House's addiction
I have something more pressing to do, but I welcome this distraction and reason to vent. I'm sure all of these things have been said before, and probably more convincingly, but here it goes. I've just read a story by kidsnurse called "Reparations" and it had to do with Wilson's culpability in the Oxy OD in "Merry Little Xmas." It's an interesting idea, and one I was glad to read, but I was bothered by some comments to it, or rather, bothered by the way they pointed out the shoddy handling of House's addiction to Vicodin on the show. Let me sketch out a few of my ideas first.
1) I think House admitted to being addicted to the pills way before he actually was addicted to pills.
2) While I think House is ultimately the one to blame for the Tritter fallout, I also think none of it would have happened had Wilson and Cuddy been responsible physicians and more honest friends.
3) I think that the writers having decreed that House is prone to a degree of psycho-somatic pain is disappointing, not because it's not interesting, but because there is still a general stigma attached to the phrase "pyschosomatic". The connotation is that House is imagining/faking part of his pain because of emotional distress. The general viewer will take that to mean that the pain (or pain increase) is NOT THERE. The fact is, people often mistake psychosomatic disorders for hypochondira or Munchausen's, but the difference is that, with psychosomatic disorders, the patient experiences real physical symptoms, including pain.
Now, someone on that thread brought up the placebo effect as proof that part of House's pain is in his mind. Cuddy tells him he's getting morphine, she gives him saline, and bang, he feels better for a bit. Keeping in mind that I've already conceded that it seems "canon" House is prone to psychosomatic experiences of breakthrough pain, being susceptible to the placebo effect DOES NOT PROOVE, in any way, that House's pain is psychosomatic.
Granted, the writers on the show set it up to play out that way by emphasizng the emotional turmoil House was in and then letting Cuddy have the last word on it, but since the writers and Cuddy both occasionally screw up where medicine is concerned, I just wanted to add that this one episode cannot represent proof of psychosomatic disorder. The fact that House felt better after the saline is only evidence of the fact that, in that one instance, he had the placebo effect. Now, in different medical situations, the supposed benefits of placebos can be almost entirely psychological, but it can and does work a bit differently when pain is in the picture, because the experience of pain is so connected with neuro-endocrine responses.
To steal an easily understood summary from wikipedia, that bastion of knowledge for a depressing majority of fic writers - "People can be conditioned to expect analgesia in certain situations. When those conditions are provided to the patient, the brain responds by generating a pattern of neural activity that produces objectively quantifiable analgesia."
House has had morphine before, he knows its effects, and his brain provided those effects to him to fill the gap between the time the "morphine" was administered until it kicked in. That anticipation of pain relief actually produces endorphins that have a physical effect on pain. Maybe that was enough to get him to the point where the massive amount of Vicodin he'd already taken levelled out his pain enough for him to feel "normal" again. Personally, I'm all for House getting on an alternative to Vicodin, because it's going to kill his liver. But shoving this reaction to a placebo in his face as some sort of proof that his pain is not real? In my opinion, it's irresponsible medicine. He debased himself to get those drugs. If you're going to use his moment of vulnerability to teach him a lesson about his drug use, be smart about it. Get him on a fentanyl patch or something, see if he's still functional and able to work, and then you'll have an alternative pain management that won't box his liver.
Again, I'm not saying his moods don't change his pain levels, but just like the writers screwed up the difference between addiction and chemical dependence in Season 1, they screwed up the meaning behind the placebo effect in Season 2. As to that...I think a lot of people in this fandom have come to the same conclusion regarding House's addiction, or at least regarding the shoddy medical reasoning behind his declaration of addiction in "Detox."
I'm not going to rant and rave about it, but just to state my opinion clearly - from everything we saw of his character in Season 1, I don't think House was addicted to the pills at that point. I DO think that Cuddy displayed an astounding amount of ignorance about the subject of addiction, though, which is just another reason I don't quite trust her whenever she tries to give her opinion on House's drug use. She used physical withdrawal as an absolute proof of addiction, completely failing to point out that physical dependence on a narcotic will lead to the same severe withdrawal symptoms. At most, I think he had pseudoaddiction at that point. Of course, once Stacy came and went, it looked like House stepped up off-label use of Vicodin, popping pills when emotionally distressed and giving the impression he was doing so because he was emotionally distressed. And then season three, with the escalating drug-seeking behavior during the Tritter storyline. Again, drug-seeking because of improper pain management (aka forcing him into detox) can be a sign of pseudoaddiction. That, coupled with the fact that House apparently went off the meds the entire time his pain was in remission, lets me believe stories that claim he's not really an addict, but honestly, it could go either way at this point. I just wish the writers of the show would explain to the viewing several the fact that it could go either way.
As to Wilson...I'm on the fence when it comes to the big walk out on Christmas Eve (both in terms of his role as a doctor and his role as a friend). Really, I'm completely ambivalent about it. What I'm not ambivalent about are the detox challenges in seasons 1 and 3, the lying about patients, the dismissal of returning pain, and the denial of antiemetics when House was going through withdrawal. I love Wilson, but he was wrong. As a doctor, and as a friend, he was wrong. I can't say if I'm basing that judgement on the fact that I don't like seeing House suffer (at least when it comes to his leg). I can't speak about doing the hard thing when confronted with an "addiction" because, thank God, I've never been in that position myself. But still, that's where I stand on things. Off the soap box now.
1) I think House admitted to being addicted to the pills way before he actually was addicted to pills.
2) While I think House is ultimately the one to blame for the Tritter fallout, I also think none of it would have happened had Wilson and Cuddy been responsible physicians and more honest friends.
3) I think that the writers having decreed that House is prone to a degree of psycho-somatic pain is disappointing, not because it's not interesting, but because there is still a general stigma attached to the phrase "pyschosomatic". The connotation is that House is imagining/faking part of his pain because of emotional distress. The general viewer will take that to mean that the pain (or pain increase) is NOT THERE. The fact is, people often mistake psychosomatic disorders for hypochondira or Munchausen's, but the difference is that, with psychosomatic disorders, the patient experiences real physical symptoms, including pain.
Now, someone on that thread brought up the placebo effect as proof that part of House's pain is in his mind. Cuddy tells him he's getting morphine, she gives him saline, and bang, he feels better for a bit. Keeping in mind that I've already conceded that it seems "canon" House is prone to psychosomatic experiences of breakthrough pain, being susceptible to the placebo effect DOES NOT PROOVE, in any way, that House's pain is psychosomatic.
Granted, the writers on the show set it up to play out that way by emphasizng the emotional turmoil House was in and then letting Cuddy have the last word on it, but since the writers and Cuddy both occasionally screw up where medicine is concerned, I just wanted to add that this one episode cannot represent proof of psychosomatic disorder. The fact that House felt better after the saline is only evidence of the fact that, in that one instance, he had the placebo effect. Now, in different medical situations, the supposed benefits of placebos can be almost entirely psychological, but it can and does work a bit differently when pain is in the picture, because the experience of pain is so connected with neuro-endocrine responses.
To steal an easily understood summary from wikipedia, that bastion of knowledge for a depressing majority of fic writers - "People can be conditioned to expect analgesia in certain situations. When those conditions are provided to the patient, the brain responds by generating a pattern of neural activity that produces objectively quantifiable analgesia."
House has had morphine before, he knows its effects, and his brain provided those effects to him to fill the gap between the time the "morphine" was administered until it kicked in. That anticipation of pain relief actually produces endorphins that have a physical effect on pain. Maybe that was enough to get him to the point where the massive amount of Vicodin he'd already taken levelled out his pain enough for him to feel "normal" again. Personally, I'm all for House getting on an alternative to Vicodin, because it's going to kill his liver. But shoving this reaction to a placebo in his face as some sort of proof that his pain is not real? In my opinion, it's irresponsible medicine. He debased himself to get those drugs. If you're going to use his moment of vulnerability to teach him a lesson about his drug use, be smart about it. Get him on a fentanyl patch or something, see if he's still functional and able to work, and then you'll have an alternative pain management that won't box his liver.
Again, I'm not saying his moods don't change his pain levels, but just like the writers screwed up the difference between addiction and chemical dependence in Season 1, they screwed up the meaning behind the placebo effect in Season 2. As to that...I think a lot of people in this fandom have come to the same conclusion regarding House's addiction, or at least regarding the shoddy medical reasoning behind his declaration of addiction in "Detox."
I'm not going to rant and rave about it, but just to state my opinion clearly - from everything we saw of his character in Season 1, I don't think House was addicted to the pills at that point. I DO think that Cuddy displayed an astounding amount of ignorance about the subject of addiction, though, which is just another reason I don't quite trust her whenever she tries to give her opinion on House's drug use. She used physical withdrawal as an absolute proof of addiction, completely failing to point out that physical dependence on a narcotic will lead to the same severe withdrawal symptoms. At most, I think he had pseudoaddiction at that point. Of course, once Stacy came and went, it looked like House stepped up off-label use of Vicodin, popping pills when emotionally distressed and giving the impression he was doing so because he was emotionally distressed. And then season three, with the escalating drug-seeking behavior during the Tritter storyline. Again, drug-seeking because of improper pain management (aka forcing him into detox) can be a sign of pseudoaddiction. That, coupled with the fact that House apparently went off the meds the entire time his pain was in remission, lets me believe stories that claim he's not really an addict, but honestly, it could go either way at this point. I just wish the writers of the show would explain to the viewing several the fact that it could go either way.
As to Wilson...I'm on the fence when it comes to the big walk out on Christmas Eve (both in terms of his role as a doctor and his role as a friend). Really, I'm completely ambivalent about it. What I'm not ambivalent about are the detox challenges in seasons 1 and 3, the lying about patients, the dismissal of returning pain, and the denial of antiemetics when House was going through withdrawal. I love Wilson, but he was wrong. As a doctor, and as a friend, he was wrong. I can't say if I'm basing that judgement on the fact that I don't like seeing House suffer (at least when it comes to his leg). I can't speak about doing the hard thing when confronted with an "addiction" because, thank God, I've never been in that position myself. But still, that's where I stand on things. Off the soap box now.