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House, M.D. and Mental Health in Media: A Reflection

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While stigma against receiving mental health care is shrinking, understanding the process of therapy and counseling likely remains unclear to many. How do people get happy and feel better through therapy? Does media ever show it right?

After channel-flipping the other night, I tuned in to watch the recent two-hour season premiere of House, MD. I have enjoyed many episodes, but I am not a regular viewer who focuses on the names of the characters/actors or registers details of the ongoing series, so this is not a review. Rather, I am sharing my reflections as a veteran therapist on the show's depiction of mental health and the character, House. His behavior and choices as an inpatient in this episode are striking metaphors for how people can self destruct in daily life.

Under pressure, House "voluntarily" committed himself to a psychiatric hospital for drug detoxification (and other mental health issues). He had lost his medical license. He needed a medical release and recommendation from the chief psychiatrist at the hospital to get it back. House's goal was to detox, regain his license, and return to his old life as quickly as possible. He did not want to change beyond detox.

One source of my fascination with this show was how easily I saw the hospital ward through House's eyes — not as a place of emotional healing and growth but as simply people and a place to be manipulated for his purposes. Still I expected (and wanted) House to be successful with his manipulations. My goal was his goal of a speedy discharge when, even though in my reality as a therapist, I knew he needed therapeutic help well beyond drug detoxification.

In classic House style, after detox, he initially attempted to resist therapy through his typical bullying and manipulative strategies. His plan was to cause so much trouble and disruption that the facility would rush to be rid of him. Initially, he tried to control his environment by disrupting group therapy.

Then he manipulated other hospital inpatients and caused them distress. For this, he was sent to the padded room for seclusion because he wouldn't play nice. His next attempt to secure his release was to incite a ruckus over a ping-pong table without a net or paddles — again off to a stint in the padded room to regain control. The chief psychiatrist was highly skilled to handle House's every manipulative power move. I smiled with support for House and frowned at the psychiatrist.

House feared losing himself and resisted his prescription meds. He eventually pretended to take the pills and "cheeked" them; but his deceit was uncovered by the psychiatrist's clever use of sugar pills. If House was taking his meds (the sugar pills), the urine he provided for testing should have been drug-free; but House had 'borrowed' urine from another inpatient, which tested positive for prescription drugs. Gotcha! I was still rooting for House and thought 'darn it' again. That psychiatrist was smart and a step ahead.

While his leadership and intelligence were openly recognized by the chief psychiatrist, House was too smart for his own good and every effort he made to deceive was taking him further from his goal of release. But he continued his self-destructive games with my support.

I even suspected the chief psychiatrist of being less than an honorable man because House thought so. He observed the doctor's weekly afternoon meetings with an attractive woman. He recorded her license plate and finagled a call to his best friend to seek her identity through the plates in order to blackmail the psychiatrist for his release. Ahead of House's game, the psychiatrist had defused the plot. He forewarned House's friend to expect some future request that would be counter-therapeutic. So his friend declined to help. I almost supported his refusal, and felt his tug of emotion. I also felt myself beginning to come around to treatment for House.

In yet another act of huge arrogance, House second-guessed and interfered with the treatment of a particular delusional inpatient. He thought he knew better. As a result, the young man nearly died by jumping off a roof as House watched. Not until this crisis of self-confidence did House become reluctantly open to the help offered. He felt defeated and was beating himself up over his mistake. House changed his goal of getting out to a goal of getting happy.

The chief psychiatrist was not smarter than Greg House; but he knew and understood things about House that House did not. House's self-delusion of having infinite power and responsibility for fixing and knowing everything blew up. He was forced to face his horrific mistake, which revealed his dogged belief of being unlovable and unworthy if anyone knew his inner self and failings.  Because of his self-defeating beliefs, House lived his life on an unending treadmill to be right at all costs and correct his errors before being discovered and facing rejection from others. He dodged intimacy for fear of failure.

In the series, House mistreats and ridicules others over their mistakes and shortcomings, and twists into their vulnerabilities; thereby insulating himself from emotional connections and intimacy. He becomes the guy you admire enough to dislike yet pity. The abuse he administers is 'justified' under the guise of challenge, education, mentorship, and 'just House'. House always becomes miserably right — somehow.

I found myself continually drawn into his series of manipulations and rooting for him to reach his goal. On the other side, I felt a strong sense of empathy for his inability to see the true help in front of him. House's manipulative moves are versions of self-sabotaging behavior and beliefs that become habits for many unhappy people. House was trying to change everything happening outside of him without changing anything on the inside. This was the way he expected to reach his goal of returning to the comfort of the same-old same-old unhappy place in his medical profession.

People enter therapy from different paths and mindsets: voluntary, involuntary, resistant, quasi-voluntary, pressured, people-pleasing, disbelieving, last resort, optimistic, eager, clueless, confused, hopeless, helpless, hopeful, and motivated. Many orientations are not therapeutic or geared toward success.

House expected that if he continued to do what he had always done, he would get the same results he had always gotten and wanted: control. His inpatient hospitalization interrupted that pattern. Therapy is about change. House's inpatient hospitalization seemed to last about eight weeks before the chief psychiatrist observed significant change. House's emotional issues were not resolved, but he was making progress.

A developing current throughout the show was House's new friendship with a regular visitor to the psych ward. This relationship evolved into a love attachment and a very touching scene of true emotional connection for House. His emotional attachment was cut short due to the woman abruptly moving away with her husband and children — an event that had been foreshadowed.

In an emotionally brave moment, House exposed his vulnerability and expressed his feelings to her. He felt the acute pain of her loss along with the power of her nonjudgmental affection for him. He began the process of experiencing genuine emotions, and discarding defeating beliefs and replacing them with supportive thinking and honesty. This slice of healthy humanity was the change that the chief psychiatrist needed to observe to grant House his discharge and the recommendation for return of his medical license.

Shortly before his discharge, we see a happier version of House — he humbly solves a complex medical mystery in the ward and playfully smashes his face into his going away cake. He has a sort of bond with the other residents and they with him. But we are left with a solitary view of House as he boards a public bus alone to return home.

How will House continue on his path of emotional healing and wellness? Or will he? This two-hour journey has created a great start. I hope it continues. It wears on me to see unhappy people not seek the help available — even on TV.

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