House M.D. Episode “Control”

I lam obsessed with the TV show House M.D., and in particular love the character of House.  There are so many great quotes from the show that I have used in treatment, and I hope to blog about them soon.  In the meantime, I am going to start with my thoughts on the season one House episode titled “Control.”  The basic plot synopsis is that Carly, the CEO of a major cosmetic firm, is admitted under House’s care with a blood clot in her leg. She then develops pulmonary edema (fluid in the lungs) and a bunch of other symptoms that make the team suspect that she has cancer, particularly colon cancer. She refuses to undergo a traditional colonoscopy, saying she “doesn’t want to be looked at” but agrees to a non-invasive procedure, which is negative. After this, House starts thinking about her psych symptoms, and eventually goes in while she is sleeping and realizes she cuts herself. He then deduces that she is bulimic and has been using Ipecac to induce vomiting, leading to the blood clot and heart failure. She needs a heart transplant, but the bulimia excludes her, so House lies to the transplant committee about that in order to get her the transplant.

I usually have a lot of issues with the representation of eating disorders in the popular media, but I actually really like this episode. Usually, the media feeds into stereotypes about eating disorders, always having people with eating disorders be extremely emaciated and eating about 10 calories a week. Then, they are all better once they gain weight (see recent episodes of Dr. Phil for a perfect example of this). Even when these shows feature a person who they refer to as bulimic because she bp, she is usually grossly emaciated.

However, this House episode does not do that. Carly is not grossly underweight – thin, but not visually underweight. And while her saying that she uses Ipecac to purge 3x a week sounds sort of like a writer looked up the criteria for bulimia and said “ok, the DSM says one has to purge 3x a week to meet the criteria for a diagnosis so let’s use that”, at least they don’t have her purging 30 times a day or something outrageous. Rather, this episode shows that eating disorders are serious illnesses even if the person only meets the minimum criteria and is of normal weight.

Going even further, I really like the way House talks to Carly and addresses her eating disorder. I have read a lot of reviews online where people say the opposite, but I personally like it. In short, he treats her with the same no-nonsense attitude that he treats everyone with. He tells her his diagnosis in the same manner that he uses with all of his patients – doesn’t treat her like some fragile being or give her sympathy. In doing so, he doesn’t let her get away with any of the bullshit that people with eating disorders often get away with; he doesn’t let her try and justify her actions. It isn’t because he doesn’t realize the mental issues of someone with an eating disorder, rather, he just jumps over all the stuff that is better suited for long therapy conversations and gets at the real heart of the matter – does Carly think her life is worth living? Does she care if she lives or dies? A lot of people think him asking her that question was overly harsh, but I think it was just what he needed to ask. He doesn’t have time to get into a whole therapy session with her, so he just jumps right to the end question – does she want to have a life? You can’t have both and eating disorder and a life, sorry, it doesn’t work like that.

My favorite scene though, is the last one where he visits her after the transplant, and makes a small joke about how she will now be on a strict diet, which is “exactly what someone with an eating disorder needs.” The way he delivers this line shows that he understands that the while the heart transplant fixed her physically, she still has a long way to go, she isn’t “cured.” She also asks him “why did you fight for me?” and he just says “because you are my patient.” But I think House, with his addiction, general depression, and nothing much in his life besides work, can relate to Carly. She turns to binge/purging to cope, he turns to vicodin.

The only thing I don’t like about this episode is the title.  That is the one sterotype that this episode fed into, that eating disorders are all about control. For some they might be, but not always. But, I can’t complain too much because I don’t really have an alternative title anyway 🙂

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