sheer terror and empathy, giving the material, that can verge on over-the-top, a strong humanity.

Alan Strauss (Carell) is a Jewish widower and successful therapist who has the kind of calm, understanding demeanor his profession should require. Seeing patients is almost a nice respite from his slow-burning family issues. But dark fate intervenes when he has a session with a patient and municipal health inspector named Sam (Domhnall Gleeson). Alan tells Sam he doesn’t see him truly opening up. Sam takes him at his word and decides to kidnap the therapist, chaining him to the floor of a basement. Soon enough, Sam makes his intentions clear. He wants Alan to help cure him of an overpowering drive to commit murder. He practically confesses to being a self-aware serial killer and needs help to get over his sick compulsion. Terrified but empathetic, Alan indeed tries to get to the bottom of what shaped Sam into the angry, murderous man he has revealed himself to be.

“The Patient” is the latest creation from Joel Fields and Joseph Weisberg, reuniting after the major success of their previous FX drama, “The Americans.” While that was a long serial, this one is a limited series with a sharp structure. Episodes only run to a little over the half hour mark. Shows of this kind that don’t work tend to fall into the trap of believing every chapter needs to be an hour or feature-length, which can produce nothing more than boring television. By keeping the episodes compact, “The Patient” can maintain an atmospheric, eerie tone while not overstaying its welcome. It’s essential because there’s not much “action” in the story. Tension comes from the psychological, emotional standoffs at play. Alan wants to get the hell out of there, but with each passing day he grows more intrigued by this perturbed younger man who brings him take out so nonchalant. 

With each episode, both men reveal a bit more of each other and build a mirror effect. They are both full of emotional scars that won’t go away. Alan deals not only with the death of his wife from cancer and plaguing nightmares, but with the semi-estrangement of his son, Ezra (Andrew Leeds), who runs a pawn shop and decided to become a strict Orthodox Jew. It’s a kind of reverse rebellion by one’s offspring. A touching flashback to the day of Ezra’s wedding shows how his late mother, Beth (Laura Liemi) was also a cantor and defied Orthodox rules against women being allowed to sing, deciding to perform at the reception. As Alan and his patient talk, this contrasts with Sam’s own emerging revelations about a hard childhood with an apparently violent father. One of the plot’s effective angles, which could have been absurd with lesser showrunners, involves Sam’s mother, Candace (Linda Edmond), who we are surprised to discover knows about her son’s compulsions. She’s also aware of Alan’s imprisonment. With the look of someone who has given up, she admits to Alan she knows Sam is not well, but he’s her son. She can’t just turn him in.

This is how the narrative keeps going for most of “The Patient,” with small revelations and unnerving twists mostly involving Sam bringing home a new victim Alan tries to converse with through a door. Sam is also just aching to kill someone connected to his job that truly irritates him. Again, this could have easily become a dark comedy in the style of Marjane Satrapi’s “The Voices,” or a morbid entertainment like “Dexter.” Yet somehow it works because Carell brings out the tension of being entrapped while Domhnall Gleeson brings an almost cheerful, disturbing naivety to the role, as if Sam is so aloof he really thinks this is all going to end well. By the final section of the season, there is a sense Alan has broken through and is making hard-earned progress. But Sam is driven by such dark rages that (coerced) couch sessions can’t just subdue them the way other people deal with social anxiety or childhood traumas that never resulted in murder. “The Patient” doesn’t change the rules of streaming, but it’s an effective series designed wisely to be consumed in small chapters. It’s effective and in large part because the acting is so good, generating suspense from the idea that even monsters are desperate for some kind of release from their torment.

“The Patient” begins streaming Aug. 30 with new episodes premiering Tuesdays on Hulu.