Alvie: They broke you!

House: They didn't break me. I am broken. Now stop worshipping me and go worry about your own loser life.

Alvie: I hate you.

— Broken

Broken is the premiere episode of the 6th season of House and first aired as a two-hour special on September 21, 2009. In syndication and foreign market, the episode is generally broadcast in two separate halves. This is the only episode of the series that was originally broadcast over two consecutive hours. The story takes place during over a period of about two months at Mayfield Psychiatric Hospital.

Upon detoxing from Vicodin, the director of the hospital threatens House's medical license if he doesn't remain a voluntary patient in the hospital. House is introduced to his fellow patients in Ward 6, whom he immediately describes as "crazy". His primary physician is the by-the-book Dr. Nolan, who has the final decision on whether House is well enough to resume the practice of medicine. However, overwhelmed by Dr. Nolan's lack of imagination and the slow progress, and with no diminution in House's caustic nature or medical skills, House immediately sets to work diagnosing his fellow patients in a matter of seconds just to amuse himself and annoy the ward's primary care physician, Dr. Beasley. Wanting out at any cost, he turns to attempted blackmail followed quickly by disruption, then deception. However, Dr. Nolan appears to be up to the challenge and meets House's manipulations at every turn, then tries to convince him that surrender is the only way out. Meanwhile, House soon takes an interest in one of the other patients but will even House be able to convince the staff at Mayfield that he may have the answer about him? He also starts to take an interest in a frequent visitor, but whatever good the hospital may have done for him may all go for naught because of her.

The episode puts the flip side on the diagnostic and treatment process typical of the series. In the vast majority of episodes, the diagnosis is difficult and the cure fairly easy - House and his "magic bullet". Here, the diagnosis is easy, but the episode shows much of the truth about medicine, particularly psychiatric medicine - the cure is often messy, uncertain and lengthy. All those factors are increased when the patient is skeptical and uncooperative.

House wakes up dizzy and disoriented in a plain room. Looking at a yellow pill, he finally swallows it and joins his fellow patients. We see a delirious House receiving a sponge bath, and he takes another pill. His right thigh obviously in pain, he pounds at the door of his room calling for help. He is finally restrained to his bed until he lapses into unconsciousness.

He wakes again, less disoriented than before. He is no longer restrained. He takes a few tentative steps while clutching his leg. He starts packing his suitcase and heads for the exit. He tells the nurse his dry heaving has stopped and asks to be released. She says she has to check with Dr. Nolan, but House reminds her he is a voluntary patient. She says she has to check anyway. House breaks in on Dr. Nolan to ask why he hasn't been released. Dr. Nolan interrupts his conversation with another doctor. He tells him that he wants House to stay. House says he's better - no painkillers, hallucinations, or delusions, and his leg pain is manageable. However, Dr. Nolan pointed out that if all he wanted to do was detox, he could have done that anywhere instead of checking into a psychiatric facility. House says he was deluded into thinking he was crazy. Dr. Nolan tells him his issues run deeper and he should go into long term care. When House continues to insist on leaving Dr. Nolan informs him that he will withhold recommendation to restore his medical license unless he stays for treatment.

House is welcomed to Ward 6. He speaks to Dr. Beasley about his therapy. He just wants to get his medical license back. He threatens to turn the ward upside down if they don't cooperate with this goal. House is assigned a two person room with a roommate with bipolar disorder, Juan Alvarez, better known as Alvie, who refuses to take medication. House introduces himself. Alvie then introduces him to the rest of the ward. House requests a new roommate from the staff, but they ignore him. Alvie can't stop talking because of his mania. House heads for the piano, but it's locked up.

The doctors talk about House's threat to turn the ward upside down. Dr. Nolan is concerned about it and tells his staff to watch out.

Dr. Beasley starts a group therapy session. House immediately starts to figure out the patients' problems. Jay-Bird wants to go outside, so he's diagnosed with claustrophobia. Another patient named Richter wonders where Stomp is going, and House diagnoses him with paranoia. He diagnoses Hal, who says he keeps gaining weight, with anorexia nervosa. He notes Susan has cut her wrists and makes a joke about suicide. Dr. Beasley ends group early and directs Dr. House to the solitary cell where they keep uncooperative patients.

Later, they are playing basketball. House sits down with Dr. Beasley who asks if he is ready to play nice. She just wants him to talk to her and deal with other people. Instead, he plays on all the other patients' fears and anxieties. Dr. Beasley forbids House from leaving the yard, but he ignores her.

He hears someone playing piano, and it turns out to be Lydia, the wife of the brother of Annie Bohm, the patient who won't speak. Dr. House tells her Annie is merely nodding to the beat of her own pulse and not the music. The orderlies come to lock Dr. House in the isolation cell again. Dr. Beasley comes to visit and tells him if he keeps this up, it will be his permanent residence. She asks him if he wants to try something different.

Finally, House goes to the rest of the ward and seems to apologize, but then turns the patients against their doctors. When he points out they are being treated like children - they aren't allowed table tennis paddles although they have a table and balls. They start to turn against Dr. Beasley. When Dr. Nolan shows up, the room quiets down, and it also turns out he has table tennis paddles. The rest of the patients stop rebelling and go back to playing table tennis. House wonders if Dr. Nolan is going to do everything that everyone else wants, but Dr. Nolan tells House he's a natural leader and if he wants to do some good for himself and the other patients, he'll do something about it.

House is taken aback and tries to form a new strategy while relaxing in bed, but Alvie is too distracting.

Dr. Beasley starts another group session. A new patient, Steve Alcartine, thinks he is a superhero and prefers to be called "Freedom Master". House walks away from group, but isn't being disruptive. Steve takes an interest in Annie as someone who needs to be saved. Dr. Beasley calls for a break and tells House she knows he is scheming. She asks him to cooperate for a few days. However, House says he already has a new plan and is "committed".

Back on the basketball court, House asks Alvie if he can go to the third floor and break into Dr. Nolan's office and find out who he met with at 11 am that day. Alvie realizes House is trying to blackmail Dr. Nolan.

Back at the piano, House notices it's unlocked and runs through the first bar of Beethoven's Fifth Symphony until an orderly comes to lock the piano. Alvie is in the custody of the orderlies - he's been caught. However, he reports back to House that the calendar only had time marked off with no name. However, House got her license number and plans to call Wilson to find out who it was. However, the phone is a level five privilege and Hal is the only one on the ward who has it. They need to get his cooperation, but phone privileges are expensive and neither of them has anything worth that much to trade.

To get the material to bribe Hal, House and Alvie agree to fake a fight. House is soon subdued and sedated with a Haldol pill in his mouth. However, House has faked swallowing and keeps the pills in his cheek. The pills are traded to Hal to get access to the phone. House calls Wilson who is concerned about House's pain, but he is managing it with analgesics. He tells Wilson he will get out if Wilson gets him the name of the woman who was with Nolan. However, Dr. Nolan has already called Wilson to warn him, and Wilson refuses to cooperate. He tells House he will be able to visit if he cooperates and hangs up. House goes back to Alvie and tells him that he's his only friend, but he still hates him. He tells Alvie he's going to have to pretend to cooperate.

House starts participating in group and his privileges score on the big board starts to improve from 0 to 1. He plays some basketball and goes to a 2. He is allowed to go outside unsupervised, and he goes up to a 3. He starts playing Blind Man's Bluff with his cellmates with cigarettes as stakes. House cheats by looking at his card in the glasses of another patient, Diane. He's also not taking his medication.

He once again runs into Lydia. She shares with him that Annie was her best friend and that she used to be a concert cellist for an orchestra in Philadelphia. He suggests she bring a cello next time.

Dr. House meets with Dr. Medina. They start talking about the fight with Alvie. However, the doctor has noted that House isn't having any side effects from the medication he's taking and his story about his fight with Alvie doesn't make sense. House offers to take a urine test, and Dr. Medina agrees. They go to get a sample, but the doctor has to watch. House has arranged for Hal to be hiding in a stall to give a sample. He starts singing from HMS Pinafore to cover the sound. When the results come back, House moves up to a 4. Dr. Medina apologizes for doubting him.

Dr. Medina asks Freedom Master to move the piano. House challenges Dr. Medina's methods, but the doctor tells House that the patient is delusional. Dr. Medina then tells the patient he is not a superhero. Steve points out that Annie is always looking at a music box that is in the locked pharmaceutical room. Dr. Medina tells Freedom Master that his wife is dead and that no one could have saved her. However, Freedom Master becomes extremely agitated and tries to get the music box.

While outside, Alvie tells House not to keep scheming. He says he is upset with himself for not interfering with a doctor who did something totally out of line. Alvie reminds him that if he keeps up the act, he can go home in a few days. They are ordered inside because Susan is being released. They give her a re-birthday cake and a send off. House asks Dr. Medina where Freedom Master is and is only told he can't take part. House goes to look for him and finds him catatonic in his bed. Alvie tries to distract House with the cake, but House challenges the doctors about this method because Freedom Master used to be happy and functional and now he can't function at all. Dr. Nolan arrives and asks Dr. House to come with him.

House tells Dr. Nolan he's angry because they screwed up Freedom Master. He also points out he's got a higher score than Susan, who just got released. House wants to continue to be treated on an outpatient basis, but Dr. Nolan refuses. He shows Dr. Nolan that he's not taking his medication and he still is high functioning. Dr. Nolan opens up one of the pills and tells Dr. House to taste it by licking it off his hand. Dr. House realizes that some of the pills are placebos. Dr. Nolan realized he was progressing too quickly and that he probably wasn't taking his medication, so he switched them. When the urine was positive, he realized House wasn't cooperating. He tells House to stop fighting the system and let him do his job.

Alvie asks what the new plan is, but House doesn't have one. He asks Alvie to stop talking.

House sees Lydia arrive with a cello. He comes to offer to help carry it, but when she refuses it because of the disability, he offers the services of Freedom Master. They go outside and they talk about why she comes to visit her sister-in-law five times a week. Freedom Master struggles with the cello, but it's clear he's still depressed. House asks for her keys so he can drive the other patient around the grounds. She agrees. However, he tells her he's making an escape attempt just before he drops her off. House and Freedom Master go to an amusement park where they go on a ride that simulates a parachute free fall. Steve starts to feel better, as does House. He asks his fellow patient to tell Dr. Nolan he's an idiot. However, he sees Freedom Master standing on the edge of the parking garage, and he jumps off.

House returns to the hospital. Freedom Master survived but is severely injured. Dr. Nolan admonishes House for reinforcing Freedom Master's delusions. Nolan believes House doesn't care about anything and that he's going to be transferred to another psychiatric hospital. House asks not to be transferred and admits he needs help.

Dr. Nolan starts a psychotherapy session with House. House doesn't know where to start, but Dr. Nolan tells him the only way to find out what to talk about is to start. House says he's sick of being miserable. Dr. Nolan offers House SSRIs, but House is resistant. Dr. Nolan asks him if he's afraid to lose his edge. They talk about whether Van Gogh would have lost his inspiration, and Dr. Nolan says he wouldn't have, but his life would be better. House takes the pills and agrees to start taking his medicine.

Alvie thinks House is still faking and is upset he's started taking medication. House says he was broken and is now getting better. Alvie tells him he hates him.

House has been there four weeks and Dr. Nolan comes to see him and asks him about his relationships with the other patients. However, when House does, Dr. Nolan notes that he has only talked about how one of the other patients sees him - Alvie. Dr. Nolan tells him he has to trust people. He then hands him a suit and tells him to get dressed.

Dr. Nolan takes House to a cocktail party where he doesn't know anyone. He tells him to talk to some of the other people. He starts talking to a donor who he figures out used to be a patient. After at first admitting that he takes advantage of his one friend, he tells the donor that Dr. Nolan is his lover. He runs into Lydia who reminds him he isn't gay. She also reminds him that if he's going to share secrets with people, they should be true. However he and Lydia start playing with one of the other guests, pretending they're married to fool with her mind. Dr. Nolan comes to him later and House admits he was screwing with people and having fun. Dr. Nolan realizes that House has been lying about what he was - a philanderer or porn producer. He tells him the point of the exercise wasn't to get him to trust people, but to show him he could trust people. He points out that no-one ratted out his terrible fake secrets. He wonders why House didn't just tell them he was a patient. Lydia comes over to ask if he's in trouble, but he's not. She asks if he wants to act as her pimp. He just wants to talk about why she isn't mad about him stealing her car and ruining Freedom Master's life. She thinks he is misguided and irresponsible, but also nice. She says she comes to visit her sister-in-law so often because she used to be her best friend, but then she started withdrawing from everyone. She says she married the patient's brother after she got sick because they were going through the same thing. The brother stopped coming, but she didn't, and she still misses the person Annie used to be. She says she has to leave and House wishes her good night. She gives him a little kiss before she leaves.

House goes back to his room and Alvie starts talking to him again, asking what happened. House says he had fun.

House's back in psychotherapy telling Dr. Nolan that he and Lydia kissed. Dr. Nolan points out that Lydia's married and House's institutionalized, and he realizes House has been doing nothing but thinking about what the kiss meant. House asks about the woman in the parking lot, but Dr. Nolan denies having an affair with her. However, House starts questioning him. He's noticed he only has one number on his speed dial - his father. He thinks Dr. Nolan is lonely and has no personal life.

Lydia comes for another visit and House asks her why she kissed him. She says she just likes him. House plays the piano for her. Freedom Master comes back in the room, and he's depressed again.

House goes back into psychotherapy and tells Dr. Nolan the kiss meant less to him than seeing Freedom Master back in his depressed state. Dr. Nolan asks why Dr. House why he dwells on his failures so much. House says success is fleeting, but failure lasts forever. Dr. Nolan tells him to acknowledge failure and move past it. He says House is punishing himself for causing pain in others. He has to apologize to Freedom Master, feel better, and move on.

House goes to see Freedom Master, but doesn't say anything past "Hey". However, before anything happens, Dr. Beasley calls for a group session and tells them they will have a talent show. When Dr. Beasley asks for Freedom Master's opinion about Diane's talent, he is unresponsive. Dr. House doesn't think that he's going to get better the way they are treating him. They have to make things better rather than hoping they will. All of a sudden, House remembers that Freedom Master said "they stole her voice box" when he got agitated, and that he keeps staring. He realizes he and Annie are staring at a music box that's locked up in the secure room. He tries to get it and Dr. Beasley calls for an orderly. However, House insists that the music box will work. Dr. Beasley relents. Dr. House grabs the box and gives it to Freedom Master to make him speak, but he stays silent. Dr. Nolan comes along and tells everyone to take a break. He tells House he's still trying to fix people instead of moving on.

Lydia comes back with some sheet music for a Dvorak duet so they can play together. Dr. House asks her why she keeps coming to him, and she says they are just friends. He's afraid that someone is going to get hurt. She tells him everything comes to an end, but it doesn't mean they can't enjoy themselves. He says goodbye to her.

Back in group therapy, Diane is wondering if she should have electroshock therapy. Alvie is having trouble with his rap for the talent show. Dr. Medina brings Dr. House a day pass and tells him Dr. Nolan wants to see him. He finds Dr. Nolan with a comatose patient - his father. He wants to show House his father's chart. House asks him if he ran out of sane doctors, but Dr. Nolan thought he might enjoy a break from the ward. Apparently, his cleaning lady found the father unconscious on the floor. The other doctors didn't think anything could be done, but he wanted House's opinion. However, Dr. House confirms a lacunar infarction with a hemorrhagic stroke. This compressed his brain, replacing brain tissue with blood - the other doctors were right. House realized that Dr. Nolan realized this before House arrived and he just wanted permission to pull the plug. He realized that at some point in his life Dr. Nolan lost everything except his father, and now House is the closest thing he has to a friend. Dr. Nolan tells House to shut up and that he doesn't want to play games. House takes off his jacket and sits by the bedside with him.

House comes back to the hospital and finds Lydia crying and apologizes for pushing her away because he was afraid. She says it's not about House and she's calling herself pathetic for bringing a cello for her sister-in-law to play at the talent show. They hug and start slowly dancing. They find somewhere private and start kissing, finally undressing to make love.

At the talent show, Dr. Beasley and Diane dance the Macarena. Hal, Richter, and Jay-Bird sing "You're Nobody 'Til Somebody Loves You". Stomp does a percussion routine. Alvie does a rap, with House helping to fill in when Alvie runs out of ideas. Alvie finally invites House to the stage and they do a rap duet.

Later in psychotherapy, House asks Dr. Nolan how he's dealing with his father's death. House says things are going well. House finally goes to apologize to Freedom Master and takes the blame for his injuries. Dr. Nolan looks on and nods encouragement. House takes Freedom Master to get his meds, but instead leaves him with Annie. Freedom Master gives her the music box. She opens it and is responsive. Dr. Nolan and House are astonished. She says "Thank you, " and Freedom Master replies "You're welcome." Lydia arrives later to find Annie playing her cello for the patients and staff. Eventually, Annie is released with a cake and send-off for her re-birthday.

House goes to confront Dr. Nolan again. He says that Annie has been unresponsive for a decade and can't just go back to her life. However, Dr. Nolan tells House that she's going to a rehabilitation facility in Arizona first, along with Lydia and her brother. House asks for an overnight pass, but Dr. Nolan is worried about him and wants to help. He says he will give him the pass if he wants it, but he knows why he wants it and tells him he hasn't thought it through. House asks for the pass anyway.

House goes to visit Lydia, whose young son answers the door. Lydia comes to the door and tells House her family always wanted to move to Phoenix to be closer to her husband's company, and now they can, since Annie is better. She apologizes for not coming to say goodbye, but says she can't break up her family and has to go with them.

Dr. Nolan is about to leave when he finds House in the parking lot. House tells Dr. Nolan that Lydia left him and that he feels lost. Dr. Nolan agrees to write the letter to recommend the reinstatement of his medical license. Dr. House wants to know if he is just being nice, but Dr. Nolan tells him that he's doing it because he connected to another person and that he came to see him about the pain instead of running to take drugs. He tells House to go get a good night's sleep so he can say goodbyes the next day.

They give House a cake and a send off for his re-birthday. He pretends not to want to hug Alvie, then he hugs him anyway. He then shoves his own face in the cake to the delight of everyone.

House is released and goes to the bus shelter. Alvie watches him go, and then goes to ask Dr. Beasley for medication for his condition. House gets on the bus and goes to sit at the back while it's revealed he's wearing one of Alvie's T-shirts that has a big smiley face on it.

• This episode doesn't start with the usual cold opening followed by the "Teardrop" theme, but instead starts with a montage of shots of the psychiatric hospital and the opening credits with the song No Surprises by the British alternative rock band, Radiohead heard playing at the beginning as House detoxes from Vicodin.
• "Ward No. 6" was a short story by Anton Chekhov.
• The episode won the 2009 Writers Guild of America award for Best Episodic Drama.
• The part of Dr. Nolan was specifically written with Braugher in mind.
• Hugh Laurie (House) and Robert Sean Leonard (Wilson) are the only regular cast members to either appear or be credited for the episode.
• Although much more optimistic, the overall tone of the episode was drawn from Miloš Forman's 1975 film One Flew Over the Cuckoo's Nest, and this is confirmed in the DVD commentary. Even some specific elements from its main character Randle McMurphy (played by Jack Nicholson) are used. For example: House wearing a wool hat (taken from the wheelchair patient), House described by Dr Nolan as a "natural leader" and trying to make his fellow patients claim some autonomy, House playing cards with them for cigarettes, House taking Freedom Master for a ride outside the facility, etc..
• Given the date on the big board, House entered Mayfield on May 25, 2009.
• Brass tacks is an English idiom that means "getting directly down to essential details". It comes from the fact that brass tacks were used to make precise measurements, particularly of cloth.
• Annie Hall is a 1977 film written and directed by Woody Allen (who plays the character "Alvy" in the film) that won the Oscar for Best Picture.
• "Bolt" is Usain Bolt, the current world record holder for the 100m and 200m. However, unlike past 100m champions like Carl Lewis and Jesse Owens who also competed successfully in the long jump, Bolt is strictly a sprinter. Alvie is right that the long jump record is one that has rarely changed over the past decades. The current mark of 8.95m is held by American Mike Powell, who set the record back in 1991. Before that, the record was held since 1968 by American Bob Beamon. Jesse Owens also held the record for a lengthy period of time, from 1935 to 1960.
• The room number of the isolation room is "232".
• The "CIA" is the common abbreviation for the United States Central Intelligence Agency.
• House criticized Lydia's piano playing as being "heavy on the right foot". The right or "sustain" pedal on a piano lifts all the dampers from the strings. When the pedal is not depressed, the damper comes down on the string as soon as the key is released, cutting off the note. With the pedal depressed, the string will continue to vibrate until it runs out of energy or the pedal is released. If a pianist's keyboard technique is imperfect, he/she may use the sustain pedal briefly and repeatedly to mask it. This is the point of House's criticism. Also, overlong sustain can interfere with the harmony of later chords.
• Alvie is correct in that thinking you are a superhero is a much less common delusion than thinking you are a religious figure.
• The card game played by the ward residents is Blind man's bluff.
• The major symphony orchestra in Philadelphia is the Philadelphia Orchestra. While several others exist, none is called the "Philadelphia Philharmonic".
• The song House sings in the washroom is "He is an Englishman" from Gilbert & Sullivan's H.M.S. Pinafore. In real life, Hugh Laurie who plays Greg House is English.
• Clark Kent is the secret identity of Superman. Bruce Wayne and Peter Parker are also secret identities, of Batman and Spider-Man, respectively.
• "Shaq" is a reference to basketball legend Shaquille O'Neal.
• "Ritz Bits" are a smaller snack food version of Ritz Crackers.
• A "nooner" is slang for a mid-day sexual encounter, usually an illicit one.
• "Writing with a crayon" is a reference to the habit in North American education systems in giving students more advanced writing implements once they master basic printing and writing skills. The progression starts with a crayon in kindergarten, usually moves into a pencil in first grade, then a pen later on. However, particularly poor writers often struggle to get past the crayon stage. Your humble administrator still has nightmares about that.
• The Space Needle is a 605 ft tall tower in Seattle, Washington. It was built for the 1962 World's Fair and has become an iconic part of the city's skyline.
• Bonnie Parker and Clyde Barrow were the leaders of a gang of notorious armed robbers in the 1930s. They did die in a police ambush in 1934. Their lives were the subject of a film of the same name in 1967. House's attempt to compare himself and Lydia to them is a good example of an Analogy Backfire.
• Another reference to Vincent Van Gogh. The reference to him still having both ears refers to an incident where he accidentally cut off a part of his own ear with a razor while fighting with his friend Paul Gauguin.
• According to the name on Dr. Nolan's father's wristband, which is "Nolan, Darryl Sr.", Nolan was named after his father.
• Antonín Dvořák was a Czech composer in the late 19th century.
• The Macarena is a dance set to a song by the same name by the Spanish duo Los del Rio.
• You're Nobody till Somebody Loves You is a frequently recorded song that was written in 1944.
• The music box plays "Das klinget so herrlich" from Act One of The Magic Flute, an opera by Wolfgang Amadeus Mozart. In the opera, Monostatos and his men capture Papageno, who then plays the tune on his glockenspiel (in some productions a hand-cranked music box is used). The music enchants the would-be abductors, who sing and dance happily and forget about Papageno. This parallels the music box causing the cellist to become responsive again. The DVD commentary for this episode is from executive producer and director Katie Jacobs and two of the writers, Garrett Lerner and Russel Friend. For this scene, none of them says anything about the music. In the DVD extra about the production of the episode, property master Tyler Patton gives some information about the music box. He says he narrowed his choice down from many music boxes so that it could be "the best prop possible". But he too says nothing about the tune. Audio such as this is added in post-production, so it's possible someone chose the tune at that point. Currently there is no further information about who chose the tune and the reason for that choice.
• Annie plays the beginning of the first movement ("prelude") of Bach's Cello Suite #1 in G, BWV 1007. However, she starts off-tempo and speeds up to the proper tempo. This could be to show her slowly returning from "broken" to normal. It could also simply be artistic license.
• The shirt House wears on the bus as he's leaving matches his face: both have a smile. It is the same shirt that Alvie was wearing earlier in the episode, another suggestion that they had bonded as friends.
• On Netflix as well as the Region 2 DVD, this episode is split up into two parts.
• When Lydia first meets House, she is playing "About Foreign Lands and People", the opening piece in "Kinderszenen", Op. 15 by Robert Schumann. This could be applicable in many ways, such as simply meeting someone new, the way outsiders regard the patients (and perhaps vice versa), how House seems to everybody else, etc. Later Lydia plays Impromptu Op. 142 #3 by Franz Schubert.
• The title card for the episode excludes the use of "M.D." to reflect the fact that House has lost his medical license. However, the "M.D." is the medical degree and a suspended physician still retains the degree title even though using it during a suspension is difficult as it may be seen as misleading.
• Ana Lenchantin is a professional cellist but unlike her character, she generally plays the cello with rock-and-roll artists such as Brian Wilson of The Beach Boys and Billy Corgan of Smashing Pumpkins.
• Freedom Master's reference to "the warmth of your yellow sun" is a direct reference to the source of Superman's powers.
• The Family Guy episode "Patriot Games" is playing on the television in the ward.
• When House shows Alvie he has cheeked the Haldol pill, Alvie swipes the side of his nose with his finger. Swiping or tapping the side of the nose can indicate different things, such as "I know what you just did and I can be trusted, " or "I know what's going to happen and I'm ready." It can be seen in many places, such as in the film The Sting.
• Polite Dissent noted that Lin-Manuel Miranda's portrayal of Alvie's manic state was actually subdued.
• The producers worked closely with the National Alliance on Mental Illness on this episode in order to accurately depict the patients with mental illnesses.
• This is the first episode to have Hugh Laurie credited as an Executive Producer.
• The scene where House shoves his face into his going away cake was improvised by Hugh Laurie, so the cast was completely surprised and their reaction was entirely genuine.

Treating uncooperative patients:

Psychiatrists are accustomed to treating patients who do not want to be treated. However, as a general rule, every patient who has the appropriate mental capacity has the absolute right to refuse medical treatment for any reason.

Indeed, House himself commonly treats patients against their will. This was a major theme in Informed Consent. He's also used to treating combative patients (see The Jerk) and even patients who are incapable of consenting to treatment (see Wilson's Heart).

Of course, the difference between organic and psychiatric illness is quite telling. Most people with some form of mental illness refuse to believe they require treatment. Psychiatric patients are often in the worst position to see their symptoms. Indeed, psychiatric patients have been known to project the symptoms they do feel on the population as a whole.

House clearly falls in the middle here. Many characters who know him noted that he may benefit from some sort of psychiatric intervention; however, he's always felt that such intervention would be useless.

In addition, proper psychiatric treatment requires a tremendous level of trust between the doctor and the patient - probably more than in any other area of medicine. Nolan clearly goes out on a limb with House. He starts off with a very restrictive regimen for House (which includes periods in isolation for misbehavior), slowly offering more and more incentives when House co-operates. However, he knows that House is perfectly capable of carrying out on his threats of disruption and focusing on the goal of getting back to practicing medicine rather than addressing his mental health issues. Nolan risks having a patient that won't trust him to, ironically, build trust.

As such, Nolan has to "lead trumps" by threatening the loss of House's medical license. House knows this is no idle threat. Medical regulators have a wide range of powers available to them when a physician shows signs of substance abuse and consistently bad behavior, and that would include requiring House to undergo the very treatment he's desperately trying to avoid.

• Trying to give a combative patient a Haldol pill is ill-advised for two reasons. First, orally administered Haldol takes about five minutes to have any effect. An injection would be a better choice. Secondly, Haldol is overkill for the purpose. There are lots of other appropriate sedatives with milder side effects.
• Both Dr. Medina and House take the exact wrong approach with a delusional patient. If a delusional patient is confronted about their delusions, they will thereafter refuse to trust the doctor - a fatal blow to the doctor/patient relationship. Moreover, a doctor should never confront a delusional patient in a public space. If a doctor must confront a delusion, it should be mildly and entirely in private. Delusions are usually an attempt by the patient to cope and they will hang onto the delusion until they are properly treated, usually with a combination of medication and psychotherapy so that they eventually stop leaning on the delusion as a crutch.