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‘The Patient’ Review: Steve Carell Delivers His Best Dramatic Turn in FX/Hulu Serial Killer Drama

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Daniel Fienberg
·7 min read

While most showrunners are content to use Leonard Cohen’s “Hallelujah” for soundtrack shorthand, Joel Fields and Joe Weisberg prefer slightly deeper cuts from the Canadian singer-spiritualist.

The duo potently utilized “Who By Fire,” with its ties to the Hebrew “Unetaneh Tokef” prayer, at the climax of the fourth season of The Americans. They return to Cohen again with a song that I won’t spoil featured pivotally in their new FX limited series The Patient, which will air exclusively on Hulu.

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It’s easy to see why Fields and Weisberg respond to Cohen (or why their music supervisor thinks their shows and Cohen’s songs are a good match). Like Cohen, Fields and Weisberg are engaged in their own blending of the profane and the sacred, using the trappings of pulpy genres as a delivery mechanism for richer, more haunted storytelling that you might not be able to get people to engage in without the hook.

With The Americans, of course, Fields and Weisberg made a spy drama with an undercurrent of ’80s nostalgia, but it’s the portrait of one of the most complicated marriages in television history that makes the show special. Or maybe what makes it special is that it did both things with equal success.

Running 10 episodes, most under a half-hour, The Patient might be a harder sell. It’s a serial killer show with comedy icon Steve Carell at its center. It’s also a patient-and-shrink exercise in popular psychology. But buried on a level you definitely won’t see anybody put in a trailer, it’s a very Jewish exploration of faith and regret (that’s probably redundant). The odd part is that many people tuning in for the serial killer stuff will be disappointed, and the armchair psychiatry stuff doesn’t always work. But, driven in large part by what is possibly Carell’s finest dramatic performance to date, there’s a nuanced series here beyond the juicy pitch — it’s In Treatment meets Hannibal meets Black Snake Moan — that has caused it to linger in my mind long after completing it.

Carell plays Alan Strauss, a renowned therapist and author who wakes up chained to the floor in an anonymous basement that was probably decorated three decades earlier. In addition to the dingy carpeting, wood-paneled walls and a high-up block-glass window, the basement is furnished with a bed, a bedpan and a plastic urinal of the sort in-home caregivers might use. Patricio Farrell’s production design is, by intention, expertly banal and it’s interesting to watch how series directors Chris Long, Kevin Bray and Gwyneth Horder-Payton make use of the claustrophobic space.

Alan has been abducted by the former patient he knew as Gene, but who turns out to actually be Sam Fortner (Domhnall Gleeson), a restaurant health inspector whose treatment had reached a dead-end after initial candor about an abusive father. Part of why their sessions fell flat is that Sam hadn’t been able to open up about his real problem, namely his side gig as an apparently prolific serial killer. Sam wants to battle his compulsions to strangle people who irritate him — I mean, who amongst us…? — but he lacks the necessary coping tools and he hopes that an unorthodox, but exclusive, relationship with Alan might help.

Very quickly, a ritual is established: Sam comes home every evening with food from a different restaurant that meets his exacting standards — Vietnamese! Greek! Indian! Then they discuss Sam’s dark desires over what appears to be the finest food ever shared between an abductor and his victim. That leaves Alan with a lot of time for self-examination, and Alan has plenty to self-examine. His wife (Laura Niemi), a Reform cantor, recently died, and Alan is wracked with guilt and anger about his estrangement from his son Ezra (Andrew Leeds), whose conversation to Orthodox Judaism prompted the family schism. Unorthodox, indeed.

After the frequently painful caricaturing that occurred in Apple TV+’s The Shrink Next Door, it’s a relief to report that when it comes to its approach to the intersection of Judaism and psychiatry, The Patient is a more spiritually invested thing. Alan is extremely secular and he’s driven by his irritation at his son’s relatively new and relatively isolating beliefs, but whatever truth there is in his version of facts, there’s the built-in irony that comes from a man who demands introspection from others failing to demand the same of himself. Judaism and the field of psychiatry share similar roots and perspectives on the search for meaning, and The Patient goes at that directly and ambitiously, touching on modern philosophy and the Holocaust in a way that I found initially worrisome and then impressively considered. It’s an intro course to a bigger subject, but at least it’s an honors intro course with smart people involved.

There will always be a part of me that wishes a story with this level of Jewish specificity could have cast a Jewish leading man, but there’s no sense of Carell affecting performatively Jewish traits. It’s just a serious-minded performance into which he’s able to slip little doses of humor. He gets better and better as the season progresses, especially when flashbacks and other devices allow him to share moving scenes with Leeds and Niemi, plus a solid David Alan Grier and excellent Linda Emond in roles I won’t reveal. For what could basically be a single-set play, just two actors in a basement, The Patient builds and gets value from a very good ensemble.

Gleeson is properly skin-crawling, though I never figured out how much of the uncomfortable oddness of his styling — Wig or not a wig? Eyeliner or no eyeliner? — was intentional and what thematic weight it would carry if it were. I’m also not sure the series ever settles on how literally we’re supposed to take everything related to Sam and his homicidal pastime. To my mind, Sam doesn’t have a very believable killer process or m.o., nor is the show’s composition of his psychological profile — almost splitting the difference between nature and nurture — very subtle. Sam references Ed Kemper as an example of a serial killer with a need to unburden himself, and the character more often than not feels like somebody inspired by film or television treatments instead of a real person.

The obsession with food is a nice touch, one that viewers are left to unpack on their own or else just to accept as a means of finding empathy for a potentially vicious character. Plus, it’s an excuse for our two protagonists to sit opposite each other without overt antagonism. Since Alan’s own self-examination and unease includes stories of unnerving meals with his now-kosher-keeping family, some of the echoes are obvious. And sometimes, to paper over points of narrative thinness, the priority here just seems to be briskness — this and In Treatment suggest viewers wouldn’t want to spend more than a half-hour at a time in TV therapy — instead of depth.

I don’t mind. It’s already putting pressure on viewers to spend this much time in the tacky prison of Sam’s basement. Whatever shading hour-long episodes might provide, the risk of fatigue or the likelihood of quibbling would be great. Better to just let the little waves of intensity carry you from one conversation to the next, along with Alan’s evolving efforts at healing and inevitable contemplations of escape.

I spent the first three episodes of The Patient entertained, but waiting to see where the refinement would come. Then I spent the next couple of episodes interested, but worried the excursion into Jewishness and the Holocaust might be an overreach, before buying in entirely for a few episodes. And if the finale wasn’t entirely convincing, it still left me pondering in productive ways. Fields and Weisberg’s The Americans follow-up isn’t on that level or at that scope, but it’s five hours of good TV, worthy of consideration.

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