“The Silent Patient” by Alex Michaelides :: Book Review

Trigger warnings: murder, abusive parenst, suicide & suicide attempts, self-harm, stigmatising mental health, domestic abuse fantasy, sexual assault, racism, fatphobia and body shaming.

(also, sorry for typos. i haven’t proof read this post because, i do not have the energy to relive what i wrote lol)

Before we get into this review, I wanted to share the trigger warnings with you. And yes, there’s a lot. This author didn’t spare his readers any expense when writing this book. There are a lot of traumatic elements, many of which aren’t relevant to the plot at all.

If you haven’t gathered from my tone already, I did not enjoy this book at all.

Overall rating: 1/5 stars
Genre: Thriller/mystery
Page count: 339
Synopsis: Alicia Berenson lived a seemingly perfect life until one day six years ago when she shot her husband in the head five times. Since then, she hasn’t spoken a single word. Psychotherapist, Theo Faber, wants to work with her to figure out the truth.

Overall Thoughts

I really did have high hopes about this book. It has brilliant Goodreads reviews, and the blurb sounded like something that, if nothing else, would be entertaining.

But I was actually kind of shocked to my core with this book. Not only was it badly written, but it was so problematic. And I think I learned more about the author’s unconcious bias towards women, people that aren’t white, and people that aren’t skinny, than I did about anything else.

On the topic of plot and characters, though, this was not good. I almost said “it fell short”, but no. It was worse than that. It intentionally changed the rules of fiction – and not in a good way – to work as a story.

I will be sharing spoilers in this review, but in case you don’t want to read those, here’s my mini review: This book isn’t good. It’s not entertaining. It will make you angry. The plot is so slow. Nothing happens for the first 80 pages, and then it’s scattered. There aren’t any subplots. It’s mostly dialogue. The ending is super rushed and written in a way that felt like the author didn’t really map it out detail by detail. It reads both like a debut novel, and something a successful author has lazily written because they had a deadline. It’s a weird one.

Now, for the review. I’m going to break it up into 5 parts since there are 5 parts to this book. Let’s go!

Part One :: Why Does She Not Speak?

We open the book with the million dollar question… why doesn’t Alicia speak? I wanted to know, too, of course. But really, I felt from the beginning that the reason would be have to spectacular for me to believe it, because who wouldn’t speak when their husband has just been shot? Like… has that ever happened in the history of any murder ever?

Next, we get a little background about the murder and Alicia and where she is now. And right off the bat, I’m not impressed with the writing. It’s very factual. There’s nothing sparkly about it. It’s filled with Theo’s insanely annoying inner monologue which is more about him than it is about Alicia, and I instantly don’t like him. I try to be forgiving and let him win me over throughout the book, but he’s never capable. And as I’m battling through my relatinoship with Theo, then the author begins to annoy me. Everything is a cliche, from the writing to Theo’s backstory.

Theo grew up with an abusive father. The way it’s written feels like recycled material from other books. There’s nothing unique about his situation; the author makes no effort to shed more light on it than “he was just abusive”. It’s not written in a specific way that helps me to relate or empathise with Theo. I’m just told that his dad had “unpredictable and arbitrary rages”. Why? What did he do? What does Theo feel?

Well, the author does try to tell me, let’s not brush over that. But he tells me in ways that has already been written. His desperation “gives way to nothing”, the world around him is a “world outside his house” which portrays “unimagineable beauty” “out of his reach”. The idea of freedom “burns bright, a tiny light surrounded by darkness”. Like… okay Dumbledore.

I really appreaciate when an author can be creative with their writing, but this felt like it would get flagged up on a plagarism site.

All through these chapters are Theo’s speech about how much therapy has changed him and how he’s a better person. Not only does it read like a motivational speech by someone who gets stage fright, but it’s also… not true. If you’ve read the book, you know that Theo turns out to be the “villain”. So why lie? If you’re going to write an unrealiable narrator, they can’t just lie. They have to be lying to themselves, or there needs to be some literary technique to make the lying work. Just straight up lying? No.

The next major issue I noticed in the book was the way the author wrote about their non-white characters. One person we meet is Stephanie, who is described as “Carribean”. I’m not sure how the narrator knows this, since he never asked what country she is from, but the author seems to be afraid of words like “black” or any other racial description, since he seems to instantly know which country anyone is from whether it’s the Carribean, Turkey, France, etc.

Now, throughout the book, Stephanie is Theo’s number one victim for all things intolerant. It starts off with him describing her as having a firmer and tighter grip than the man he’d previously met (so what?) and that she’s not welcoming. Then he says, “I better keep on the right side of her if I wanted an easy life” since she was “bossy”. Instant stereotyping of a black woman – that she’s going to be overbearing, inpolite, etc. Like COME ON. 2019 this book was published.

Oh and by the way, what did she do that was so bossy? Told him to carry a personal alarm to ensure his safety while working in a psychiatric unit. Nice one, Stephanie.

Speaking of, there are only female patients in this psychiatric unit. I may have missed it, but I don’t think it was a female only place? In general, having all female patients and 99% male staff, in a book written by a man, didn’t sit right with me. It felt weird. Then, we get the male staff talking abou their female patients in such a derogatory way. One says, about Alicia Berensen, that trying to talk to her was a waste of time, because she sat on her bed and stared out the window. I’m sorry but as a mental health professional – it’s literally your job to spend time with these patients, even if they’re not particularly responsive.

As you can see, I’m already unimpressed by this book, and it didn’t really get any better.

Because the next thing that irks me is the way the author sensationalises mental health, self harm and suicide. Theo is a psychotherapist, so I’m assuming he’s been taught the ethics regarding mental health. I studied journalism at uni (journalism, where the industry is riddled with unethical people) and I was taught how to be ethicaly when writing about mental health, so I was shocked to see the way Theo described suicide and self harm, using sensational langauge to portray what patients did, instead of stating the facts. It all read as very amatuer.

Then Theo begins with his theories, which carry on through the book with no evidence. For example, he makes a claim that murder never happens spur of the moment. It’s always rooted in someone’s past; there’s a moment that turned them into a violent person. Now, this is just so beyond ridiculous to me because people kill all the time in a spur of the moment attack, or – self-defense.

“Go home to your wife. Go home to Kathy, who loves you… Leave Alicia behind.” Yet another moment, where I’m screaming, “But this is your job!!!”

Speaking of Kathy, we get this backstory to how they met. Well, guess what? They both cheated on their partners to be together. Which thinking about it, ruins the book even further for me. Because the whole reason the entire mess of Alicia killing her husband even happened was because Theo was made his wife was cheating. But like… you cheated, too.

Also: here’s another example of how the author beautifies whiteness, yet no other skin colour throughout the book: “There was so much white everywhere: white sunlight… white bedsheets… the whites of her eyes. I never knew skin could be so luminous, so transluscent: Ivory white… threads of colour in white marble.” Okay friend.

Part Two :: Unexpressed Emotions Will Never Die

Then we finally, 60+ pages in, get into Alicia’s head. It felt strange to me that we weren’t in her head from the start, when clearly, she’s the more intriguing character. Anyway, we have this anecdote of her painting her husband as Jesus on the cross, and her husband is a little upset about it, and she can’t understand why. But like… that’s weird? So I’m instantly put off of her because if she can’t understand why her husband doesn’t want a picture of him being crucified, then how am I supposed to emphathise for her, too?! I can’t.

Then I begin to notice the author likes to use the word “crazy” for everything. Everyone and everything is crazy for being even just a little bit not…. typical. And normally, I could put this off to a dislikable character, but our main character is a psychotherapist!! So he should not be using the word “crazy” to describe everything.

But then again, I have no reason to trust that any of these people have a degree that would qualify them to work in a psychiatric unit, considering on page 73, the doctors are giving Alicia a horse’s dose of medication on a daily basis. Like… what?

Oh, and by the way, in case you’re wondering what’s happening in the book… Nothing. Nothing is happening. Theo got a job in the psychiatric unit and is having conversations with people that don’t allude to anything later on. That’s it. Finally, Theo starts to have sessions with Alicia but they’re actually so boring and uninteresting, that the book would be better off without the scenes in them for this section.

Then, finally, we have a subplot. Theo catches Kathy cheating. And we go from chapter 5, where Theo is at work to chapter 6, where Theo arrives home. Now, later on we find out that we’re actually jumping back in time whenever we have these “Kathy cheating” scenes, but there is no mention of that in the narration and that is the only reason the story works. The author defies the typical rules of flashbacks and flashforwards and intentionally confsues and manipulates his readers, so that we don’t realise that he’s catching Kathy cheating on him with Alicia’s husband. When I write it like this, it actually sounds kind of cool and interesting. But reading it is so beyond frustrating. We hvae this man who just found out his wife is cheating, but when he goes to work later (or so we think), it doesn’t phase him at all. So I become even less interested in his marriage and character arc because he NEVER mentions his wife, unless we’re in these unknown flashbacks.

Anyway, in the first scene where he catches his wife cheating, her laptop is open on her sexual emails with this random man whose username is literally BADBOY22. Like… no way. Second, she would not have left her laptop open. Whose laptop doesn’t have a password anyway? I hate reading about passive characters, particularly in thrillers, where everything is so convenient so the author doesn’t have to do any thinking work to make their plots work.

Anyway, it’s all very anti-climatic because the chapter ends and Theo goes back to work (but of course, this is years later, we just don’t know. Ugh. See my issue?)

Then… we got to the point in the book where I just lost all hope. I mean… I kind of already did, but this was definitely the thing that cemented my hatred of it. Theo fantasises about beating his wife, and then… crying into her arms?

“I wanted to hit her. I wanted to leap on her and beat her with my fists. I wanted to smash up the room, break the furniture against the walls. I wanted to weep, and howl, and bury myself in her arms. I did none of this.”

Theo – you cannot be redeemed now. I’m not sure if you were supposed to, but honestly, there has to be something about a character the reader can like so we enjoy reading about them. But with Theo? Nothing. And then this. Dear Authors, stop normalising the fantasy of abuse. It’s not cute. It’s not normal. It’s damaging. It’s not what real love is supposed to be.

Theo is angry because his wife is cheating, and he has this whole inner dialogue about how he’s going to tell her he knows, come clean, etc. But then he randomly decides that he isn’t going to because then he’ll “break down and fall apart”. But it’s like… stop being so passive. Just bite the bullet and tell your wife you know, because what you end up doing is so much worse, and really – honestly – makes no sense.

Then we’re introduced to the narrator’s (although I believe it’s the author’s) fatphobia. If you’re not skinny, you’re described in these ugly, sensational terms. “Up close, Elif was even more intimidating. It wasn’t just her massive size, but also…” etc. This writing doesn’t sit well with me. Also – Elif really has no role in the book other than to be intimidating. She doesn’t get an arc or really, any other agency, than being big and scary which is just awful.

Theo decides to start interviewing everyone, basically, that’s ever known Alicia, to try and figure out why she won’t speak. But really – it’s just stupid. He’s the one responsible for her killing her husband, so why go through this effort to get her to speak? Isn’t it obvious what’s going to happen? She’s going to tell the truth about that night. So I’ll never understand why Theo goes out of his way to ruin his own life. And clearly, neither does the author because there’s no real, deep, psychological reason we get at the end of the book. It’s almost like the only reason he conducts these interviews is so the author can throw in a dozen pointless red herrings for us to look at instead of Theo. This includes Max, Alicia’s brother in law, brother to her dead husband. Who’s a lawyer. Who was part of Alicia’s legal defense team for the murder of his brother. Who does that? Who, with their law firm, defends their brother’s murder? Oh, but it’s what he would have wanted… No, no he wouldn’t have. Lol. If my husband murders me, there’s no way I would have wanted my sister to then go on and defend his case. Literally. Makes zero sense.

Then we’re back in Alicia’s diary, where she reveals that Max sexually assaulted her. She doesn’t tell her brother, or anyone, because it will disappoint them to know what kind of man Max is. Since this book is written by a man, this again, didn’t sit well with me. It just kind of read as: men can get away with sexual assault because our egos and pride is more important. See? Look? Told you so. Alicia and Gabriel apparently have this close bond in their marriage, yet she’s too afraid to tell him about his predatory brother? It’s her choice, but her reasoning seemed a little off. She wasn’t scared of Max. She was just scared of Gabriel being hurt. And giving Alicia yet another passive subplot was super disappointing. Everything in this book could have been resolved with communication. But obviously the author doesn’t know how to write proper communication, hence the premise of this novel being a woman who refuses to speak.

Everything in this book could have been resolved with communication. But obviously the author doesn’t know how to write proper communication, hence the premise of this novel being a woman who refuses to speak.

We get another example of the author’s fatphobia: “She was enormously overweight – a swollen neck, fleshy forearms, massive legs like tree trunks.” This is referring to Lydia Rose, a character who, again, has no other role in the book than being fat and angry. I don’t know why the author needed so many characters, and why he coudln’t think to give them any other role than their physical appearance.

I don’t know if the author was going through a hard time while writing the second half of this novel, but there’s a sudden increase of the word “bitch”. Like any woman who isn’t pleasant, white or pretty is suddenly a bitch. It gets really really boring, really really fast.

It also felt like the author didn’t know how to pack in his book, because suddenly we are meeting even more characters. He even stars to give them some random backstories, that never become relevant. It was like he workshopped a few characters, and then just thought, “whatever, let’s throw in what I wrote for funzies”. And that’s what sorta became the middle of this book.

Then we have a lot more body shaming, micro-racism and stigmatising mental health including, but not limited to, the “fact” that “boderlines are seductive”. Not even people who have borderline personality disorder. Just borderlines. And also – what a stereotype.

Anyway, this gets Theo thinking… what if Alicia has seduced him? Keep in mind they’ve spent 2 sessions together, at about a maximum of 2 hours, and he really doesn’t ever narrate about her in any sexual or beyond friendship way. Yes, he’s fascinated with her, and very obsessed with her case, but to suddenly wonder if he’s in love with her when he knows exaclty why he’s obsessed with her case (to clear his name, I guess?) is just bad writing.

I start to realise that Theo just wants control over every female, and male (but mostly female), character in his life. When Stephanie, who is higher up than him in the world of work, is struggling, he takes delight in it because it means he has more power. We meet Barbie, who actually seems sure of herself and confident, yet that just makes Theo mad. How dare a woman be authentic, confident and exist in his social realm?! Of course, he makes sure to degrae everything about her from her “considerable amount of plastic surgery” to her “loud protestations”. Yet, he agrees to meet her later, at her house. I found it really bizarre how casual everyone seemed about going to each other’s houses even they were all basically strangers.

We find out through Barbie that Alicia had a stalker (later, we find out it’s Theo) and Barbie tells Alicia to call the cops. She doesn’t. Just because. And this is the only reason Theo got away with what he later does. Because the author ensured every character in this book was just passive enough for him to glide through his storytelling with no stumbling blocks. And it’s just bad. It’s just so bad.

Part Three :: Honest by Chance

We start off part three back in Alicia’s diary where she’s super scared of this stalker, but… not scared enough to call the police. For no reason, other than it would ruin Alex Michaelides story.

She does tell her husband, however, that someone is watching her. But of course, because she has a history of mental health challenges, or as Michaelides would say – she’s crazy – Gabriel doesn’t believe her. So that’s the subplot there squashed, and we all know what’s going to happen. I mean, Alicia literally sayas to herself, “I’m just going to forget about it.” If it was that easy… every women would just forget about their stalker and then… problem solved, right?! Or how about…. men just stop stalking women.

Nothing else really happens in this section. Alicia just thinks some thoughts, argues with her husband and ignores her stalker (even though it’s all she writes about…)

Oh, also, her diary entries? Full dialogue. Not diary writing at all.

Part Four :: Enable, Confront, Grieve

“She was too narcassistic to ever really want to hurt herself.” SAYS A LITERAL DOCTOR. aRE YOU kIDDing ME?! How did nobody flag up this extremely damaging and stereotyping of suicide? Narcasstic people aren’t immune to depression and suicidal thoughts. I couldn’t believe it when I read this line. The author hasn’t proved to know how to write about mental health properly thorughout the entire book. And when writing a book about mental health, it’s pretty important to know how.

We go back and forth between Theo’s relationship with Alicia – who is still not speaking, and now it’s lost its intrigue – and Kathy, who literally has no other personality trait than being a cheater. Like come on, give the girl some depth. We’re told she’s this amazing actress but we never see her act, and every time she’s apparently at rehearsals, she’s actually just sneaking off with her lover (Gabriel Berenson). Theo starts to follow her when she meets up with Gabriel. He listens to them having sex in a park and his inner dialogue, again, is rooted in misogyny. He can’t understand how any other man could love her. All Gabriel wants is her body. As if there’s really nothing more to her than a body. I mean, I can see why she isn’t head over heels for you, Theo…

Bad writing and poor portrayal of mental health carries us through the next few dozen pages, until finally, we learn something about Alicia. We’re on page 273 now, and we might have just learned why she doens’t speak. And it’s because her dad “sentenced her to death”. Now, that’s not exactly what happened, but it’s how the author writes it. Alicia’s mum died in a car accident while she was in the car. Her dad says, only like… a few days max after the accident, “Why didn’t Alicia die instead?” and that’s the moment Alicia apparently “dies”. I mean, yes, it’s a crushing statement, but he didn’t sentence her to death. She litearlly says “My dad just killed me”. But like… that’s not what happened. He was angry, grieving, probably speaking irrationally. And sure, it’s reason to never speak to him again, but he didn’t kill you. Because you’re still alive.

How does this link to the rest of the story? Well, it’s a stretch but we’ll find out…

First, though, Alicia has to speak. And she does. And surely this is the climax of the novel? Well. No. Not really. The writing is rushed. Theo doesn’t even record the session. And then the author literally says “Whether you believe it [what she says] is up to you.” Now, technically she does lie, but it’s this kind of writing that makes me mad. The writer is supposed to make me believe and this whole novel, he’s been loosely holding me in this slippery grip where he can’t really seem to win me over. And now, I’m even more lost.

Anyway, we get her side of the story, which does turn out to be a lie, btu it’s a badly written lie. She says that it was this random man – the stalker – who shot her husband. But if that were the case, why wouldn’t she speak? If she were innocent, she definitely would have told the authorities that someone else killed her husband. Anyway. This doesn’t turn out to be true, so it doesn’t matter, but if you’re going to red-herring me, make it worth my time.

Anyway, Theo tells his boss – which doesn’t make sense because Alicia is still not being honest, so you’re still a free man. But he doesn’t care, so Theor tries to kill Alicia by injecfting her with this crazy amount of morphine. But somehow, after being drugged, she still manages to write this super long, detailed diary entry where she reveals the truth. So close to the end of the book, and we just get the truth at the last minute. The only person who can do this and get away with it is Gillian Flynn. Sorry, not sorry.

“Alicia Berensen wanted to die. At some point she was bound to succeed. Or at least, partly succeed.” Alicia Berenson is now in acoma, and everyone thinks it’s a suicide attempt. Yet, a health professional literally says this above line. Suicide is not a success, and wow, what a disrespectful and insensitive thing to say taht her being in acoma now is “partly successful”. Man, I’m just so confused.

Then finally, we get Theo’s confession that he was the one stalking Alicia. But we get it through this reveal that the whole book has been written in this dual narrative between past and present tense. Unless you’ve read it, I can’t exaplain it, but it just doesn’t make sense the way the author has written it. Flashbacks don’t work unless it’s explicitly stated that we’re reading a flashback. This just made the whole book seem like a jumbled mess in my head.

Part Five :: Mine Own Mouth Shall Condemn Me

SO, Theo shows up at Alicia’s house one night 6 years ago “to help her see clearly” because his wife is having an affair with her husband. But like… after having Theo’s emotional speech at the beginning of how therapy changed him and he’s so wonderful and wholesome now, albeit still a little messed up beacuse sometime he gets high blah blah blah, I don’t understand why Theo thought stalking and intruding on Alicia’s life was his only option. It’s not like he ever tried anything else? And also… what happened to him not wanting to admit that he knew about the affair beacuse then he would fall apart and break down? Isn’t this far far worse?

Oh well… it’s up to you whether you believe it or not… says the author.

That’s very much emphasised in the fact that this whole section is written while Alicia is drugged with morphine. Not only is she writing a long – and I mean LONG – diary entry about it, she’s doing full sentences, inner monologues, detailed dialogue. Like… she could have just called a nurse or doctor through and told them face to face? But I don’t know, maybe that wouldn’t have been as fun to read about?

Anyway, then we get the reason she killed her husband. Theo, decidedly for some reason, tells Gabriel and Alicia that he’s going to kill one of them. Only one of them can live, and Gabriel has to choose. He chooses himself, and boom, sentences his wife to death. Sure, he did. This time, he really did. But appraently, this brings up stuff from her dad saying why didn’t Alicia die instead? But in my mind, those two events aren’t related. They both suck, but in one sitaution, a man had the power to kill her, and in the other, he didn’t. Gabriel had the power, and he chose to take it. Anyway, Theo just runs off and Alicia kills her husband in the end, I guess, because he said this. A little dramatic, but oh well. Then she doesn’t speak for 6 years, but I feel she could have maybe taken a different route in life had she spoken? Had she told the authorities about Theo? The stalker? Her husband sentencing her to death? It could have been reviewed as self defense considering the gun was still lying there after Theo left. Maybe she was scared. It all just seems way too contrived for me, and again, the fact we get this super complex and detailed analysis of emotions in only a couple of pages out of a very long book – it’s lazy.

Then we jump back to present day – bouncey bouncey bouncey all over the place – and the hosptail staff are keen to turn off Alicia’s life support because “they need the bed”. Everyone in this facility should be fired.

We get a little bit of Theo’s dialogue about why he did what he did and it all comes back to helping people. I don’t understand why he didn’t just write Alicia a letter. He knew where he lived and who her husband was having an affair with. Why did he care so much about her to awaken her from this sad little life she lived? He’d never met her in his life.

Unconvincing.

Anyway, Theo seems suuuuuper relieved because Alicia doesn’t seem like she’s going to make it and there’s no evidence that he ever knew her before working at the unit… but then, he realises the diary is missing. Oh no. Where is it? Can’t find it. Oh well. I’ll just go home to my wife, who is gaining weight – in case anybody cared. Who cares? People’s weight fluctuates! But Theo seems personally offended byt his because he’s a shallow jerk. Then a detective shows up at his house, sits down, asks for a cup of tea and Theo is super chill because the detective is super chill and it seems like he really got away with it all. In fact, we’re told many times that he is relieved.

But then… the detective pulls out the diary. Alicia has written a diary entry about Theo stalking her, basically setting her up to kill her husband and then drugging her with morphine. And you’d think, because Theo dedicated his entire life and career to covering up his tracks, that he’d be pretty bummed right now. But nope. He’s so relieved. Wait, wasn’t he just relieved about not being caught 2 seconds ago? Yep, but now he’s relieved again and the book finishes with this lovely (sarcastic) image of him catching snowflakes as the detectives tells him what he knows.

Catching. Snowflakes.

So chill.

After everything we’ve been through. Alicia is in acoma, and our villain doesn’t really care about anything enough to have any kind of human response to what he’s just been through in the last few weeks. We really were blessed with a bunch of passive characters caught up in a plot too complex for Alex Michaelades to write well enough to build a story around anything other than… silence, for the sake of silence.

7 thoughts on ““The Silent Patient” by Alex Michaelides :: Book Review

  1. Okay, I did not read your entire review because of spoilers but I’m very curious about this book now. I heard great things about it as well, and I did not expected what you described. Now I really want to see how bad it is. Is that weird? Probably!
    I guess it’s good sometimes to read very bad books, as the best ones become even better in comparison 🙂

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    1. Haha! I get this. I actually have a spoiler free review on my instagram stories right now (@bethsbookshelf). I enjoy reading bad books. It helps me a better writing, a critical reader and like you said, more appreciative of good books!

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  2. I read this book back in January and I loved it, but after reading your review I can see how you thought it was bad. I appreciate your honesty about this book. There are a lot of references that you made that I personally didn’t catch. It has made me realize that I need to think more critically when I read a book.

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    1. Oh, that’s so cool to hear this has changed your perspective on critically reading! I really think it’s so important. Entertainment and critical reading are two different things, and we can definitely still enjoy books that we realise are problematic, so don’t let it ruin your reading. ❤

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    1. I’m glad you enjoyed the book, although after reading your review, I’m still not sure what made it so brilliant in your eyes. What were your thoughts on the way Theo treats his patients? About his choice of “revenge” rather than just communicating with Alicia and her husband about the affair? A “well-tied together” ending doesn’t mean that it was a creative, convincing or well-written ending.

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