House MD: Anti-Procedural Procedural
by zunguzungu
On the surface, House, M.D. looks like a procedural. But unlike, say, The Wire, the show eschews the banality of actual every-day process, just as Sherlock Holmes stories are less a realistic narrative about police work than the fantasy of a world that where it wouldn’t be necessary. You already knew the show was not about real hospital procedure, of course; House’s ability to do as he pleases is implausible on so many different levels that it’s the primary disbelief we have to suspend to makes sense of the show. One might even suggest that this implausible fantasy is one of the guilty pleasures which makes the show what it is: the fantasy of freedom from rules (which House so often tropes on, especially with regard to Cuddy as “Mommy”).
This disbelief in process has narrative consequences, however. The teaser in the opening, for example, is always a vignette that leads up to a predetermined conclusion: one of the myriad of new faces will, by the end, “present” with a dire symptom of some sort, which eventually prompt the intervention of the show’s cast, but which will — more immediately — lead into the show’s credits. Since you know this is what is happening, and the show knows you know, they play games with your expectations as they go through the motions. Is it the little boy? Or his teacher? Or perhaps the Fed-Ex employee entering from left field? These characters will be introduced and placed in motion, but the “story” being told is as irrelevant as the national anthem before a football game, a necessary ritual that needs to be dispensed with. Or, rather, it’s the “mystery story” paradigm in miniature: can you guess the ending before it ends? And nothing else matters.
Every commercial break is more or less like this; since the logic of the show cannot allow causation to be obvious, it’s a given that the patient “seizing” or needing to be “intubated” will come out of absolutely nowhere, both immanent to the show’s narrative economy — since it has to happen — and, because unpredictable, completely unintelligible within the terms the show has set up to explain it. Moreover, because this crisis moment is (apparently) causeless, it is just as apparent that nothing can be done about it: like House’s assistants, we can only gape helpless at the awesome power of the human body to die spontaneously. It is therefore the commercial breaks which resolve the crisis of the moment, providing a temporary (but necessary) relief both to the patient and to the viewer. And when the show returns, the patient has always been stabilized in the mean time, transforming a problem of crisis into a problem which can be addressed at leisure.
What has been cut out, then, is process, bureaucratic procedure. In the teaser, after a soon-to-be-patient has collapsed — often in a public space because drama is a function of spectacle — something has had to happen to transport that patient from the crisis-space of the public to the private and controlled environment of Princeton Planesborough hospital. That thing, it is worth noting, is a function of bureaucracy: for an ambulance to arrive on the scene, there have to be rules, procedures, and a standardized system of behavior dictating how EMT people respond to a situation they do not understand in order to stabilize it. In other words, all the things that House hates about bureaucracy, the ways that rules and regulations and procedures cannot think but must simply respond according to a sharply constricted logical order, are precisely the things that an EMT’s job necessitates. After all, it is in the nature of the job that an EMT cannot understand what is wrong with their patient: this is what defines them as such.
On the other hand, not only does House live in a world in which only causation matters, but so does House, MD. House can callously ignore short-term symptoms (while in search of their cause) because, well, he can. Other people are there to pick up his trash, and while he might not do anything to keep the patient alive long enough to be cured, he can be sure that someone else will. Occasionally, he (and the show) recognize this, as in the current Cameron-as-replacement-Cuddy storyline: without the right kind of oppressive mommy figure, the bad boy doctor can’t do his job properly. And without the offstage angels of medical infrastructure — ambulance drivers and such — to make everything possible, House could not exist. But while he silently requires (and could not exist without) both a vast network of technicians and process-followers and an administration to create the conditions for his existence, think about how carefully the show works to hide them from our view. Sweeping the EMT’s under the rug of the first commercial break is only the beginning. How many nurses has the show ever bothered to name? How many other doctors in the hospital have ever been given identities? Not only is House himself uncomfortable with their presence, but the show’s narrative engine effectively works to silence them, creating the illusion of a hospital staffed by one doctor, three assistants, two colleagues, all emerging ex nihilo in a puff of narrative necessity.
The important point, then, is simply this: since narrative necessity requires untraceable chains of causation to be transformed into clear causation (somewhere inside the black-box of House’s mind), the show is terrible at thinking about why irrational rules actually need to exist. We need rote “in case of emergency” rules and procedures as a way of stabilizing crises in order that they can be properly comprehended. It is in the nature of a crisis that it is unstable, untraceable, and incomprehensible. House would be helpless in a real crisis (as he frequently is); in a situation where one’s choices are both unpredictable — when one lacks the necessary information, but still must choose — his master prognostication would be useless. So the show never puts him in that situation.
This is why it always feels like a dodge when the show wants to make the problem of House into a categorical imperative dilemma; what if all doctors were like Gregory House, it likes to ask, flouting the rules at will? But that’s simply not the right question. The actual alternative to House, M.D. is the world we actually live in, a world where there are one set of agencies and procedures for dealing with time-sensitive crises and another for taking the time to assess situations that are stable enough to do so. This is, if I may, why the show’s 24 tendency is its least intelligent one; its “ticking time bomb” scenarios might be much more interesting than Jack Bauer pablum, but it — like 24 — falls (or leaps) into the fallacy of presuming a crisis situation to negate the necessity of procedure. But crisis is precisely when procedure is most necessary; it’s when you don’t have enough information to make a good decision that you have to be prevented from making a bad one. Thus, while 24 simply invents the fiction of efficacious torture (solving the problem of insufficient information by producing information from nowhere), House has a different fictional solution: positing the non-existence of support staff and administrators, we are allowed to overlook House’s reliance on them.
Hmm — you’ve gone straight to the modern instance of show that is really reworking the Western in a vastly different form, at least the libertarian, isolated-hero-who-needs-no-community-structures angle. You can’t escape it, eh?
Thinking about all these shows that mystify not only the need for larger social structures but also their logic, I have to wonder if this is why my students have such a hard time _seeing_ structures and analyzing them.
Wait… was this post an elaborate defense of BURAUEACRACY? I kid, I kid. I wonder how far you can stretch this analysis though… essentially anything that focuses on individual agency ignores (or renders invisible) structural causes. Not to get all slippery-slope on you or anything.
And did I just mispell “bureaucracy” and capitalize it?
?? the show regularly shows house interacting with the support staff, and makes a point of his dependence on them.
J, the fact that he “interacts” with support staff isn’t the point; while the show occasionally toys with the idea of House being dependent on other people, it always, in the end, rejects the idea and makes them dependent on him. House needs support staff to the extent that they function as extensions of himself. So Winslow, the post *was* a defense of bureaucracy, in this sense: while House’s interactions with “support” staff always reinforces the idea that (as Sisyphus was getting at) the true hero doesn’t need other people, that social standards and conventions are simply one more obstacle a true hero has to overcome, in reality, there are situations where dumb, unthinking, codified “procedure” is exactly what you need. An emergency for example; when there isn’t time to think, it’s a good time to follow a procedure that’s been designed for crises. Which is what makes shows like 24 or House disingenuous: they pretend that emergency situations give people the right to go *off* the reservation.
Also, Sisyphus, I’m charmed by the idea that these shows have brainwashed our students against the idea of structure. And I think my own reliance on the “western” as a key to all mythologies is as inevitable as the third act crash cart (though I hadn’t realized that’s what I was doing when I wrote the post).
how can a show be disingenuous?
i take it that the show assumes the existence, and coherence, of situations in which life-and-death decisions are imminent but no routine procedures have proved effective at resolving the situation. but it does so in order to play with the dramatic effects of combining knowledge, proof, doubt, and interpersonal ethics revolving mostly around truthfulness and coercion.
failure to thematize something is not the same as thematizing it in a failed way.
So we’ve been watching the lighter-themed Scrubs lately.
I’m currently pondering the show where each major character’s parent or parents come to visit, and each major character is thrown into their own brnad of parent-induced-neurosis.
So you remember that I’m coming to visit in April, right? And I’m expecting a clean apartment.
J, I say the show is disingenuous, I imagine, in the same way you say it “assumes the existence of…” and so forth. I feel your point, though — and believe me, I’m a fan of the things you describe, I’m just describing the underside of those choices — but I do think there is a joy in its failure to thematize, an enthusiasm that it shares with its principal for situations where the more brilliant members of society suddenly gain a certain kind of freedom from social constraint. 24 imagines a world in which real Americans no longer have to obey the law (but for America!!@!!!), while House imagines a world in which smart people don’t have to listen or care about the opinions of stupid people. But we don’t live in a meritocratic despotism; in real life, doctors *need* mindless routine and process in ways the show strategically masks. I’m not saying the writers have an agenda, simply that the show reinforces certain misperceptions people tend to have about such things, and certain fantasies that are common about how we deal with crisis situations (put most bluntly, I think crisis is when the normal rules are *most* necessary, whereas it is common to argue the reverse, especially these days; it might be a fair point to say, though, that I’ve shoehorned an argument about the war on terror into a reading of House, but that is what I’m trying to do, and I think it works).
As for the parental visit, I deny that the post I just put up (on new technology and paternalist supervision) has anything to do with my mother commenting on my blog. Hi Mumma! I’m lucky to have parents from whom I never had to escape…
No time just now to work out what follows, but I wanted to say before I forget that, somewhere in your argument here, there’s room to examine the relationship between what you say here and House’s (the character’s) mantra that there is a reason for everything. Just one quick example: much of the tension between House and the hospital’s bureaucracy (which, as you argue, he’s ultimately dependent on) is precisely that he can find no reason in/for it–why, for example, he’s obligated to work in the clinic a set number of hours per week.
Reason, for Gregory House, is apparently some transcendent construct that places its disciples in some sort of beyond-good-and-evil-like space; workplace obligations (and interpersonal ones as well, come to think of it) are apparently some sort of violation of Reason–perhaps even something like a sin that those systems’ internal logic can’t justify (“Everybody lies”).
John, I like that a lot. The way I’m using “crisis” is as a description of situations where causation is undeterminable (or at least undetermined), and House’s insistence on reason as a solution to everything (his insistence that since everything has a reason, hold your horses while we look for it) is totally irreconcilable with that situation. And has to be ignored? But it does change the economy of morality and obligation on a fundamental level; defining Reason with a capital R allows one definition of it to trump all others.
z., i think it’s perceptive to draw an equivalence (in opposite directions?) between what our two readings are doing to the object, but i feel quite strongly like yours amounts to, basically, faulting the show for not being a different show. for, if it were not ‘masking’ the routine procedural reactions to crises that now mostly off-camera characters would have to be brought in to handle, it would actually have to have different plots, different characters, a different form. not just new ones – presumably the old ones would be affected.
regarding crises and the use of reason, it would surely be apt to focus on the vast number of times in which house’s quite ordinary, empirical, scientific demand that things be given explanations and reasons runs up against his own personal desires to save the patient or be right against the reasonable estimation that, given exhaustion of routine ideas, the patient will die without a breakthrough in the diagnosis. this is the dimension of reason relevant to the medical crises. the other stuff (like playing hooky from clinic duty, or laying scorn on the ignorant), though connected to a sense of ‘reason’, is just adolescent entertainment for nerds. and the use of reasons in the medical crises is not at all uniform; it’s often the site of the thematic differences between episodes.
j, thanks for that, that’s useful. You’re not wrong to say that I’m interested in the way House, MD isn’t another show, but I think something good comes out of that approach; knowing what it isn’t is often a good way to know what it is. That said, there might be a bad style of criticism where you totally ignore what a writer has tried to achieve and accuse it of having failed to achieve something different, but I would say that what I’m trying to do is come close to but not quite do that. After all, if I’m faulting the show, I’m faulting it for the moments when it seems *unaware* of this other show that it might be, when it doesn’t just place them offscreen, but actively effaces their existence. This isn’t an argument that it makes the wrong choices, but rather that makes simple what should be (and is) complex. The fact that Cuddy has become a total joke as an administrator (and House has apparently become unfireable), for example, doesn’t make it a better show; it would be a much more interesting show if it were *both* things, if (for example) there were real consequences for Foreman’s decision on monday’s show (and if someone spoke up for the reason why exceptions can’t be made just because we like the person, or something). That might not be the best example, but I have to get back to grading papers and hopefully it gets the point across: my bottom line is that it would be a much more interesting show if it embraced some of these choices more, if it played as many games with the “unknowability” factor in life, rather than (somewhat reassuringly) resolving every single episode as a solvable problem. In fact, I think it would do the show some good to change a bit; I was mighty disappointed with monday’s show, which seemed to be really going through the motions; I think they’ve run their formula into the ground, and the only way to refresh it will be to change in some fundamental way.
By the way, I should reiterate that that your second paragraph puts its finger on the stuff I *do* really like about the show; my argument is simply that the show should (and could) do that across a broad spectrum of areas, but that it has instead hewed to a formula that’s becoming a caricature of itself. As John pointed out, the show is most interesting when it thinks about the ways the “everything has a reason” ideology fails in practice; I want it to do that more often (and find the idea of “crisis” to be a point where it pointedly (and 24-ishly) elects not to do so).
The one House MD episode that stays with me more than many others is one from the second season in which our hero remains flummoxed when the closing credits roll. When a young girl with terminal cancer comes in for treatment, the show’s big subject (for me, anyway) is the source of what gets called her courage. House literally and figuratively wants her head examined for abnormalities; surely, Reason tells him, she should be terrified of that fact that she doesn’t have much longer to live, and the fact that she isn’t must mean that something is physically or psychologically wrong with her brain. But that’s not the case, according to Wilson. Shows like this, in which genuine human responses remain genuine and aren’t exposed by House as some sort of lie–shows in which, as Z. says above, the “everything has a reason” ideology fails to explain, are the more substantive ones.
Another, kind of unrelated thought: House is such an avowed enemy of irrationality because his crippled leg is the result of his own irrational choice, as the episode “Three Stories” from the first season reveals: an undiscovered clot in his leg has led to substantial tissue death, and the prudent, “reasonable” course would have been amputation. But House doesn’t want to lose his leg and argues instead for surgery to restore circulation to his leg, despite the near-certainty of chronic pain for the rest of his life–if the surgery worked and it saved the leg. He’s wrong and right simultaneously, though for very different reasons. But the exploring of why this has not in some way humbled him but angered him at the world (and, of course, himself, though he doesn’t admit it) is something that might also make for some decent TV drama, too.
huh, i thought the happy case above was a less substantive one because it played to the conventional: the view of house’s character / view of the world that all it needs to be fixed is some genuine, unexplainable human feeling.
isn’t there an important element of breach-of-consent in ‘three stories’ that puts house on exactly the receiving end of his normal strategy? (and a breach arrived at by collusion between cuddy and stacy, which i always took to be meant to suggest something about how house was later able to stay at the hospital, and why his relationship with stacy failed. something about residual resentment and guilt. but it never seems to have been discussed later on directly by anyone involved, so i may have just been hoping to see it.)