First, a caveat. As many of you know, I'm a former social worker who used to work with individuals diagnosed with serious mental illness. I once interned in a state psychiatric facility, and in later jobs coordinated with various psychiatric hospitals the admissions and discharges of my clients. For numerous reasons, the picture of life in a psychiatric hospital in House is completely false. As I've stated before, House is fiction and should be taken as such. This episode is no exception.
Last season ended with House admitting himself into a psychiatric facility after experiencing hallucinations related to his Vicodin addition. This season began with House detoxing, a process that is particularly painful and ugly, something fortunately we did not focus on.
Instead, the episode officially begins when House walks into Nolan's office, demanding to be released. Nolan is willing, but refuses to sign the form that will let House's medical license be reinstated. House agrees to remain in the hospital, but vows to make everyone's life miserable.
Thus, we get One Flew Over the Cuckoo's Nest, House-style. As is his wont, House attacks the weakest area of the ward - his fellow patients. It's not hard to make a paranoid man more paranoid, or a suicidal woman more suicidal. House is sent to solitary confinement (or whatever it's called) twice before even he realizes how cruel he is being. So he pulls a McMurphy, trying to incite a riot among the patients against the ward staff, but Nolan gives the patients what they want, quickly ending that riot. Nolan then tells House he's as stubborn as House is.
House's roommate, Alvie, the "manic Hispanic", joins House in his attempts to convince Nolan to sign the form. After a failed blackmail attempt, House decides to pretend to comply, cheeking his meds and following the rules. House slowly gains ward privileges and more freedom. When House is required to give a urine sample, he arranges for another patient to provide the urine. Thus, House proves he is taking his medication. Sadly for him, the medications he had been given were sugar pills.
In the meantime, House meets Lydia, a musician who plays piano for her best friend, a mute unresponsive woman who seems to sway to the music. Another patient, Steve or Freedom Master, joins the ward.
It is in House's relationships with Lydia, Freedom, and Nolan that change finally occurs. House advocates that Freedom, who believes he has super strength and the ability to fly, be allowed to retain his delusions. When he finds Freedom overmedicated and depressed, he decides to intervene, taking Freedom on a carnival ride that simulates skydiving. Afterward, Freedom is convinced that he once again has super powers. House at first is smug, but smugness turns to horror as he helplessly watches Freedom try to fly off the upper ledge of a parking garage. Nolan decides to transfer House to another facility, but House begs him not to. Pride is gone, only the agony of constant misery remains. He agrees to therapy.
Therapy includes anti-depressants and learning to trust others. For reasons I can't explain, Nolan decides that House should practice trusting at a hospital fundraiser. Lydia is in attendance, and instead of trying to trust others, he and Lydia pretend to be other people. At the end, Lydia kisses House. What does the kiss mean? House doesn't know. Lydia is a married woman, and House isn't used to healthy relationships with other women.
Therapy also includes having to accept failure and learning to move on. When a mute Freedom returns to the ward in a wheel chair and casts, House tries to apologize, but finds he cannot. He notices Freedom staring at an object in the staff office, and House demands the staff give it to Freedom. The object turns out to be a music box, but even when given to Freedom, he remains unresponsive. House, dejected, tells Lydia their relationship is at an end. Relationships by their nature are brutal - why continue on?
Therapy includes learning to be there for other people. Nolan gives House an unexpected day pass. To a hospital. Where Nolan's father is a patient. Nolan wants a consult. House quickly determines that Nolan's father is terminal, which Nolan knew. Out loud, he processes Nolan's motivation in calling House to the hospital, finally concluding that House is the only friend that Nolan has. Nolan looks at House with tears in his eyes, "I don't need you here to play this game." House thus pulls up a chair and sits with Nolan, who makes the decision to "pull the plug."
Therapy also includes making connections with people. House returns to the hospital to find a weepy Lydia. She's not crying over him, but over her friend's illness. He hugs her, and as often happens on television, sex ensues. However, it was sweet and tender, and House cried through it.
Therapy also includes helping out others, even when you don't like the person very much. At the ward talent show, Alvie, the "manic Hispanic", has problems with his spontaneous rap. House, watching from the back, throws out a few rhymes to Alvie, and eventually joins his roommate on stage and helps make the rap a fun affair. Later, House tells Nolan that he actually feels pretty good.
House finally apologizes to Freedom, who makes no response. It's medication time, and as House wheels Freedom to the med window, Freedom gives the music box to Lydia's unresponsive friend. She takes the box, opens it, and then thanks Freedom. At last, a miracle. Lydia returns to the ward to find her friend playing the cello.
Finally, therapy involves letting people go. House learns from Nolan that Lydia and her family are moving to Arizona. House, devastated, demands an overnight pass, even over Nolan's objections. He takes a cab to Lydia's house. There, she tells him she doesn't want to leave, but she can't break up her family. Telling him their affair ended perfectly, she closes the door on him.
House returns to the hospital, and Nolan agrees to sign the form that will reinstate House's medical license. House is incredulous, but Nolan points out that House connected with someone and didn't resort to Vicodin when it ended badly. Time for House to go.
This is a long post, but this was also an intense, and two hour, episode. House stepped out of its procedural formula, and instead, focused on the character of House, the character. The character has always been the driving force behind the show, with his brilliance, sarcasm, cruelty, and self-hatred affecting everyone around him. House tries to pretend he doesn't care about the people near to him, but the deaths of Amber, Kutner, and his father were all too much for him. This extended stay in the hospital allowed him the opportunity to heal, to learn something about himself, and to reconnect with the important people and things in his life.
I've seen a number of people express their fears that with House in therapy, he'll become a shell of his former character. But the genius of this show is that it allows House to change, and even though he's in therapy, the second episode of the season saw a House that continues to be sarcastic, rude, and brilliant. Never normal, never boring, therapy can't change House that much.