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Season Eight Episodes:

  1. Twenty Vicodin
  2. Transplant
  3. Charity Case
  4. Risky Business
  5. The Confession
  6. Parents
  7. Dead & Buried
  8. Perils of Paranoia
  9. Better Half
  10. Runaways
  11. Nobody's Fault
  12. Chase
  13. Man of the House
  14. Love is Blind
  15. Blowing the Whistle
  16. Gut Check
  17. We Need the Eggs
  18. Body and Soul
  19. The C Word
  20. Post Mortem
  21. Holding On
  22. Swan Song and Everybody Dies

Episodes12345678

Park: "I deserve respect. I’m a good doctor."
House: "People respect you. They just don’t like you."
―Perils of Paranoia

Perils of Paranoia is a Season 8 episode of House which first aired on November 28, 2011.

A district attorney appears to suffer from a heart attack while cross-examining a witness. The initial diagnosis is hyper-anxiety, but the team finds an arsenal at the patient's home and start to believe that his extreme paranoia is a physical symptom. Wilson becomes convinced that House is hiding something at 221B Baker Street, which leads to an epic battle of wits between the two men. Park tries to be more social with her workmates, while Taub and Chase wonder why Foreman hasn't had a romantic relationship in a while.

While treating a patient, the team discovers that, without the patient's family knowing, the patient has accumulated a large arsenal of weapons. The team argues whether this indicates an underlying medical condition related to his current symptoms. However, it's more worrying for Park, whose belief that she doesn't seem to be fitting into the team is largely based on her behavior and personality.

Meanwhile, House and Wilson engage in a battle of wits when Wilson becomes convinced House is in possession of a gun, which would put his parole at risk.

Recap

In the middle of devastating a witness on cross-examination, a district attorney goes to the judge to ask for a recess because he thinks he is having a heart attack. The judge calls for an ambulance.

Foreman tells House about the case - the patient didn’t have a heart attack. House thinks it’s an anxiety attack, but Foreman has already ruled it out by lying to the patient to get him to relax. House gets interested.

House calls his team together to do a differential. After they go through the possibilities, House figures it’s a toxin and orders tests and an environmental scan. He also tells them to check out the patient’s wife because he thinks she may have done it. When Chase complains he doesn’t want to do the work alone, House allows him the choice of Taub or Park. Chase and Adams both call dibs on Taub, but Adams “settles” for Park.

Chase and Taub run into Foreman on the elevator and compliment him for lying to the patient to rule out anxiety. However, they are concerned Foreman is misbehaving and tell him to get a girlfriend. Foreman assures them he’s just trying to make sure House does his job. Chase tells him that a girlfriend is a better idea than trying to keep track of House. Taub agrees despite his alimony and child support obligations.

Adams and Park are driving to the patient’s house. Adams is talking about how wonderful her new car is, but Park thinks she’s avoiding talking about why she doesn’t want to work with her. Adams assures Park that House’s belief that no-one wants to work with her is simply his way of getting under everyone’s skin.

The wife is talking to Taub and dismissing the possibility that someone would want to poison her husband. Everyone at work likes him, even the criminals he prosecutes. She says he only eats stuff he brings from home. Taub thinks the patient is afraid of something, but when Chase talks to the patient, he tells Chase that his first job was at the health department and he knows how dirty restaurants can be. Chase asks him if he got any strange packages or letters, but the patient denies it and notes his three kids are healthy and it’s unlikely they would not have been exposed to something that made him sick. Chase brings up the possibility of his wife deliberately poisoning him, and the patient dismisses it. The wife tells the same thing to Taub.

Park and Adams are having no luck, and Park wants to run in case someone called the police - they would give a prosecutor’s home higher priority. However, as they go to leave, Park notices that the walls of two adjoining rooms are a lot further apart than they should be. Adams thinks she’s kidding about there being a secret room, but Park remembers seeing a magnet of the type used to open child-proof cabinets on their refrigerator and tells Adams to get it. Park sees a spot behind the books, applies the magnet, and swings back the bookcase. They call House and tell him that the patient has a bunker stocked with "enough guns to defend Fort Knox."

Park and Adams go to confront the patient. The wife knew nothing about the guns. The husband said he built it in secret to keep the city from finding out. The wife asks him why he needed so many guns.

Park and Adams go to report to House, who has already figured out what the patient told them - that he was afraid the government was going to collapse. House is also screwing with clinic patients, calling out their names only to tell them to wait. Adams is astounded, but House says that’s what everyone with a bunker full of guns is afraid of. Chase thinks it might be a symptom, but Adams and Park get into an argument about the patient‘s beliefs. House orders tests for everything they’ve suggested. He returns to clinic duty and picks the most attractive clinic patient to examine.

Park asks Taub who’s more paranoid - the patient or her. He replies he doesn’t think the patient has a mental illness and tells Park not to let House get to her. However, Park says she doesn’t think the team respects her and Chase doesn’t even try to hide it. Taub says Chase just likes working with him and does respect her. Foreman interrupts them and asks to speak to Taub.

Foreman asks Taub to stop telling the nurses he‘s looking for a girlfriend. Taub denies it, but Foreman asks why he keeps getting lunch offers and boxes of cupcakes. However, Taub says he’s been to busy to even think about talking to nurses. However, Park realizes he’s lying and Taub says it’s for Foreman’s own good.

House tells Wilson the patient is just stupid, but Wilson reminds House he owns a gun. House says that’s different - the patient has an arsenal, and House denies owning a gun. Wilson tells him he does and, as a felon, if he’s caught with it he could go back to jail. House says he doesn’t need a gun - the only thing worth stealing would require a crane to remove it. Wilson is still not convinced - House is very attached to his possessions and likes dangerous things - even making fireworks. Wilson pretends to give in, but House realizes he’s lying and Wilson admits he is.

All of Adams’ and Chase’s tests are coming out negative. They start talking about the “feud” and Adams wants to know why Chase didn’t pick Park that morning. Chase says Park is weird. Adams counters that Park is a good doctor, but Chase says good doctors can be weird, like House. He admits Adams is weird too, but it’s easier to put up with her because she’s hot. He backs up and says she’s normal and a pleasure to be with. She calls him weird. They start talking about guns. He thinks she likes shooting sport weapons for fun. Chase makes up a story about shooting kangaroos, but Adams realizes he’s screwing with her.

The wife is staying with her husband, but he wants her to give her mother a break from babysitting. She’s worried that he thinks the world is coming to an end. He assures her he hopes never have to use the guns. However, Park discovers he’s bleeding from a sore on his leg.

The patient has also developed a fever. They decide to do a biopsy of the sore and start treatment for sclerosis. Park goes to ask House why she’s calling her an idiot when it’s obvious he doesn’t really believe that. She says she doesn’t mind him making fun of her, but she doesn’t like being manipulated. He assures her he’s only making fun of her, but she says she deserves some respect. He assures her that people respect her - they just don’t like her.

The patient’s wife has left the hospital and the patient believes it’s because he lied to her. He assures the doctors he’s not crazy. Chase reassures him.

Foreman and Nurse Regina are arguing about why the paperwork hasn’t been entered in the computer when House leaves the clinic early because he got an emergency page. Foreman tells Nurse Regina to find someone who can do the paperwork because he has to leave.

House arrives home to find Wilson in a net trap. Wilson sent the emergency page and calls House an ass. House won’t let Wilson out of the trap until he admits that House is too clever to let Wilson ever find a gun even if he had one and will always be one step ahead of him.

Foreman is at the gym with a punching bag when he gets a page. When he goes to answer it, a beautiful young woman, Anita, introduces herself and asks him how bad his day was to take it out on the punching bag, but Foreman thinks Taub sent her and threatens to treat him like the punching bag. However, Anita says she doesn’t know what he’s talking about. Foreman is still suspicious, but Anita says she will be in the gym for a while if he changes his mind. Foreman picks up his phone again. Taub is on the other end telling Foreman the patient is wrecking things and tells him he’s got to go.

The patient is put in restraints. He was hallucinating he was being attacked by bears and Adams says that points to clinical paranoia. Adams and Park argue about whether it’s new or old paranoia when Chase interrupts to suggest it may just be a mental illness because all the tests are negative. Park still thinks it’s a brain infection, but Adams thinks it’s autoimmune. House agrees with both Adams, orders treatment for GAD - steroids and immunoglobulin.

Park follows House and tells him that she’s not paranoid and it’s not that her teammates don’t like her, they just don't know her that well.

House arrives home again and finds a trip wire that he spots before he actually trips over it. He sees an open closet door. He pulls the wire with his cane. The trap springs harmlessly and Wilson delightedly jumps out of the closet only to have his spirits fall when he sees House standing untrapped. House tosses him and his trap out the door. House returns triumphantly to his apartment, only to lock himself in the bathroom when the doorknob comes off in his hand. He finds the second door locked too. He goes to examine the first door, but the outside doorknob to that one falls off too.

As it falls, someone kicks it to one side and when they kneel down, it's shown that it's Wilson who has managed to get into the apartment.

House looks through the hole in his door and sees Wilson on the other side. He concedes defeat while also remarking, "Touche".

Wilson outside the bathroom door.

It then cuts to Wilson who stares back at House, an evil and smug smile on his face.

Foreman goes to Anita’s house and they start making out. However, they hear a man call her name and she tells Foreman he has to go right away. As he leaves, she tells him it’s her husband.

The patient’s fever climbs. Park calls House, who is still stuck in his bathroom. Park says that it must be an infection, but Adams says they probably just started treatment for GAD too late. House orders more steroids. Park objects because if it’s an infection, the steroids will be fatal. House counters that if it’s an infection, they’re probably already too late but they can still treat GAD or at least slow it’s progress. However, Park keeps arguing they can treat an infection. House finally gives in, but tells them ordinary antibiotics would be useless - they need to identify the infection. He orders tests. Adams reminds him that he just ordered more steroids, but House tells her he changed his mind and to follow Park’s instructions.

Wilson finishes searching House’s apartment and manages to get into the bathroom before he admits there’s no gun, although he found his own sunglasses, tennis racket and money clip.

Park and Adams are still arguing about the diagnosis. Chase breaks in to say maybe House was right to let them have a fight to settle things. Foreman interrupts again to speak to Taub. Foreman is trying to blame Taub for almost having him get beat up by Anita’s husband by screwing with his head. Taub tells Foreman he needs a life so he won’t come back to the hospital at midnight just to yell at him. He asks Taub to stay out of his business. Taub still proclaims his innocence. However, when he leaves, he tells Chase that although he got off to a bad start, he’s glad Foreman is trying. Chase calls him an idiot and their pagers go off.

They arrive at the patient’s room to find him in anaphylactic shock. Chase performs a tracheotomy, but it doesn‘t restore breathing. Taub calls for epinephrine. Nurse Anne tells him they already tried it, but Taub realizes that the blockage must be below the incision and that they have no other option.

They manage to get the patient breathing again, but they realize the anaphylaxis and edema rules out both infection and GAD. Allergy also seems to be ruled out because it wouldn’t get worse after admission. House turns back to toxins, but there was no-one with the opportunity to poison the patient on all occasions. However, Park suggests squamous-cell carcinoma. Although it wouldn’t cause hallucinations, related paraneoplastic syndrome would. House orders a biopsy.

House finds Wilson in his office. Wilson confronts him with a gun he found in House’s apartment. Wilson was sure House would have moved the gun, so he went back after he searched House’s apartment the first time. House denies it’s a gun, or that something looking like a bullet is a bullet. He says it’s a magic prop. Wilson doesn’t believe him, but House gives him the gun to shoot him. Wilson refuses, but House goes to shoot Wilson instead. He then shows Wilson the barrel is plugged by sticking a pencil in the barrel half-way. Wilson is confused, and House asks him to admit he found nothing. Wilson admits House has won. When Wilson turns around, House lets the pencil drop all the way into the barrel, showing us the gun is real. House looks at the gun and starts thinking.

He goes to see his team and tells Park, and everyone else, they were wrong. It wasn’t tracheal edema that blocked his airway, it was a pseudomembrane growing across the trachea. The patient isn’t even clinically paranoid - he was poisoned by a bacteria. House asks for a bronchial scope and warns the patient he won’t be able to breathe, but he has to look down his windpipe through the tracheotomy hole. When House tells Park to call the CDC for anti-toxin, she realizes it’s diphtheria. They didn’t consider it because no-one gets it anymore. House realizes the patient hasn’t been getting the vaccine for it.

Foreman goes to congratulate Taub for their work on the case. He tells Taub he’s just been at a meeting about parking.

The patient slowly starts to improve. He cheers up when his wife shows up. However, she tells him she’s moved the kids out of the house. She says she doesn’t like being lied to and she can’t live with all the guns. She says that when he gets out, she can move in with them, but they can’t return to their old house. He embraces her.

Foreman is working hard on his paperwork when Nurse Regina comes in. She invites him to a staff get-together, but he says he has too much work to do. She tells him to drop by if he changes his mind.

Park arrives at work and sees Adam and Chase in the elevator. She invites Chase for a drink. Chase asks her if Taub put her up to it, but she says she’s been thinking about it for a while and decided to ask. Chase says it’s a bad idea to socialize with colleagues, but Park knows about Cameron. He finally agrees to go out that evening.

Foreman is still working. He grabs his phone and tells someone he’s changed his mind.

House puts his gun back in its box. He then takes his father’s sword out to look at it.

Foreman meets Anita at a bar.

Clinic Patient

House is seeing a patient who has discolored fingers he thinks are due to frostbite. House wonders why he thinks it’s frostbite when he’s not been out in the cold and, besides, it looks nothing like frostbite. He tells the patient what he needs to do is take a long vacation before his boss finds out that he’s been stealing from the till - the discoloration is from silver nitrate put on cash that stained his fingers to show his boss who the thief is. The patient’s reaction shows House he’s right. He tells the patient the only way to get rid of the stain is to grow new skin - a process that will take at least thirty days.

Zebra Factor 9/10

Diphtheria is exceptionally rare in the United States, with no confirmed cases since 2003. It is, however, far more common in countries without widespread vaccination programs.

Major Events

  • Taub tells Foreman he needs to get a girlfriend. Taub spreads word among the nurses that Foreman is single and looking, which causes a few to approach Foreman with gestures.
  • Whether or not anyone on the team likes Park becomes a point of contention, of which House happily fans the flames.
  • A woman approaches Foreman at the gym, and he is immediately suspicious. However, it turns out to be unrelated to Taub's meddling. They connect, but Foreman discovers she is married.
  • Foreman changes his mind and starts seeing the married woman, Anita.
  • Park asks Chase out for a drink. He agrees.
  • House appears to have inherited John House's service automatic and Mameluke sword.

Title

The title is most likely a take off of The Perils of Pauline, a melodramatic serial.

Trivia & Cultural References

  • The hockey references are to the New Jersey Devils, based in Newark, their chief rivals the New York Rangers, Ilya Kovalchuk, Jason Arnott (Now with St. Louis), Zach Parise, Martin Brodeur (who has only been with the team 19 years, not 20), and Johan “Moose” Hedberg.
  • The “New Jersey Chronicle” is fictitious.
  • House makes a reference to Archeus and poison. This refers to the terms placement within alchemy and the controlling of life forces. This also could be a reference to the Pokémon named Arceus, as he refers to 'Arceus' as a creator of the universe. In the Pokémon universe, Arceus is considered to be a god of creation.
  • Salma Hayek is a Mexican-born actress of Lebanese descent.
  • When House guesses it was the wife, the pattern of his guess follows that in the board game Clue.
  • Fort Knoxis the home of the gold repository of the United States government.
  • "Imperio absenti chaos regit" is Latin for "With power absent, chaos reigns".
  • Jell-Ois a gelatin dessert marketed by Kraft Foods. House is making an allusion to Jell-O wrestling.
  • Bloomingdale’s is an upscale department store chain.
  • In the viewing room, the CT scan from the episode Ugly can be seen.
  • Black Friday is the day after American Thanksgiving. It is one of the busiest and most competitive shopping days of the year.
  • The Kangaroo is distinct two legged marsupial native to and only naturally found in and around Australia. Despite being native and a cultural symbol; water management and grazing practices has seen Kangaroo populations rise in some areas and Kangaroos are often culled. Kangaroo meat is widely available in Australia. Outside of rural areas gun ownership rates in Australia are amongst the lowest in the world.
  • Yngwie Malmsteen is a Swedish guitarist renowned for his technical ability.
  • House's bathroom must have recently been redone: the door from the bathroom to the bedroom was previously a standard door (as seen in episodes such as Now What? in the previous season), but is now a sliding door.
  • La Crosse, Wisconsin is a city of about 50,000 people next to the Mississippi River. While it may not have the world’s largest beer can, it clearly is home to the world’s largest six-pack, courtesy of the City Brewery.
  • Manny Pacquiao is a professional boxer. He is the first and only eight-division world champion.
  • Dorothy Dietrich is an American magician and escape artist. She is well known for performing the bullet catch trick.
  • While a large focus of the show is on whether or not House owns a gun, in Euphoria he not only possessed a revolver, but used it inside of the hospital. The pistol shown near the end of this episode is a different type, though - suggesting House has owned more than one gun.
  • House is shown with his late father's Marine Corps Mameluke dress sword, meaning that he owns at least two swords, having failed to open a bottle of champagne with a 1796 Light Cavalry Saber in Now What?.
  • Taub asks for racemic epinephrine. Some molecules have the same chemical formula, but the molecules are arranged as a mirror image of each other. That means the molecules react differently with the body.
  • The Bucket Listis a 2007 film starring Jack Nicholson and Morgan Freeman as two terminally ill men trying to fulfill their wish list before they pass away.

Music

Goofs

  • The elevator has dual panels showing the floors. When Foreman hits a button, it lights up, but the corresponding button on the other panel remains unlit.
  • A hospital would never admit a patient for non-cardiac chest pain unless it was immediately life-threatening. Once a cardiac cause has been ruled out, the patient would be asked to return on an outpatient basis for a full work-up. Most emergency rooms see at least 10-20 patients with such symptoms in a typical day.
  • House usually starts with antibiotics. Had he done so in this case, they would have been immediately effective as diphtheria responds well to broad spectrum antibiotics.
  • You never perform a biopsy on a random part of the body looking for cancer. You target a particular feature, like a lesion, that appears out of place.
  • Diphtheria always causes respiratory symptoms and swollen lymph nodes, both of which point to infection. Tommy had neither.
  • Anxiety can be situation specific, like being in a high stress situation such as... appearing in a courtroom. As such, it cannot be ruled out simply because it doesn't present under controlled conditions in a hospital.
  • Tommy's symptoms are closer to respiratory distress rather than anaphylaxis, which also presents with swollen airways.
  • Fahr's syndrome causes movement disorders, which the patient doesn't have.
  • It is not clear why Tommy was put on a ventilator after his throat blockage was cleared. A ventilator is generally only used when the patient's lungs are not working properly, not just because they had an obstruction. Once the obstruction is cleared, the patient can usually breathe normally, even if they're given a tracheotomy.
  • It's a bad idea to give someone with an infection steroids, but it doesn't matter if you give a patient with GAD autoimmunity antibiotics - they won't affect the patient's condition.
  • They performed a cardiac catheterization even though he had a normal EKG and normal cardiac enzymes.
  • Schizophrenia and schizoid personality disorder are two entirely different conditions.

Reviews

  • IMDB users rated the episode a 7.9. It was most highly rated by women from 18-39 (8.5). It was least highly rated by males over 45 (7.7). The most common rating was an 8.
  • The Onion AV Club rated the episode a "B".
  • TV.com users rated the episode an 8.1.
  • Polite Dissent thought the medicine was poorly done and gave it a "D". However, he liked all the sub-plots and gave them a B+.

Medical Ethics

Mental Illness or behavioral disorder?

House leaps on the patient's possession of a weapons cache as proof that he must have a serious underlying condition. However, it's dangerous for physicians to do this as not every condition in the DSM is caused by an organic illness. This has been an issue in psychiatry since it started to be developed as a separate discipline in the 19th century, and in medicine from the beginning of the profession in ancient Greece.

But there's a clear distinction between conditions that are caused by an underlying organic condition (like schizophrenia) and those that only appear to be disorders of behavior (like antisocial personality disorder). It's true that many serious conditions like schizophrenia have common comorbidities, and that this relationship can often be complex and not specific to the condition. For example, many schizophrenics use drugs, and drug use puts individuals in a higher risk group, but the nature of the relationship is still unclear. However, many people with behavioral disorders use drugs despite the lack of an organic condition, and many people treat mental illnesses with self-medication with alcohol being very common.

In this case, it's not even clear the patient's seeming paranoia is even a behavioral disorder. As Taub quite rightly points out, the patient may just be at the extremes of normal human behavior.

In any event, none of this is clearly indicative of an underlying organic illness and House seems to have jumped to conclusions. This is unfortunately very common, particularly with physicians who treat marginalized populations like Native Americans or the extremely poor.

Cast

Quotes

Dr. Robert Chase: He's not *in* prison; It's kinda hard to gas a guy unless you can seal him in a room first.
Dr. Gregory House: Which is why Arceus created the universe with three states of matter, and three hundred solid and liquid poisons that could cause these symptoms.
Dr. Chris Taub: Arceus?
Dr. Gregory House: Look it up.

Dr. Taub: Impressive.
House: The wiliness with which Foreman ruled out anxiety or his complete wiliness-less-ness before he met me?
Dr. Taub: The fact that you managed to smear jelly on almost every page.

Dr. Adams: Wait, why would you think his wife poisoned him?
House: Because dangerous people don't break into your home, they live in it. And although his kids are old enough to want Daddy dead, they're still too young to do anything about it.
Dr. Taub: Must be such a pleasure to live in your head.
House: You're right. Kids might be precocious.

Dr. Park: So what do you think--is the patient paranoid or am I?
Dr. Taub: I don't think that stockpiling weapons is the most reasoned response, but, given what I've seen at Bloomingdale's on Black Friday, I wouldn't say it rises to the level of mental illness.
Dr. Park: And me?
Dr. Taub: Again, given what I've seen at Bloomingdale's...

Dr. Taub: If anarchy breaks out, I plan to do what my ancestors have done throughout the ages--run.

Dr. Wilson: You like anything dangerous--monster trucks, motorcycles, fireworks.
House: Everyone loves fireworks.
Dr. Wilson: Watching them, not making them.

Dr. Adams: So why didn't you want to go with her this morning?
Dr. Chase: She's weird.
Dr. Adams: She's not weird. She's a good doctor.
Dr. Chase: Most good doctors are weird. Look at House.
Dr. Adams: Am I weird?
Dr. Chase: Yeah, but you're hot so it's easier to put up with. (Adams glares) You're completely normal and a pleasure to deal with.
Dr. Adams: You're weird.

Dr. Chase: Back home, I keep a few for hunting 'roos.
Dr. Adams: You hunt kangaroos? But they're so cute.
Dr. Chase: They're also delicious.
Dr. Adams: You're screwing with me.
Dr. Chase: Totally.

Nurse Regina: Since Claudine left, no one's been inputting the numbers.
House: I miss Claudine
Nurse Regina: She left because of you.
House: I thought that was Nadine.
Nurse Regina: Her too.

Dr. Wilson: Well, you don't have a gun, but you do have my sunglasses, my tennis racket--I can't imagine why...
House: Had to kill a mouse. It was really hard with those stupid little sunglasses.
Dr. Wilson: And my money clip.
House: Was there any money in it?
Dr. Wilson: Not anymore.

Release Dates

  • United States - November 28, 2011 on Fox
  • Canada - November 28, 2011 on Global
  • Israel - February 22, 2012 on HOT3
  • Finland - February 28, 2012
  • Hungary - April 18, 2012
  • Germany - April 24, 2012 on RTL
  • Sweden - October 23, 2012 on TV4
  • Netherlands - January 24, 2013 on SBS6
  • Czech Republic - January 28, 2013 on TV Nova
  • Slovakia - February 26, 2013 on STV1
  • Japan - October 22, 2013

In Other Languages

  • Quebec and France - Tous Paranos (Eng. "All Paranoid")

Links

Video

House_Season_8_Episode_8_Perils_of_Paranoia_Trailer

House Season 8 Episode 8 Perils of Paranoia Trailer





2_Perils_of_Paranoia

2 Perils of Paranoia

Round up the usual suspects



3_Perils_of_Paranoia

3 Perils of Paranoia

Dangerous course






4_Perils_of_Paranoia

4 Perils of Paranoia

Next - bopping sharks on the nose





5_Perils_of_Paranoia

5 Perils of Paranoia

Consulting Detective





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