This episode in particular made me wanna post because I’m quite surprised by the (admitedly few, compared to how many there are) other comments I’ve read.

I was put in a psychiatric hospital when I was a teenager, although not in the US – in a major european country (ie not a third world country). And while several people criticize this episode for giving a negative view of a psych ward, I’ve always been bothered by how positive it seemed to me. I thought there was a tendancy in american media to show such institutions with a weird sort of quirky mood (the music in this episode particularly struck me as innapropriate: upbeat sometimes entirely silly) when my experience of a psych ward was more of a sort of garbage bin for humans – but I guess the difference in depiction stems from a difference in reality.

For example: I was amused by people showing surprise at the use of antipsychotics when I was given large doses, everyday, as a minor, for… depression (on top of the anxyolitics, antidepressants, etc.). And the anorexic 13-year-olds weren’t given points but more of a “if you reach this weight, you’ll be allowed to call your parents” kind of reward.

So I guess psych wards in the US are just nicer than where I live :P

OK, he was on it for only some number of days, so maybe the adverse effect hadn’t kicked in yet.

And if so many years of high-dose, CNS-depressant narcotics haven’t dampened his libido, or at least, his capability…..

I know, he’s tolerant to it. Still seems that 80+mg/day of Vicodin would … more dramatic license.

OK, they both mean the same, but if we’re nit-picking House, then the standard med terminology should be used here, too. :)

Question: Why couldn’t House be tapered gradually, as is *always recommended* to avoid severe adverse events of “cold-turkey” withdrawal? Or do what he did in the “Skin Deep” episode with the teen super-model heroin addict: Iatrogenic coma + opiod antagonists, or buprenorphine, etc.? Is this to “punish” him for self-medicating for unbearable pain, to discourage relapse? Or should doctors (psy included) do their best to relieve suffering and get the patient well again (physically, then we start on his psy)?

I suppose there was a time element that prohibited gradual taper, but he got the supermodel off of heroin – much stronger drug than Vic — in 24 hrs.

That said, it does annoy me when they get the little things wrong in the medicine that are ridiculously easy to get right. The dosage and directions on the Zolpidem (Ambien) bottle; shoving a pill into the mouth of a struggling psychiatric patient when he could so easily choke on it; the faulty representation of how a cochlear implant really works; Chase is suddenly a surgical savant — he can do it ALL!

@ Mr Buddwing

I don’t know if anyone has answered yet, i didn’t work through all of the 199 responses, but House last smoked when he was in rehab to get rid of Detective Tritter (unfortunately, I don’t know the exact episode). He apparently just smoked to do something forbidden, since he sat right next do a “No smoking” sign ;)

1) I have worked with people suffering withdrawal symptoms, and I’ve never seen any patient beeing locked away in a prison cell and beeing restrained to a bed (like the beginning of the episode) They normally have a “protected” living area which is closed to public but they are free to go everywhere anytime in this area. I think its an over-exaggerated image of drug rehab. Actually people in drug rehab look much more better than House!

2) You never put people away in a “confined cell” for punishment, you only do this to protect the patient from himself or to protect others and only as long as the danger is present. If you use the confinement as a method of punishment , the therapy is based on fear and comply which may be productive in case of House but not on other patients.

3) Normally Psych Nurses do check if patients are actually swallowing the pills and if there is any suspicion that the patient is hiding them in the oral cavity, most anti-psychotic medicines can be given on a liquid base (Haloperidol e.g.) or can be grinded so it’s nearly impossible to hide them.

4) The “Point” System shown in this Episode is complete crap, on a Psych Ward with such a broad spectrum of practice, it won’t work on several patients, especially not for the patient with the bipolar disorder. They would simply overrule it.

5) It’s completely unethical and a sign of a complete misunderstanding to certain disease by award a point to an anorexic patient if he eats his whole plate. His body image won’t change if he gets a point for eating more

6) On real closed wards, there is (if possible) a table-tennis-table with a net, there are board-games, a TV, a Radio, Flowers and a little bit more “neat” appearance

7) Is a normal psych – ward appopiate for a rehab patient like House? Is a normal psych ward appropiate for someone with anorexia? There are some (smaller) mental units who generally treat all of these diseases, but normally general psychiatry does not involve post-rehab patients or anorexia patients unless there is a co-morbidity involved with the drug problem

8) Are Houses Issues something for a closed Psych Unit? Are there a little bit too complex and in my opinion not life threatening or dangerous enough to monitor him on a closed ward?

9) A padded cell is useless, it is possible for the “inmate” to hurt himself seriously inside the padded cell and it would be very dangerous to approach the patient and monitor him, you would place him in a secure room with little to less furniture on a restrain bed and only if all other measures of de-escalating the situation fail. Also a restrained or solitary-confined patient needs to be monitored frequently

10) The Job of the orderlies working at the hospital is based on an image of a male nurse in the 1890’s where Psychiatric Hospitals are just beeing lockups for mental patients. The Job as a mental health nurse can be physical, but in most cases is more in the communicative way.

I’m not pleased with the overall image of Psychiatric Hospitals and treatment…it’s just far too old-fashioned and won’t help to remove the Stigma of psychiatry.