House MD and The Voices of Intelligence

'There's no need for fiction in medicine,' remarks Foster... 'for the facts will always beat anything you fancy' - Sir Arthur Conan Doyle

Dialogue is story for weekly procedurals. More so than movies, serials or prestige television, procedural shows like House MD and Criminal Minds largely follow a monster of the week structure, modelled off classic cartoons like Scooby Doo. Each episode our core cast of characters must overcome some obstacle, this is the plot. In the act, their interactions and interpersonal relationships are the story.

House MD is exactly that for the most part. Discreet, contained stories featuring the same six or so characters. Each week the titular Gregory House must work with his team of medical consultants and off-sider Wilson, to solve a medical puzzle. The first series begins procedural, with contained medical cases each week.

The dialogue and relationships between our core cast, in particular House’s nihilism and anti-social exterior, define the show. Most episodes follow a similar format: the gang takes on a case, makes an initial misdiagnosis, there’s some further medical complication, and House or his team will find a unique way to solve the case, very often resulting in House bullying a patient into treatment, or bullying the Dean of medicine to let him do a treatment.

Relationships between our characters slowly evolve, but it’s not until Universal Studios forced the creators to add a ‘boss’ character that the nature of the show shifted. The introduction of Vogler, a philanthropist who takes over the hospital board, provides our first real serialisation beyond basic characterisation. Vogler takes over the hospital across five episodes. His addition provides a real challenge for House. So far we’ve seen Greg bull through most obstacles, but Vogler is the unmovable object to House’s unstoppable force.

The two spar instantly, from petty uniform squabbles (House refuses to wear a lab coat) to Vogler interfering with House’s treatment. The two represent opposing ideologies, I suppose. House only cares about the individual patient in front of him, while Vogler only cares about the bigger picture, the betterment of all. Neither end up being compelling arguments in the end, and the hospital protects House, losing Vogler’s 100 million dollars of funding. Perhaps most curious is that Vogler is allowed to be witty, quick, just like House and Cuddy. He is a worthy foe because he can match House in their verbal exchanges, implying his nascent intelligence.

The introduction of narrative serialisation portends the show’s future: the slow evolution from procedural with serialisation to a serial with procedural elements. The story moving forward centres House, his relationship with Wilson, and his isolation.

Think of Mad Men, and the various, agonising depictions of ad men in the 70’s who didn’t, or couldn’t, change, no matter what, forever returning to their self-destructive ways while the women around them committed to change. In some ways, House starts along a similar course.

When we meet Greg House he is deeply unhappy: properly, existentially miserable. A botched leg surgery has left him in constant pain, and he is forever slamming pain pills. He shuns interpersonal relationships. His only functional friendship is with Wilson, the every-man John Watson to House’s aloof-genius Sherlock Holmes.

House and Wilson have a non-transactional relationship: they do for each other because, not for any particular reason. But when our cast opens their mouths, dialogue is brash, nihilistic. Witticism becomes the chief language of House MD. The show feels a lot like the West Wing, with Singer even imitating Sorkin’s “walk and talk” dialogue scenes, trading the corridors of Washington with the halls of Princeto-Plainsobro.

As an example, here’s an exchange between House and the Dean of medicine, Cuddy. She’s pissed at him because he’s refusing to help with an epidemic.

Cuddy: You just don’t want to deal with the epidemic.

House: That’s right. I’m subjecting a 12-year-old to a battery of dangerous and evasive tests to avoid being bored. [Everyone stares at him.] Okay, maybe I would do that, but I’m not. If it turns out she does have meningitis, you’re right, you win, but if we go back downstairs and she dies… your face will be so red.

Cuddy: You have one hour.

The show is endless strings of rejoinders, where House constantly pushes the envelope of acceptable behaviour because he ‘doesn’t care’ what anyone thinks of him. There is a charm to this jaggedness. He seems to rise above, to be compelling, despite being rude. For all this, House does eventually want to change, it seems.

Cameron, the young female on his staff, draws him into vulnerability: he must ask her to come back to work, and go on a date with her. This begins the trajectory of House as a man who discovers the pain of change, and avoids it. While he is miserable as he is, he does everything in his power to stay the same.

Every time he reaches the precipice of change, he fails to crest the hill. He is a man in constant, silent need, dogged at all times by the invisible, predatory bird on his back: addiction, not just to the pills, but to the nihilism - to the self-fladuation, to the safety of remaining the same. Often we’re told this by others in the show: the way patients react to House’s causal rudeness, his active transgressions against social norms.

Singer’s camera initially imagines House as visually distant, too. His cane and suit jacket, rather than the lab coat, afford House a distinct silhouette from his team and other cast members.

In the pilot, and Singer’s subsequent episode 3, he frames House in heavy shadows. We often view him through glass walls, or disrupted by blinds and objects - even from outside the building, looking in, as if being permitted a voyeuristic glimpse at a world cut off from our own. That we are only permitted to visit this place of twisted genius. We do not belong here.

This creates thematic contrast between the fast, snappy dialogue. The underlying implication is that only through this determined isolation can true genius thrive. That House himself seems to believe that remaining aloof, remaining an addict, is the heart of his genius.

Early in the season, House gives up the pain pills for an episode. It destroys him, and he admits he is an addict, but disagrees that he has a problem. ‘They let me do my job,’ he explains. House willingly participates in the tortured genius narrative: indeed, he constantly sabotages his relationships seemingly in service of this goal.

If he gets the right diagnosis, the collateral damage is irrelevant. This is taken to the extreme many times, where House literally ignores the needs of the many during a potential viral outbreak to treat a single patient as we discussed earlier.

And this is the real contradiction at the heart of Greg House. The paradox of House’s ideology is simple: he is dedicated to solving the medical case in front of him, which reliably saves a life, if not lives. And yet he does not care to contribute to the greater good. The needs of the many do not outweigh the few. In fact, the needs of solving the puzzle outweigh all.

This philosophy ends up being blandly nihilistic at times, but is buttressed by the core cast of characters. They all empathise with House’s plight, his pain, his trauma, but it’s only Cuddy and Cameron who challenge his active detachment. Their belief in him and half-hearted encouragement to change are played completely straight. The only realist of the story is Foreman, who operates with his own independent, arrogant set of ethics that allow him to work with House as long as it gets results. Two sides of the same coin.

At least in its incepting season, Dr Gregory House remains ineffable to us. He exists beyond, outside of. And the show participates in the proposal that this suffering, this distance, is necessary for his genius. Rather than being a treatise on genius, the show provides us the language of the intelligent, those things that make our cast superior to everyone else, to us, the prolaterate: rejoiners, sarcasm, inappropriate jokes, but above all, the will to get it done, no matter the cost.