The TV practitioner, examined from the inside

Dr. Gregory House, the gruff medical savant in the eponymous television show on Fox, embodies at least two psychological universals. First, a chronic pain, like a trick knee, can mar your happiness much more than breaking your leg, because chronic pain does not subside. The second thing is that chronic frustration and pain will tend to push individuals to “spread the pain around.” That is, take it out on others.

House is a breezy but tortured soul who really strikes a nerve, so to speak. But why?

The character-driven series is an original take on a classic figure: an existentially troubled, physically challenged yet deeply principled loner who only takes the most difficult cases. He plays resolutely by his own rules. However — and this is key — he is supported by a coterie of competent but pedestrian physicians who gawk in wonder at his bravado. Portrayed with subtle comedic timing by Hugh Laurie, House is a limping, quipping, hybrid of Columbo and Hawkeye Pierce but more of a jerk and more of a hero than either, and he needs but rails against the support of his team.

Like “Columbo,” “House” is a detective show — but with a medical culprit. We watch House’s team engage in Shakespearean recitations of jargon seeking differential diagnoses that have real effects on patients — treatments sometimes make the patient worse. The unpredictable course of action closes in on the biological perp.

But the twists and turns in each episode take a darker turn on the human condition than they did in “Columbo.” That’s because the murders on “Columbo” were stage props — barely believable — while House deals with illness, lies and the turmoil of the soul.

A basic credo House adheres to is: “Everybody lies.” That cynical and aggressive bedside manner fleshes out his character. Along with his physically painful limp requiring a cane and Vicodin use, he climbs the medical mountain each episode.

His long-suffering foil, Dr. Wilson, gives him a very insightful psychological analysis: “You hate yourself, but admire yourself. Misery doesn’t make you better than others.” Indeed, self-regard paired with self-loathing is a common dichotomy psychologists often find in narcissistic personality disorder.

The evolving intangible in the show is House’s struggle with himself. Background into his life is only alluded to — a fraught relationship with a critical and distant father and an unrequited love affair with a woman. It is a human universal to want to find one’s place in the world, and House has an ego problem (as many of us do). We rate ourselves and our own basic worth — and House sees himself as constantly wavering between noble and rotten. He is either great (cures a patient) or worthless (flubs a diagnosis). His cynicism is his way of pushing himself to be great. He chooses his disciples because they are also damaged in some way.

The personality House has forged is a complex one for a television show. House skirts the law but follows his own moral code, which can include doing heroin and getting a visit from a call girl. He does what he thinks is right — in spite of others and in defiance of the law.

Watching someone overcome chronic disability with brash logic and wit is fun and inspiring — even if the life this doctor is saving is ultimately his own.

Dr. Nando Pelusi is a licensed clinical psychologist who maintains a private practice in New York City and serves on the board of advisers of the National Assn. of Cognitive-Behavioral Therapists. He also serves as a contributing editor to Psychology Today.

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