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Skin Deep Review

Skin Deep


One of the most powerful Season 2 episodes, Skin Deep explores the issue of House’s leg pain and dependence on pain killers in quite a different way than did Season One’s Detox.  The POTW this time is a young supermodel, who House shows an interest in right from the beginning. 


The episode opens with House (after the teaser) with House awakening on a rainy day.  We see House as he probably begins each day, painfully aware of his leg, trying to rub away the ache that is there each morning.  He gets up slowly, gingerly testing his leg, making sure it can support him.  On this morning it can’t, and his leg gives out from under him, making him collapse back onto the bed.  You wonder how many mornings like this House experiences every month. 


Somehow, he makes it into the hospital, somewhat worse for wear—enough that Wilson notices.   Wilson annoyingly calls House on the pain, jabbing him meanly about it.  House deflects as ususal. 


The POTW and House—On the surface, House and the POTW have a connection.  Are either (or both) of them victims of PTSD (Post Traumatic Stress Disorder)?  House explores the idea during the diagnostic process, but one gets the sense that he is also exploring the possibility about himself.  As he discusses the effects of PTSD with the father at one point, he explains that the physiological effects of psychological conditions can cause be severe enough to kill.  As he explains this to the father, you can see the flicker of recognition in both House’s expression and in Hugh’s delivery of the speech.  House is considering whether his own increased pain, as suggested by Wilson, is psychological in origin. 


I loved the subtle way that House was ProjectedImage!House to his staff, while being TruthSeeker!House in the subtext and between-the-lines storytelling.  He projects his lecherous jerk image well from the beginning.  He goes in to see the patient and observes much about her, takes a cursory history, but I think, simply from their conversation, figured out the heroin.  His disdain for the father is clear from the start, and he suspects, even from their first meeting, that the girl is being exploited by her manager-father.  It’s interesting that Cameron believes House’s projected image so well at this point (he’s no longer her tarnished knight at this point) that she assumes that he simply went into to talk to the patient to gawk at her.  House feeds that supposition by his reply to her about the hypocrisy of sexualization of teenage girls, while forbidding contact with them at that age.  It’s done in such a way that Cameron leaves believing that House is a lech rather than being disgusted by the notion.


I think sexual abuse and exploitation is a hot button issue for House.  It’s been quite consistent that he disdains and is digusted by parents or other adults that exploit or abuse children.  It’s been a consistent character trait since the beginning of the series. 


House reads the tabloid-mag, reading out the description of the girl from the interview.  He appears to be completely engrossed in it, much to the chagrin of both Cameron and Foreman.  But House has an ulterior motive.  He’s looking for clues to support his sexual abuse/PTSD theory.  His reaction to the father as soon as he finds out that dad slept with the girl, he disgustedly and rather pointedly tosses the magazine in the trash where (in House’s opinion, it is clear) it belongs.


House really doesn’t have a lot to do with the girl, and after the initial meeting, barely looks at her other than to tweak her iv line.  At no time does he (contrary to what would be expected of him) pay undue attention to her, gawp at her, or otherwise treat her exploitively.  So, shut up Cameron J


House’s relationship with the dad is at best confrontational from the start, as House takes an immediate dislike to him, probably understanding that as his daughter’s manager, he’s probably objectifying her (at best). His opinion of the guy grows worse as the episode wears on.


So why not report the guy?  My guess is that what he told Cameron was the truth.  That investigating the guy would throw them on a tangent they couldn’t afford to be and he needed the guy around in case he needed more information.  House also probably knew that the guy (sleaze that he is) would deny it and the case would go nowhere, and again, waste valuable diagnostic time.


I did think that House was unduly harsh in the revelatory scene when he lays it out for the dad.  I know he did it to smack the dad, but the girl/boy is an innocent bystander (sort of) in this.  Although knowing what he probably did about him/her at that point (that she was equally exploitive and manipulative) probably didn’t make him too sympathetic to either one of the duo.


House and the team:  I thought the first really interesting team moment (aside from the first little conversation with Cameron, who assumes that House is interested in the case because she’s a teen supermodel) was when House’s leg gave out and he fell into the credenza.  House’s pain at this early point is definitely obvious, and as he gets up to get some coffee, he stumbles, nearly toppling himself and the contents of the credenza.  The only reaction is a pause in the conversation.  The team know that House eschews anything resembling pity, so they know better than to try to help him, something that doesn’t go unnoticed by  House, who snarks at them about their lack of sympathy (he has taught them so well).  Foreman picks up on the increase in House’s pain and is predictably snotty and arrogant about it.  He tries to give House advice and House takes his point, but points out correctly that if Foreman has an issue with House’s medical decisions he should not make it personal.   This is something that House is always teaching:  one needs to separate personal biases and assumptions and medical issues.


Both Cameron and Foreman have an issue with House not reporting the dad.  Although Cameron is terrified that there will be repercussions from House because of it, House, true to what we know about him, does not  punish her for it.  “you did what you thought you had to do.”  He will never call a subordinate for standing up for what they believe.  He lets them “get away” with more than most bosses would, because of it.  It his way of teaching independence and out-of-the-box thinking. 


House and Wilson  --  Hmm.  Wilson continues his harping on House, certain that House has a conversion disorder.  Although Wilson really redeemed himself with that MRI scene.  House was clearly worried in that scene.  The expression on his face was of gave concern, concentration and anxiety.  Wilson made him laugh almost in spite of himself with his “God” routine.  Great bedside manner, Wilson.  In that scene anyway.  But I think Wilson, like House, knew what the MRI would show:  no change.


House and Cuddy:  This could be a six page essay all on its own!  House is desperately in pain during this episode.  I think breakthrough pain—and it is the start of his physical decline throughout the latter part of season 2.  The pain builds all during the first half of the episode (even while trying to diagnose the girl—not while he’s bored) and finally to the point that he believes an intracathetal (spinal) injection of morphine is the only way to control the pain.  It’s extreme, but not an unheard of treatment for chronic uncontrolled pain. He goes to Cuddy while she’s still upset with him for not reporting the dad.  It’s clear that this is not something he wants to admit to her or to do.  He decides not to go to his staff, because they would question his judgment if they knew exactly how much pain he’s in.  Foreman, in fact already questions the effect of the pain upon his judgment.   At this point, while he knows that Wilson believes his pain to be psychological in origin, he trusts Cuddy to treat him.  He is her patient, and he’s at his most desperate.  He’s not resorting to self-treatment; to mainlining morphine or any other injectables.  He’s trusting Cuddy to help him.  She is resistant to treating him, agreeing with Wilson; dismissing him by telling him to take more pills if he’s in so much pain—or get one of his lackeys to do it.  She is completely dismissive of his pain and the desperate state he’s in.  House then plays a card he’s reluctant to play, he reminds her quite visibly what she had a part in doing to him.  He drops his pants and reveals the horrible scar that was left after his surgery.  At this point, House is panicked, afraid, desperate, hurting and at the end of his emotional and physical rope.  We are right with him.  Cuddy relents (we think) and gives him a shot.  We think it’s morphine. But it’s revealed that she has given him a placebo.  She did it to prove to him that his pain was “imaginary.”  Not real.  It’s a terrible thing to do to him.  Even if his pain is psychological in origin, it’s still real enough, as he tells dad about the girl, to kill if severe enough.  When Cuddy ultimately reveals that she gave him a placebo and not morphine, and then leaves him standing alone in her office, it is cruel.  To leave him alone to deal with this information was a terrible thing.  I hope that it was only the cut in the scene and not what actually (behind the scene) happened between them.  There is such a thing as “placebo effect.”  It’s amazing what believing that your symptoms are being treated will do to make you feel better.  It’s a real effect and it’s probably what happened to House.  And if he thought about it, he’d realize it.  But instead, with his consistently low self-esteem and self-hatred, believes Cuddy’s words.  Which brings us to the final scene of the episode.


Whew.  That final scene will go down in my mind as one of the most powerful scenes of the show.  No dialogue.  Just House, engaged in a silent, terrible battle with his own pain.  He leaves Cuddy’s office not knowing how much, if any, of his pain is physiological in origin.  If it’s psychological, he must reason, then he can overcome it.  He doesn’t need to medicate it.  He can will it away, or distract it away.  He assumes Cuddy is right.  Contrary to his well-known, surficial arrogance, House is not sure of himself about a great many things.  This is now another.  We find him playing that gorgeous Bach French Suite.  A tremendously difficult, complex piece.  I love Bach, so I was in complete heaven seeing him play all those trills and triplets and grace notes.  The camera pans in on his face.  He is concentrating on ignoring the pain that is surely building in his leg, and his growing sense that he’s losing the battle with it.  His vicodin is there.  A relief valve against the pain if it become too much.  As he plays, the pain is finally too much, and even the distraction of the Bach piece won’t help him as he hits a wrong note, the pain winning this battle. 


He pours out the bottle of vicodin reluctantly.  He believes that he is succumbing to something not real.  Something in his head.  But he takes the pill anyway, shame written across his face.  He feels trapped by the pain, by his state of mind and by the pills.  He’s not sure of anything anymore.  And that’s how we’re left.


This is where Cuddy (and Wilson) did House a terrible disservice and what, I think, led to the discussions they must’ve had about ketamine later, and ultimately the treatment.  She was mad at him and very unsympathetic as a result.  She wanted to “show” him, by the saline injection that  it was (as Wilson believes) all in his head.  But it’s not.  And to make House believe that about himself—a man who is all about the mind, intellect and trusting in the power of his reasoning skills and mind—is unbelievably cruel.  I think this episode led to House’s putting together his own little morphine kit, which he then resorted to in WYD.  He can trust no one about his pain, but himself, until cuddy finally sees the error in her own judgment of House.


The image of House sitting at his piano, so depressed and in pain, he is nearly in tears, gripping his leg, eyes closed as he hopes the vicodin would work, as the camera pans back, is one of the most indelible final scenes in the series (IMHO)




As usual you have captured exactly what I felt about this disturbing and excellent episode.
I too was bothered by the cruelty of the two scenes you mention--HOuse's unnecessary cruelty to the POTW (which just felt like bad writing to me), and more importantly Cuddy's real cruelty to him with the saline injection. Having begged and trusted her, as House did--and it is so hard for him to trust and allow himself to appear vulnerable--how can anyone fault him for turning to morphine later, when no one will listen?

This episode--and especially the last two scenes--really got to me in a visceral way, and you described beautifully exactly why.
You're right. House and Cuddy never seem to do the right thing by House concerning the pain. It's all very well and good to say that they're not fostering an addiction or not admitting that the pain is all physical but they just seem to always stuff it up for House, basically, with the games that they play.

I think Wilson's fine on his own, in this episode, at least. Although House runs the usual gauntlet as he comes in Wilson enquires after his wellbeing. He doesn't push the issue, though, leaving us to imagine exactly how he got to work. Wilson does, however, help him with the MRI (House probably resented the test and would resent it even more if someone else did it) and comforts a no doubt very worried and uncomfortable House with jokes.

The MRI scene is interesting in that you get the feeling they're both going through the motions, but they know they're not going to find anything. Wilson (and Cuddy to some extent) feel that they have to do something, so they grasp at straws. Hence the harmful meddling, unnecessary and probing from House's point of view. Very interesting given that in a few episode's time House is calling Wilson a 'functional vampire'.

I love this episode. It really turns the House angst up to 11, so to speak, and stands out, in my opinion, in the better half of season two.

Finally had a chance to read your review on one of my very favorite season 2 episodes.

Your comments on Cuddy's cruelty: My opinion is that, in Cuddy's mind, the placebo and subsequent admission to House that she gave it to him, followed by her leaving the room, would be viewed by her as "tough love", the way you treat a wayward teen. Many of House and Cuddy's interactions are tinged by this "mom" and "wayward son" mentality, not the way two grown adults are supposed to interact. Once he even cried, "But, Mom!" when he wasn't getting his way, lol, which was hilarious, but this may partially explain Cuddy's behavior on some other basis besides simple thoughtlessness or cruelty. She's trying to make a point, to teach him a lesson, not feel sorry for him or 'feed' his problem.
She and Wilson bring the tough love stance to a head in "Meaning", and things in this area may really heat up once "House" restarts next week after the baseball pause. (Sorry, a bit O.T.)

"At no time does he (contrary to what would be expected of him) pay undue attention to her, gawp at her, or otherwise treat her exploitively. So, shut up Cameron"
Lol! You are too funny, Barbara! :)

The MRI scene was just wonderful...so different from the usual House/Wilson interactions of wariness, combativeness, accusations, deceits. Sort of a flashback to that little wonderous scene with no dialogue as they ate carry-out Chinese in season 1.

House asking Cuddy for help in her office and the ending scene rate up there as some of Hugh's finest acting, worthy of an Emmy.

Thanks for your review!