SPOILERS ALERT! This story includes details from the last episode of FX’s The Patient on Hulu.
The patient — a dark limited series about psychotherapist Alan Strauss (Steve Carell) trying to treat serial killer Sam Fortner (Domhnall Glesson) — has ended its run on Hulu. Here, creators Joe Weisberg and Joel Fields (The American) talk about what inspired their story and why it was important to finish the story the way they did.
DEADLINE In the penultimate episode, there is a moment when Sam is watching a video of a serial killer on YouTube. I wonder if something like that happened to you that originally spawned this idea. Did it start with something like this?
JOE WEISBERG As far as I remember we started talking about this video that I think Joel saw years ago. Just the idea of a serial killer being different from other serial killers and having some sort of visible conscience or desire to get better…which is pretty unique in the annals of serial killers. As far as I remember we were talking about therapy shows and we were going to write about therapists and then it kind of all came together.
So this video shows a real serial killer.
JOEL FIELDS This is a real guy who turned himself in. He has done all of these things. This is a real interview with him. And yes, part of what made him turn himself in, he says, is that he really wanted to understand why he kept doing it. He wanted to stop. That was part of what rang our creative bell early on.
JOE WEISBERG By the way, Mindhunter invented this guy. He was also on this show but a fictionalized version of him. We brought it back to non-fiction.
When you first penned this, did you know Steve Carell’s character had to die in the end?
Weißberg: There should be a simple answer to that, but there really isn’t. I think that was our first instinct. Then there were many iterations of the ending that we talked about, that we wrote about, that we experimented with, that we played for each other. This was the one that felt the most true, authentic and meaningful to us.
Susanne Tenner/FX
Can you talk about Steve’s journey? You really see him break down.
FIELDS Oh boy. We put the guy through the bell. I mean, he put himself through the bell. He almost never worked anywhere but in the basement on this little set. He had a very small area to actually walk around in. He was chained the whole time and with a really heavy chain, you know? And the stuff he did in a dramatic way was so intense and so painful.
WEISSBERG And as you can see, he didn’t call. He wasn’t a whiner either. He’s just doing a lot of prep work and a lot of speeches. He would do the work and then go home. I remember it was a really intense day. I think maybe it was Elias [Alex Rich] was killed. The next day we got together to read through one of the episodes and he walked in and said, ‘Man, that was an intense day yesterday. It was really tough. I even had a hard time sleeping.’ And Domhnall goes behind him and says, ‘I slept like a baby.’ It was very intense work, but they also found ways to have fun.
The series becomes intensely violent, gory and dark. We’ve all been in closed environments during the pandemic. Were you concerned if this was the right topic for the time? I mean, the situation got so bad that Alan dreamed of being in a concentration camp.
WEISSBERG We actually felt it was the right topic. I think in a way the whole thing has grown out of the pandemic. We were all kidnapped by something and held in our homes and couldn’t leave. I don’t think there was that much blood. They’re looking at violence, but not too much blood. None of us are fans of blood for gratuitous purposes, or violence for gratuitous purposes, or even just to be awkward or gross. But we also didn’t want to shy away from the reality of what Sam was doing. And as much as we want to understand and even sympathize to a degree with this person who is doing terrible things, you don’t want to use that as an excuse to hide from the awfulness of what he’s doing or the impact of what he’s doing , to hide on others. The concentration camp is another part of it. That a Jewish character is kidnapped and chained in a basement and threatened with his life and forced to work to dig his own grave? If we ask ourselves the question, “What would this character think?” For us, these images came pretty instantly.
Did you also gossip back and forth about that last moment? Did you feel like you had to give the viewers a reward and Sam had to be caught by the police?
WEISSBERG I don’t think we went back and forth there.
FIELDS We’ve had a lot of discussions about what we owe, what we’ve set up for audiences to have reasonable expectations, and what we’re going to tell them. And of course we owed another part of Sam’s story, but it was very complicated. We tried many things and almost everything felt artificial or glued on until we understood that. And that felt true, like a final piece for him and his mother, Candace [Linda Emond].
Alan was the perfect therapist. He always said the right thing. Based on your years of analysis, did you know what a therapist should say? Or did you get help?
FIELDS We got help. I don’t mean, as you say, to downplay our years in analysis. We have enough years in the analysis to probably expand and help seven or eight people grow and develop. If you delve into it enough, you’ll get a feel for how it works and how it works. But nothing beats an expert. And Dennis Palumbo was ours. He’s a therapist with years of experience and he was able to sort of rearrange things and give us a therapist’s perspective on things that even a patient with years of therapy would never quite come up with. So that was incredibly helpful.
I really felt sorry for Alan and his wife [Laura Niemi]. Was his son Ezra [Andrew Leeds] rebel by becoming an orthodox Jew? Or was that just his desired path all along?
WEISSBERG I think you have the same answer to that as we do. It could have been his way all along. It could have been rebellion, or as Joe and I say, sometimes both.
FIELDS Such things can have so many causes, it can be the rebellious aspect or it can be somewhere in the middle. That’s why people are complicated and interesting.
David Alan Grier was such a brilliant choice to play Alan’s therapist, Charlie.
WEISSBERG He was just so brilliant. He’s such a wonderful actor and a great person. And it turns out that his father was a psychotherapist, so he actually grew up very close to the subject. Thanks to our casting director, Jeanie Bacharach, for suggesting him for the role. And boy was she right.
As it came to an end, did you start to think you didn’t want this to be a limited series?
FIELDS I don’t think we felt like going on like this. It was a really great experience, but it was always meant to be a one-season story. We were ready to say goodbye.