Mr. Jekyll and Dr. House: The Reason-Emotion Split as Manifested in House, M.D.

Author’s note: This article pertains to the first two seasons of House, M.D.

What intrigues viewers more than any medical mystery investigated on the Emmy-nominated TV series House, M.D. is the psychological malady plaguing House himself. And no wonder, since his own creators seem puzzled as to the diagnosis.

House (played by Hugh Laurie), the title character of one of the most popular series on primetime TV, is a medical genius. He is a master of the scientific method, expertly investigating probable causes and finding clues in improbable places. He is also notoriously miserable, plagued by chronic leg pain (caused by an infarction), a painkiller addiction, and a lackluster personal life. “Humanity is overrated,” he grumbles, before proceeding to save precious human lives where other doctors have failed.

Creator David Shore describes his brilliant, cynically sarcastic medical Sherlock as “a character who firmly believes in rationality over emotion at all times,”1 with all that presumably implies. And what, in Shore’s conception, does it imply? That House is “nasty and he’s cold and he’s heartless, and everything he does is to make the patient better.”2 This indicates Shore’s conception of rationality, or at least the brand of rationality he ascribes to House.

Shore seems split on his own evaluation of House’s character, warning apologetically, “I created this character, and I love him, and you might think I’m saying, yeah, we should all be like that. No! We actually shouldn’t be like that.”3 But, one is tempted to ask, if his rationality saves countless patients’ lives, isn’t it in fact a virtue worth emulating? Or is it indeed a lovable sin, deserving of sympathetic scorn, since it dooms him to a life of lonely success?

The moral status of House’s rationality hangs unanswered, both in the show and in the minds of most viewers. Is it a virtue or a vice? Does it bring joy or misery? Should we emulate House’s devotion to reason, or should we trade in the stoic pursuit of truth for a serene, pain-free, socially prosperous life?

This dichotomy is difficult to untangle, because it flows from the very fabric of House’s fictional portrayal. In accordance with Shore’s ambivalent view of rationality, or his knowledge of the culturally prevalent view, he has created a dichotomous character—a character who is, in himself, a contradiction. In real life, rationality—that is, proceeding by relevant facts and logic—yields positive results not only in medicine, but in all areas of one’s life. A real-life House would apply the same kind of reasoning to his personal life that he does to his professional life, and would reap dramatically positive rewards therein as well. In real life, rationality is a virtue—precisely because it is the means to a life of achievement and happiness on all fronts.

That House’s rationality serves as an enormous value in the diagnosis and treatment of patients is unquestionable. Usually, it is House’s stubborn insistence on following his rational conclusions wherever they lead—even when this entails breaking every conceivable hospital regulation, hurting family members’ feelings, and defying the explicit instructions of his boss—that saves his patients’ lives. Whether deliberately stopping a hospital elevator between floors as it carries his patient to surgery so that he can defy official orders by searching her body for a lethal tick that he knows he will find (and does)—or sticking a giant needle into a patient’s chest against the patient’s own instructions, knowing the injection will save his life—House stakes everything, from his job to his friendships to his patients’ well-being, on his confidence in rationally derived conclusions.

Naturally, this rational method of diagnosis overwhelmingly appeals to viewers—because it works. As a reviewer for ScreenSelect observes, House is “the Doctor we all wish we had access to when we are ill. He has . . . the consummate genius to back up his inflated ego with cutting edge diagnosis that leaves you stunned at his brilliance.”4 Hugh Laurie writes, in praise of his own character: “This is a guy in search of truth. Incidentally, that truth one day could save your life or the life of someone you love. That’s a heroic thing.”5 So, if the rational pursuit of truth à la House is successful in saving lives—and in bringing happiness and joyous celebration with every patient he restores to health—should we not all be eager to emulate it in our own lives? Is this not heroism to which we should all aspire?

Remarkably, reviewers tend to think House is neither heroic nor worthy of emulation. Indeed, they attribute his popularity not to his virtues, but to his vices. As one reviewer, marveling over the show’s popularity, muses: “It’s smart, with a one-of-a-kind character who isn’t all that likeable or sympathetic. . . . A pill-popping antihero was just what the doctor ordered.”6

It is difficult to disagree with such an assessment, since House’s fantastic success on the professional front is so entwined with his (literally) miserable failure on the personal. Episode after episode puts us through the torment of seeing a gloomy, tortured House return to his dark, lonely apartment and pump himself full of Vicodin to numb his own pain, after sending his patients home happy and smiling, holding the hands of loved ones who rejoice with them at a seemingly miraculous recovery. We see him deliberately distance himself from his patients (as House proclaims during one episode, “Treating illness is why most of us became doctors, treating patients is what makes most doctors miserable.”); we hear him snipe abrasively at his friends (rather, friend) and coworkers, and refuse to accept affection from anyone who dares offer it; we watch him, in the words of a BlogCritics.org reviewer, “keep everyone at cane’s distance and flounder badly when his emotions are involved.”7 So it is no wonder that House is unhappy, since happiness is an emotion—and House tries to steer clear of emotions at all cost.

And why does House react so allergically to emotion? As House himself explains when responding to someone’s complaint that he never meets his patients: “It’s easy if you don’t give a crap about them. . . . If emotions made you act rationally, then they wouldn’t be called emotions, would they?”8 Allegedly, then, if one wants to be as rational and as effective at treating patients (or any equivalent task) as House is, one must also reject or repress one’s emotions. After all, rationality can lead to painful conclusions—such as the recognition that a loved one is terminally ill or that one’s spouse has been unfaithful. Emotions, in turn, if one acts on them, can lead one to lie (“Everybody lies,” says House), make one sacrifice one’s own best interests (like the wife whom House observes pointlessly undergoing surgery rather than hurt her husband with a painful truth), and generally cloud one’s rational judgment. So if, like House, you choose to regard the rational quest for truth as your sacred calling, you (allegedly) must abandon all hopes of emotional fulfillment.

Such a course is indeed hard to desire or emulate. And if rationality does, in fact, lead to brutal indifference, abrasiveness, and a life of largely self-inflicted pain, we should hardly admire it as a virtue.

But rationality—real rationality—does not lead to any such plight; indeed, it leads to the stark opposite. If House were as rational about emotions as he is about medicine, he would not be miserably successful; he would be successfully happy.

It is true that the discovery of truth sometimes leads to real emotional distress. But it is only rationality (i.e., following one’s rational judgment, including as regards one’s emotions), not emotionalism (following one’s emotions without recourse to rational judgment), that can ultimately alleviate that emotional distress—by addressing its cause. Consider, for instance, the patient on House who would rather face the risk of dying of a sexually transmitted illness than learn that his wife has been cheating on him. Such a mentality rightfully earns House’s scorn. The alternative to ignoring the truth in favor of one’s emotions, however, is not to avoid emotional attachments altogether (à la House); rather it is to acknowledge the truth, deal with reality, and thereby empower oneself to enact the cause of pleasurable emotions. What both House and his patient fail to realize is that emotions themselves have causes—and those causes can be “diagnosed” and treated just as the causes of illness can.

In the case of the cuckolded patient, for instance, consider the emotional consequences he will face if he should choose to learn the painful truth. He will feel miserable and betrayed, of course, when he learns his wife has indeed cheated. But now, to start with, he can treat his illness and recover (one can hardly be emotionally healthy when one is dead). Moreover, he can confront his wife and call for an open discussion in place of the silent chasm that had been growing between them. If he has done something to alienate her or to cause problems in their marriage, he can work to discover it and rectify his error. Or, if she turns out to be hopelessly dishonorable and unworthy of his love, he can put an end to their painful relationship and begin the process of emotional recovery. Eventually, then, he can find someone who is genuinely worthy of his love and adds authentic joy to his life.

Contrary to Pascal’s claim, our hearts do not “have reasons that reason knows not.” Emotions are not impervious to reason; they are responses to what we regard as true (given our prior knowledge and reasoning, or lack thereof). If we change our minds, our hearts eventually follow.

The man who chooses not to learn the truth, of course, does not reverse his wife’s adultery or the progress of his illness. Rather than get treated, or confront his wife about her actions, he lets both “conditions” fester and worsen. Though he may feel warm and fuzzy for a while in his ignorance, his wife’s growing aloofness—along with the syphilitic pustules that multiply on his body—will soon render him in an emotional and physical hell. Lacking knowledge of his problems, he will be utterly powerless to solve them. It is a stroke of extreme good fortune for this man that House does not care about his patient’s irrational emotions, and proceeds to test him for syphilis anyway.

One might think such a man wants to suffer—but he must not, else he would not so dread the pain of learning the truth. The only explanation is that he thinks his “pleasant” emotions can somehow reverse the truth. Were he to employ reason, he would realize that—regardless of his present feelings—an undetected deadly illness will eventually kill him, and an unconfronted affair will only cause him more emotional pain. Feigning health and happiness does not make them so. It neither erases the true consequences, nor offers protection from the pain one will feel as those consequences come to pass.

Emotions proceed from one’s ideas about the value (or disvalue) of a thing—in this case, from a husband’s idea that his wife is loving and virtuous. And it is only by forming one’s ideas rationally, in accordance with the facts, that one can achieve any kind of value (whether building a successful relationship or restoring patients to health). Contrary to what House’s actions suggest, emotions are not inexplicable, incurable pests that sabotage one’s thinking. On the contrary, they are fruits of one’s thinking (or non-thinking). In light of this truth, House’s rejection of emotion as such is senseless and, indeed, flatly irrational.

Consider House’s refusal to enter a relationship with the woman he loves, because he fears that his staunch rationality will cause them both eventual pain. Love, he claims, requires a man to change in order to accommodate his lover’s emotions—which House is incapable of doing. But it is not true that House is incapable of change. This is the same man who abandons and reverses his hypotheses about the right medical diagnosis in an instant, if he sees new evidence refuting his old theory. So why could he not change in light of a loved one’s emotional needs? The implication, of course, is that her emotions would be causeless, random whims that contradict his rational convictions, and that he would have to choose between the brutal, “insensitive” truth and the kind, accommodating lie.

Given such a premise, it is no wonder that House describes as “romantic” the woman who takes enormous pains to deceive her husband into thinking she wants children, while secretly taking birth control pills. House would never do such an irrational thing just to spare his lover’s emotions; thus, he reasons, he is not cut out for romance.

But, in fact, emotions are not by nature at odds with rationality. Contrary to the twisted relationships House observes in his fictional patients, a real-life, genuinely romantic relationship is not and cannot be based on deceit. A rational couple would determine early on in their relationship whether or not they want and are in a position to raise a child. If circumstances change, they might change their minds. But they would never lie to each other about what they want, because rational people know that desires sundered from the facts of reality cannot be achieved in reality. Nor would they act with disregard for each other’s desires or feelings. A loving couple wants each other’s happiness as a concomitant of their own. And the achievement of that mutual happiness rests on objective, rationally knowable requirements—not the least of which is honesty.

If House’s hypothetical future wife became concerned over his Vicodin addiction, for instance, she would neither suppress her concern nor react hysterically. Rather, she would look at the full consequences of his “pill popping”; weigh them against the pain he would feel if he cut down; perhaps investigate other, healthier pain-management options; and present him with objective data for discussion and assessment. If her case were strong, the rational House would consider it. If he had more relevant information to add to the mix, she would acknowledge and evaluate that data. In the end, of course, the decision about his drug use is his to make, and she, respecting his autonomy with regard to his own health, would leave it to him. Assuming that both of them consulted all the relevant facts and evaluated them rationally, both would be persuaded of the best course of action given their full context of knowledge. And both ultimately would feel happier than they would have had she withheld her concern from him while letting her frustration mount, or had he refused to address the issue rationally.

Just as House and his crew manage ultimately to reach a “consensus” about the proper diagnosis for a disease, so he and his loved one would be able to reach an eventual “consensus” about the best decisions regarding their mutual interests and concerns. The process is the same: Consult the relevant facts, and follow reason wherever it leads.

Thus, just as House applies reason to the diseases he works to diagnose, by seeking out the facts and adjusting his views accordingly, so he could apply reason to a romantic relationship and reap the consequent rewards. Just as in the professional realm he saves lives and causes great happiness by using observation and logic, so in the personal realm he could achieve great happiness for himself and his loved ones—by precisely the same method.

What rationality does not permit is treating one’s emotions as though they were seers of truth. The fact that House “feels” he needs his Vicodin pills does not make it so. Similarly, the fact that a patient “feels” it is wrong for him to get tested for syphilis does not erase the very real consequences of the truth, which is contrary to his feeling. A rational man never treats his emotions as providers of knowledge or guides to action; rather, knowing that they are products of his ideas, he evaluates his ideas and emotions rationally and acts in accordance with his rational judgment. Consequently, he basks in the reality-oriented emotions that flow from such thought and action. This is the kind of policy implied by a “belief in rationality over emotion,” if properly understood.

If one grasps the nature of the relationship between rationality and emotion, House’s split personality becomes easy to diagnose: He is rational in his dealings with human illness, but irrational in his dealings with human emotion. If David Shore has set out to portray a man who truly “believes in rationality over emotion at all times,” he has failed—by failing to understand the actual nature of both rationality and emotion.

Sadly, the lack of a proper understanding of rationality (particularly regarding its relation to emotion) takes higher tolls than merely misrepresenting a rational man’s personal life. So long as rationality is falsely presented as “cold” and “unfeeling,” its real and positive aspects also get smeared. Viewers deride House for being “cranky,” “abrasive,” and “mean”—all legitimate grievances. But they also chide his “arrogance,” his “self-centeredness,” and his “over-inflated ego,” all of which are commonly attributed to “unfeeling rationality”—since it requires elevating one’s rational conclusions over others’ emotional appeals.

Such critics once again fail to realize the proper role of emotion in relation to rationality. If House were to allow baseless pangs of doubt, or the emotional appeals of patients and fellow doctors, to interfere with his rational conclusions, he would not be the good doctor that he is. As House intelligently quips, “humility is an important quality—especially if you’re wrong a lot. . . . Of course, when you’re right, self-doubt doesn’t help anybody, does it?”9 Sarcasm notwithstanding, House’s witticism identifies an important fact about his rationality: Though he is not immune to error, he always has a rational basis for the professional conclusions he forms; thus, he has the confidence to act on them. That is why, to the shock of many on- and off-screen observers, House is “almost always right.” Often, if it were not for his executive decision to act on a diagnosis, a patient would have died from the doubt-ridden inaction of his staff.

Similar reasoning applies to House’s “self-centered” attitude—particularly his insistence on taking only those cases that he finds medically interesting. Just as emotions are consequences of one’s conclusions, so rationality is the means of achieving emotionally gratifying values. If one espies no personal value in solving a problem or answering a question, one’s mind lacks any motive to function toward that end. Thus a doctor who practices medicine not because he finds it interesting, but because he feels obligated to care for patients and cater to their feelings, will be a terrible doctor. If discovering the elusive source of an infection, or figuring out the perfect combination of pills to treat a rare bacterium, comes to him not as a joy, but as a duty performed out of “kindness,” he will be unable to think in the manner necessary to achieve greatness in his field. Try solving a difficult word problem or puzzle that does not interest you one bit—as a courtesy to a stranger. You would be unable to so much as set up the equation or organize the pieces before your mind froze from boredom. And such mental effort is child’s play compared to the effort that a diagnostic physician such as House must exert throughout the day.

Such is the nature of the relationship between reason and emotion. Rational thought is what delivers the effective cures, the successful marriages, the gratifying friendships, and all the other values that men need to live happy, emotionally fulfilling lives. House’s selfish motivation is not a threat to his patients nor to anyone around him. On the contrary, it drives him to solve medicine’s greatest problems, for the satisfaction he derives from them—and, in so doing, to heal patients and yield diagnostic innovations for future doctors to implement and build upon. Indeed, only by being equally rational and selfish in his relationships with people—by giving them the benefit of the doubt before giving up on them, and by rationally seeking out friendships and romantic relationships (which require empathy and kindness rather than rude, sniping sarcasm)—would House become much more pleasant to the people around him, and much happier in life.

In reality, a commitment to reason need not be accompanied by misanthropy, cynicism, or pain. On the contrary, it is the means to brilliant achievements and a life rich with values and joy. Yet, due to a culture-wide failure to grasp the relationship between reason and emotion, rationality is associated with rudeness, repression, and every popular vice. So it is no wonder that House-lovers praise House in a reserved, guilty way, making sure to add that they do not condone the “rude” and “improper” things that he says and does. As one House fan puts it in a BlogCritics.org review, “House says the things I might think I want to say, but never would, and could never forgive myself if I did. And I love him for it because it’s liberating to hear those thoughts vocalized.”10 For this viewer and many others, admiration for House’s character remains a guilty indulgence, which they love to watch but would scarcely allow themselves to emulate. Though they love his honesty, his brilliance, his deductive skills, his radiant confidence—in short, his rationality—they cannot recognize it as a virtue in the shadow of all the pain and cruelty that mask it. In a culture that regards rationality as “cold,” “unfeeling,” and “ruthless”—and that presents its primary fictional exponent as an “antihero”—it is hard to blame them.

The public’s irrepressible love for House, however, appears to be a positive symptom. It suggests that people’s admiration for the virtue of reason is still alive and kicking, and that they may be open to the possibility of rejecting the virulent mischaracterization that has smeared it. As the popularity of House has shown, the appeal of rationality is strong; but its strength is held in stranglehold until people can disentangle the vicious package-deal that binds unwavering rationality with cynicism, cruelty, and pain.

If House’s viewers and critics recognized the real nature and exclusively positive consequences of rationality, they would not hesitate to admire it as a virtue. And if the show’s creators understood it, they would not strap House down with an abrasive personality, a bitterly lonely personal life, a seedy affinity for prostitutes, and a crippled leg to symbolize his misery. Instead of mixing his glorious virtues with unsavory flaws to make him more “realistic” to an audience that regards rationality as emotionally sterile, Hollywood would be able to present us with a serious moral hero—one whose example, in turn, would inspire us to strive for unwavering rationality in and throughout our own lives.

About Veronica Ryan

Veronica Ryan (a pen name) earned her PhD in clinical psychology at the University of Virginia. She received her BS in psychology and philosophy from Tufts University, and subsequently worked for two years as a clinical interviewer and research assistant in the Massachusetts General Hospital psychiatry department. She has served as a contributor and editor for The Undercurrent, a national campus publication. She is a two-time winner of the Ayn Rand Institute's Fountainhead Essay Contest and a graduate of the Institute's four-year academic program.

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