“I don’t treat the ill, I treat illnesses” –Gregory House

In the 60s, television made popular two fictional doctors, Dr. Kildare and Ben Casey, and a lawyer, Perry Mason, main characters in iconic series that brought to the general public, for the first time, the dilemmas professionals in the field of health and law had to face on a daily basis. [1]

In those days nobody talked about bioethics, much less about professional ethics, but the different episodes anticipated the two core issues of the contemporary moral debate: treatment of the body of the sufferer and the vicissitudes of the subject before the law.

House M.D., where M.D. can stand for either “Medical Doctor” or “Medical Diagnostician” – first broadcast in 2004 on Fox and ended in 2012. Wikipedia, where House has also found a place, refers to it as a medical drama – characterizing Gregory House as a maverick medical genius who heads a team of diagnosticians at the fictional Princeton-Plainsboro Teaching Hospital in New Jersey.

The character is inspired by Sherlock Holmes –as the author David Shore himself admits. The similarity of their names, their addresses (they both live at 221 B) the analogy of their respective collaborators: John Watson and James Wilson, their addictions –Holmes uses cocaine and House, Vicodin). But what really makes them soul mates is the way they tackle the enigma each case represents and the deductive strategy they use to solve it.

Patients always lie

Above all, both Holmes and House avoid getting personally involved with the case –be they suspects or witnesses in the case of Holmes, or patients in the case of House. But contrary to all evidence, this distance does not mean a lack of commitment or interest. When House avoids talking too much with the patients with the now famous line ‘patients always lie –the symptom doesn’t, what he is in fact doing is removing himself from the patient’s discourse of self, which is always shown as deceivingly consistent, even when it becomes an obstacle for the cure. That which is unfailingly hidden from the doctor is far from being a matter of chance and tends to become the missing piece that solves the puzzle of complex diagnoses. On using the information and reports he receives from his collaborators, House manages to establish the operative distance he needs to intervene without getting involved, thus breaking down the patient’s manipulation of ‘self’ and save the subject.

This distant attitude has won him the description of unsociable and surly, but this should not mislead us regarding House. If on occasions he makes sarcastic remarks to his patients it is because he symptomizes his own anxiety as a doctor in face of situations he has to deal with -like when he says to a patient who doesn’t know she is pregnant:

House: You have a parasite.
Patient: Like a tapeworm or something? Can you do anything about it?
House: Only for about a month or so. After that it becomes illegal to remove, except in a couple of States.
Patient: Illegal?
House: Don’t worry. Many women learn to embrace this parasite, they name it, dress it up in tiny clothes, arrange playdates with other parasites…(showing her the ultra sound) it has your eyes.

Or when he addresses Foreman, his African-American colleague who accuses House of riding him more and more: “Really. Well, that rules out the race thing. Cause you were just as black last week.”

But this preference for irony and sarcasm –a trait shared with Holmes- on occasions slips into a cynical position, in the philosophical sense of the term. It is this shift that we are interested in analyzing.

Philosophical Cynicism

The school of cynicism, founded by Antisthenes (-450, -366) holds that happiness can only be reached by cutting the ties that bind to worldly ideals. Antisthenes himself lived by his own conception of virtue and for him social conventions meant little, for like all cynics, he played down the importance of norms and institutions. Another representative of the Cynic School, Diogenes of Sinope, is purported to have said the well known phrase: “Stand out of my sunlight” - to Alexander the Great when, on his return from one of his campaigns, he says: “Philosopher, ask of me what you want.” Or when Diogenes is banished from Sinope for debasing the currency: “The Sinopeans have condemned me to banishment, I condemn them to stay at home.”

As can be seen, the cynic assertion can take on an ironic tone, but it separates from it, when it enters a statement of truth. Unlike sarcasm, which symptomizes the speaker’s blind spot, the cynical comment always adds to the scene, reorganizing the situational universe. Diogenes’ answer to Alexander the Great responds to the demand of the sovereign, but only to show the limitations of his power, to expose the mark of inconsistency in which it is found, without even suspecting it.

From this angle the meaning of “cynicism” differs from the one we habitually give it when we use the term - this being the reason why specialists are now proposing to use the word kynicism to refer to the philosophical position, distinguishing it from its meaning in everyday use.

When clarity and clear-headedness finds its way past sarcasm, House can withdraw himself from his own anxiety –his fears, his most intimate insecurities. And this is when House provides the series with his quota of kinism, as he himself emerges as the subject in that act. As is well known, House resists wearing the white coat and walks the hospital corridors with his cane, because of the limp in his right leg. On one occasion he says to his colleague and ‘trusty aide’, Wilson:

House: See that? They all assume I’m a patient because of the cane.
Wilson: Then why don’t you put on a white coat like the rest of us?
House: I don’t want them to think I’m a doctor.

House knows that the white coat does not guarantee medical authority and therefore, does not wish to be seen wearing this emblem. But he also knows that a doctor is not a patient – and should not be mistaken for one. The cynical comment he makes to Wilson moves him away from both medical infatuation and the demagogy of equalization. The doctor must find his place outside these simplistic considerations.

A creator of possibilities

This concept is far-reaching and brings to mind Alain Badiou’s commentary made to psychiatrists during an international conference. On referring to one of the statements made by the European Commission on Psychiatric Ethics, Badiou objects to one which states that: “the psychiatrist should treat the patient with passion, not the illness,” as opposed to Hamburger’s assertion that: the patient does not need the doctor’s compassion, but his capacity.

Indeed, if the doctor centers his practice on the “patient” it is because as such the patient has already been allotted this condition. Because the patient has already been condemned to its status of “being ill.” For the doctor to center his practice on the illness, on the other hand, opens the possibility of “[…] examining a situation of contingent impossibility and working with all the means necessary to transform it,” or more explicitly, “The ethical position will never renounce the search for a possibility as yet undiscovered. However minimal. What is ethical is to mobilize every intellectual and technical method at hand in order to activate that minute possibility. There is only ethics if the psychiatrist […] does not cease to be a creator of possibilities”

Following this line of thought, each House episode could be read as a lesson in the importance of differentiating the moral field –what is already known from a situation – from the ethical dimension, that in which the doctor emerges as a creator of possibilities.

NOTAS