House M.D. Watch: Is Faith a Mental Illness?

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No, you haven’t accidentally clicked on Tuned In. This is still Healthland, but it seems like a good place to look at the latest medical mysteries on the show House M.D., which I have watched since its debut six years ago. The diagnostic riddles are the most fun part of the show for me, so I have highlighted all the possible diagnoses in bold below.

First, though, a spoiler alert: If you haven’t seen this week’s episode, go immediately to Princeton Plainsboro before reading on.

This week, House and his team tackle the case of a 33-year-old man named Ramon Silva, who comes to the hospital having choked up blood. He also has holes in his hands. It turns out that every year, Silva has some friends ritually crucify him: they tie him to a cross and then nail his hands to it with giant spikes. (Don’t you have friends who would do that for you?) (More on Time.com: ‘Oops, My Bad!’ The Scariest Words Your Surgeon Can Say)

Silva has them do this because he made a promise to God four years ago, when he learned that his daughter had glioblastoma, an aggressive type of brain tumor that kills very efficiently, sometimes in just weeks: if God would spare his daughter, Silva prayed, he would have himself crucified every year to honor the Lord’s mercy. The girl survived, and so Silva keeps his promise.

(House, of course, is an atheist who routinely makes fun of religion, and there was no shortage of insults against the faithful in this episode. My favorite is when House tells Silva, “Ritual is what happens when we run out of rational.”)

But back to the medicine. The first idea about Silva’s case comes from Dr. Taub, who says Silva is running a fever and coughed up blood because he contracted Rhodococcus equi at the stables he helps build. Rhodococcus equi is a bacterium that often causes pneumonia in horses. Chase is skeptical: “Unless this guy is sleeping in the manger,” he begins, but then Taub cuts in — “or has a history of open wounds?” (More on Time.com: “Family Only” Hospital Visitation Rules Get Scrapped)

But when the team goes to deliver antibiotics that would easily treat Rhodococcus equi, they discover one of Silva’s teeth has fallen out, which presents another symptom.

Cut to the differential-diagnosis meeting. Chase suggests it might be heavy-metal poisoning if Silva eats a lot of canned tuna and sushi, and if his home has lead paint. And so we go to the House M.D. ritual of breaking into the patient’s home, although this time there’s a twist: the idealistic new member of the team, a med student named Martha Masters, asked Silva his permission to search his home beforehand. As Chase is trying to shimmy the lock, she remembers: Silva doesn’t even lock it, and she simply turns the knob. (More on Time.com: In Illinois, Sex-Offending Doctors Continue Practicing With No Oversight)

Trouble is, no tuna and very little food of any kind. Silva’s tooth fell out because he is malnourished.

Then another symptom comes along: Silva begins to smile uncontrollably even though his legs are in enormous pain, 9.5 on a scale of 10. This moves House to say, “33-year-old carpenter presenting with narcissism, delusions of grandeur, hallucinations.” Chase replies, “You want us to do a differential diagnosis on Jesus?”

But eventually we discover from an MRI that Silva has multiple dense lesions in his temporal lobes. They are a sign of multiple sclerosis. How could someone not notice if they have MS? “It was hiding behind the malnutrition,” Chase explains. MS attacks the immune system, but malnutrition had suppressed Silva’s immune system. “No system, no [MS] symptoms,” says Chase. (More on Time.com: The Business of Weird: Why People Pay for Bizarre Experiences)

This is the most clever diagnosis in the episode, and the unlikeliest. If Silva’s malnutrition were so advanced that it compromised his immune system, it’s unlikely he would still be working and getting crucified routinely.

But I did like the explanation for the uncontrollable smiling: Silva’s lesions have tricked his temporal lobes so that he smiles when he’s in pain. It’s creepy to watch: every time Silva has to hear bad news, he smiles.

The most interesting differential debate in the episode is whether excessive faith is a mental illness. You can imagine which side House takes on that one. “Faith is not a disease,” Silva tells him.

House counters: “It is communicable, and it kills a lot of people.”

This conversation sets up the final diagnosis, which is a form of multiple sclerosis known as Marburg MS. House knows of an experimental stem-cell treatment for Marburg, but because the treatment involves embryonic stem cells, the devout Silva refuses it. He says that God would punish his daughter if he insults God by using cells from embryos. (More on Time.com: It’s True: We Shop Till it Hurts)

House then allows Silva’s daughter to confront him, and — just as House had hoped — she tries to convince him to accept treatment. “Just take the medicine,” she says through tears. “You always tell me to take the medicine.”

When Silva still refuses, House lies to him and says his daughter still has glioblastoma, meaning God broke the deal they had. “I’m sorry,” House lies, “but I’m right.” In the end, Silva accepts the stem-cell treatment, and it works (which is quite convenient as a story point — House’s deceptions once again work).

All in all, it was an episode that offered some nice comedic opportunities for Hugh Laurie: House’s condescension has entirely returned after all the weakness surrounding his Vicodin detox. But the final diagnosis came a little quickly since the show spent so much time on the personal lives of the characters. Still, I liked it because I now know how to spell Rhodococcus.

More on Time.com:

I Know the Truth, So Don’t Bother Me With Facts

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