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‘The Patient’ Starts and Ends on a High Note

However, the tonal clashes and awkward moments of the middle threaten to overshadow a great idea and even better performances from Steve Carell and Domhnall Gleeson

FX/Getty Images/Ringer illustration

Joel Fields and Joe Weisberg know how to write relationships. The creative partners spent six seasons of The Americans plumbing the depths of the bond between Philip and Elizabeth Jennings, two KGB spies undercover as a suburban couple living near Washington, D.C. The Americans used a high-concept hook (international espionage) to ease the audience into a more mundane set of themes (marriage). At the time, the MO felt shrewd. With the showrunners’ follow-up, it looks more like a calling card.

The Patient, a new FX limited series streaming weekly on Hulu, takes on a pairing of a different sort: that of a therapist and his … you get the drift. Therapy has had something of a moment on TV lately, between the revival of In Treatment on HBO and Apple TV+’s adaptation of The Shrink Next Door. (The moment isn’t quite over; Shrinking, starring Jason Segel, entered production earlier this year.) These prior shows had their own flashy twists: Uzo Aduba’s doctor struggled with addiction and boundaries, while The Shrink Next Door told the true story of Dr. Ike Herschkopf, who all but took over his charge’s life. But The Patient takes onscreen therapy to new extremes. Dr. Alan Strauss (Steve Carell) lives a relatively normal life—until he’s kidnapped by Sam (Domhnall Gleeson), who can’t reveal his true conflict until Alan is in captivity. Sam is a serial killer, and he wants Dr. Strauss to help cure him.

As an experience, talk therapy is not as widely shared as matrimony. The Patient still uses a heightened circumstance to explore looser lines of inquiry: what therapy can and can’t accomplish; who holds the power in a session, and what happens when that dynamic is flipped; why all relationships, even clinical ones, demand openness and reciprocity. Weisberg and Fields, who cowrote all 10 episodes, have an excellent idea on their hands, one that dovetails with TV’s prevailing trends. The Patient does not take place entirely in Sam’s isolated retreat, but enough of it does to make the show friendly to pandemic-era protocols. (Almost every scene features just a handful of characters.) With its narrow scope, The Patient becomes a showcase for its central players, a common setup in this era of actor-driven endeavors. Both Gleeson and Carell rise to the challenge, though The Patient doesn’t always set them up for success.

A tense, tight, 21-minute pilot—directed by The Americans stalwart Chris Long, who also serves as executive producer—establishes a darkly comic tone, largely carried by Gleeson. His Sam isn’t a mastermind, the kind of cold sociopath we might see on Mindhunter. (Though he does watch clips of Ed Kemper on YouTube; The Patient stops short of acknowledging the full breadth of spree killer media it’s a part of, but does make Sam self-aware.) He’s a creature of impulse, an overgrown child fixated on his violent upbringing by a physically abusive father. Fields and Weisberg furnish Sam with quirks meant to provide ironic contrast. He’s an avid member of No Shoes Nation, the fandom of country star Kenny Chesney. A restaurant inspector by day, Sam is obsessed with food, cataloging the cuisines (Persian! Greek!) he brings his therapist turned hostage. He takes extended bathroom breaks Alan has to listen to on the other side of a paper-thin wall. Even murderers have to take a piss.

Gleeson, burdened with a deliberately awful dye job, weaves all these idiosyncrasies into a coherent whole. On the page, Sam doesn’t make much sense; he’s powerless against his uncontrollable urges, yet able to restrain himself enough to evade capture for years on end. But Gleeson works to bridge these gaps of logic, selling Sam as a tragic figure just deluded enough to think he can change. He gathers trophies from his victims like a textbook psychopath, but only because he wanted the murders to look like robberies. He keeps a man chained to the floor in his basement, but only to make sure he won’t do the same to anyone else.

As a stand-alone creation, Sam succeeds. But he’s cast opposite a character written in an entirely different tone, without the tongue-in-cheek touch that defines Sam’s desperation. Alan is mourning the recent death of his wife Beth (Laura Niemi), a cantor at a Reform Jewish synagogue. The pain of her passing is exacerbated by ongoing tensions with their son Ezra (Andrew Leeds), who converted to an Orthodox sect while in college. If the tensions between different denominations of Judaism sound like an odd fit for The Patient’s core themes, they remain so after watching the show.

At first, Alan’s faith is yet another source of gallows humor. Sam makes sure to mention he spoke to “three Jewish therapists” (emphasis mine) before settling on Dr. Strauss, his mild antisemitism further proof of his detachment from humanity. Some of the jokes are self-deprecating: Alan explains that kosher food is “regular food with a thousand rules,” and that Jewish funerals are like regular ones, but with “more singing than usual.” But by the time Alan starts having visions of Auschwitz in his state of delirium, we’re in much more somber territory.

In his one-on-one scenes with Gleeson, Carell is flat-out phenomenal. His character has to project authority from a place of obvious weakness, a balance we watch Carell strike in real time. (He also has some help from props: Alan wears glasses when he’s on the clock with Sam, and goes without when he’s just a man fearing for his life.) The result is one of the best roles of Carell’s post-Office pivot to dramatic acting—maybe even his best since Foxcatcher, which earned him an Oscar nomination. His Alan seems as concerned for Sam as he is rightly afraid of him. Dispensing sage advice with a shackle on his leg, he looks ridiculous and knows it, but sees no way out except through.

Yet by building out Alan’s backstory, The Patient bloats its otherwise lean story, wedging a family drama into its impressively taut thriller. Some of the context is necessary: Alan’s struggles with Ezra echo Sam’s own with his father, and fantasy sequences in which Alan speaks to his own deceased therapist, played by David Alan Grier, offer insight into what he’s thinking. At a certain point, though, Alan’s crisis of faith ceases to amplify the rest of the show and starts to distract from it. The Holocaust imagery, in particular, is jarring and borderline insensitive; Fields and Weisberg have already faced questions about casting a Gentile in the role, and they’ll doubtless face more once their audience sees Carell commune with the ghost of survivor Viktor Frankl.

The Patient begins and goes out on a high note; its creators establish a riveting scenario, then resolve it in compelling, definitive fashion. In between, however, the show overextends itself, threatening to overshadow both its leads and its own best ideas. Like too many miniseries to count, it has the air of a feature film lured out of its natural habitat. The Patient doesn’t drag. But it does wander, like Alan’s people through the desert—an awkward analogy, just like the show.