The Patient is not epic. Unlike several of the major shows arriving on TV as summer turns to fall — HBO’s House of the Dragon, the Disney+ comedy She-Hulk: Attorney at Law, Amazon’s forthcoming Lord of the Rings: The Rings of Power — it does not contain dizzying visual effects, take place in a fictional realm, or have any connections to a larger cinematic universe.
In almost every way, The Patient does the opposite of what its blockbuster-level television counterparts are attempting. While they go big, The Patient remains appropriately, suspensefully intimate and contained. For long stretches, it functions as a two-hander, with scenes that involve a pair of actors doing exceptional work opposite each other: Steve Carell as therapist Dr. Alan Strauss and Domhnall Gleeson as Sam, a patient with homicidal tendencies. Much of the ten-episode FX-produced limited series is set in a single room: the spare finished basement of Sam’s isolated home in the woods. The majority of episodes have tight run times of 30 minutes or less. The first, which debuts today on Hulu alongside episode two, lasts for a mere 20 minutes, which is precisely how much time is required to set up the show’s central premise and conflict. It is, pardon the pun, all killer, no filler.
But it’s not “all killer” in the ways you may imagine. As established early on, Sam is a serial murderer who kidnaps Alan, chains him up in the basement of his home, and insists that Alan cure him of his desire to take the lives of people he deems offensive. Minor spoiler alert: Yes, we see Sam engage in some rather violent behavior. But The Patient is not a “murder show.” It does not fixate on the grisly nature of Sam’s crimes or a police investigation into those crimes or, refreshingly, any sexual compulsions that may be driving Sam’s tendencies. Creators Joel Fields and Joe Weisberg, who gave us the masterpiece that was The Americans, steer all the way around serial-killer tropes to create a limited series that offers surprising twists and thoughtful nuance in equal measure.
Written entirely by Fields and Weisberg and co-directed by Americans veterans Chris Long, Gwyneth Horder-Payton, and Kevin Bray, The Patient emphasizes a sense of claustrophobia and isolation in every artistic choice. Carell and Gleeson are often framed in tight close-ups. When Sam returns home from work or an errand, the headlights from his car illuminate the basement as though someone has finally come to Alan’s rescue, a hope extinguished each time Sam walks through the sliding glass doors. Even the scenes that take place outside Sam’s basement, which include flashbacks to moments in Alan’s life pre-kidnapping, are often set in compact interior spaces: a crowded dinner table, the deathbed of a loved one, a small office. The Patient does everything it can to put us in a headspace that is isolated and reflective of the private, sometimes uncomfortable process of seeking therapy.
Sam initially starts sessions in Alan’s office, where Sam uses an alias and is not completely forthcoming about the depth of his problem. He kidnaps Alan on the assumption that more regular therapy in his home, where he can speak freely, will finally enable him to make a breakthrough. If Sam doesn’t reach that point, it seems very likely that Alan will become his next victim, a possibility that hangs over the series like the unspoken diagnosis of a terminal disease.
Much of the tension in The Patient naturally derives from whether Alan can make it out of that basement alive, an emergency situation at odds with the calm compassion he exudes while counseling Sam. Several episodes end cliffhanger style, including the second installment, when Alan hears movement upstairs in the house but we don’t get to see who’s there until episode three. Because the show is rolling out weekly — after the first two episodes, one will drop on Hulu each Tuesday — watching isn’t quite the nonstop heart attack it would be if The Patient were instantly bingeable. But at the very least, it definitely causes bouts of A-fib.
The Patient is about more than disturbing the cardiovascular system, though. Alan brings his own baggage into the sessions, and his issues figure as prominently as Sam’s. Via flashbacks and some imagined discussions with his own late therapist, Charlie (David Alan Grier), we learn that Alan’s wife, Beth (Laura Niemi), recently died of cancer and that Alan has become estranged from their son — losses that nag at his soul and become intertwined with the emotions he experiences in the basement. Alan’s feelings about Judaism, a matter directly related to the rift in his family, become more central as the episodes progress, giving the series a sense of gravity. On a surface level, The Patient is a thriller about a man being held prisoner by someone he’s expected to treat. On a deeper one, it’s about atonement and forgiveness, finding empathy and recognizing your own blind spots, seeking justice and realizing it does not always come, at least not in the form we may want.
While The Americans was a very different show, Fields and Weisberg demonstrate a similar gift here for threading multiple needles in tone and theme, then sewing all the pieces together in an impressive finale. As was the case on their Russian-spy drama, they are aided considerably by their star duo. The camera does right by both Gleeson and Carell, magnifying their subtle choices just enough to make them register. Playing a man whose life is defined by compulsions both dark (murder) and pedestrian (Dunkin’ Donuts coffee), Gleeson never fully relaxes. Through small tics — the clenching of his jaw, the plucking of loose flesh on his hand — he conveys how uncomfortable Sam is in his own skin and how happily he would shed it if he could just figure out how. Carell gives one of his strongest dramatic performances, conveying panic in moments of genuine distress and, more impressively, in the undercurrent that runs beneath his seemingly affable attempts to encourage Sam. Alan’s life preserver is his ability to maintain professionalism in an absolutely maddening situation, but that doesn’t mean it keeps him fully afloat. Carell keys us into just how hard he’s kicking beneath the water, briefly signaling desperation in his gaze or making a nerve beneath his right eye twitch when he hears news from Sam he doesn’t like.
We see those details only because The Patient is the kind of show that keeps its focus narrow and purposeful. Because this is an original piece of television — not based on a true story or existing source material, which is beginning to feel like a rarity — there are moments of genuine discovery and shock. As Alan advises Sam during a therapy session in which he keeps interrupting, “Sometimes when we wait, people don’t say what we think they are going to.” The Patient does that repeatedly throughout its economically constructed season, right up to the very end. It may not be the most uplifting series you’ll watch this year, but it’s certainly one of the most thought-provoking and absorbing.