Cuddy: Question is, is this a bad agenda or a good one. Either you're trying to screw with me, or you're trying to show me you've really changed.

House: So which is it? I'm dying to know!

―Ignorance is Bliss

Ignorance is Bliss is a 6th season episode of House which first aired on November 23, 2009. On the eve of Thanksgiving, House and the team take on the case of James Sidas, an exceptionally brilliant physicist and author who traded his successful career for a job as a courier. For the ailing patient, intelligence is a miserable burden that has prompted depression and addiction, and this, coupled with a myriad of strange symptoms, nearly stumps the team. Meanwhile, the doctors at Princeton-Plainsboro Teaching Hospital wrestle with strained personal relationships. House will say that he loves Cuddy. This is the first episode where Cameron is gone from the show, and after House compares Chase to Cameron he loses it and punches House.

The episode explores the interaction between happiness and relationships, with just about everyone's relationships being put under the microscope. House is in a classic love triangle with Cuddy and Lucas and he seems his happiest when he believes his schemes to break them up are working. However, neither Cuddy nor Lucas takes any joy when they thwart House's plans. Foreman and Thirteen both act like adults over their recent breakup. Chase deals with his personal and professional separation from Cameron with aplomb, but can't deal with the constant need to provide him with reassurance. Ironically, only House seems not to care about Chase's emotional state and, as a result, Chase reaches out to him – literally.

But at the top of the episode is the relationship between Sidas and his wife Dara. Years before, Sidas realizes that he derives only anxiety from his work as the pressure on him to come up with even more brilliant ideas becomes unbearable. This parallels House's recent breakdown when House realizes the satisfaction he derives from his work is at risk, and then finds that it's the only thing that makes his life bearable. Both Sidas and House try to find solace in relationships, but they both have severe deficits when trying to bond with people – their intellect gets in the way. Sidas seems to have found the answer – a way to turn his intellect down to normal without damaging it permanently. He does it because he truly cares for Dara and realizes that in his "clear" state, he will punish her for her limited intellect.

As with a lot of episodes, we see a lot of foreshadowing. Cameron's breakup with Chase parallels the breakup between Cuddy and Lucas later in the season, and largely for the same underlying reason – neither Cameron nor Cuddy seems comfortable dealing with a real issue in their relationship. House's dialogues with Sidas give him insight too – that he must find his own path to a relationship before it's too late.

A bookstore owner recognizes famous physicist James Sidas when he makes a delivery to his store. He asks him to sign one of Sidas' books. Sidas tries to comply, but has trouble using his hands and becomes disoriented.

House is trying to get the cafeteria cashier Daria to charge Wilson for his bagel. Cuddy comes by and pays for House. Cuddy gives him Sidas' case. He describes Sidas' case to his team. Thirteen thinks it's an infection, but that appears to be ruled out. Taub thinks it's sickle cell anemia, even though Sidas is Caucasian. Foreman thinks it's thrombotic thrombocytopenic purpura and when Thirteen and Chase agree, House orders tests for it. He pages Wilson, but gets no response.

Taub and Thirteen meet the patient, who is with his wife. They ask why he isn't working in a better job given his reputation. Sidas says he doesn't like thinking so much and having so much anticipation for him. He says he's happy in his new job as a courier and he likes being happy better than being smart.

Foreman talks to Chase about Cameron, but Chase says it's over. He turns aside Foreman's offer of help.

Taub talks to Thirteen as to why the patient, with such a high IQ, seems so normal. They talk about why they returned to work for House. They confirm TTP and Taub wonders why House took the case if it was so easy. However, Taub thinks it's a test. He suggests to House they do a splenectomy because plasmapheresis has been ruled out. House agrees and assures Taub he's not just testing them. He says he took the case, even though it's easy, because he wants to find out about Sidas. House is looking for Wilson in the men's washroom, but still can't find him.

Wilson arrives late after a dental appointment and House asks why he hasn't been answering his pages. Wilson knew the pages were about Cuddy. House is planning to break up Lucas and Cuddy by crashing Cuddy's Thanksgiving dinner with her sister. However, House doesn't know where the sister lives and Wilson says he doesn't know either.

Sidas shows signs of improvement, but all of a sudden, it appears he's delirious. Chase realizes he's having a stroke.

They manage to treat the stroke and the patient suffers no brain damage. They realize it isn't TTP because the removal of the spleen would have improved it. Taub thinks it's a form of vasculitis, but nothing showed on the CT scan. House is trying to find Cuddy's sister by calling everyone in the phone book with Cuddy's sister's name. They finally decide to test for rare toxins and do an environmental scan. Taub and Chase go to the patient's apartment and Taub asks Chase for Thanksgiving dinner. Chase figures it's just because Taub thinks he's lonely and politely declines. Taub finds a lot of Sidas' notebooks. They realize he was working on physics in high school even though it wasn't part of his homework. Chase finds hidden alcohol.

Cuddy finds House doing voluntary clinic duty. She figures he's up to something, either screwing with her or trying to show he's changed. She invites him to Thanksgiving dinner. House goes to Wilson. Wilson suggests it might be a trick, but House has checked out the address even though it's a three hour drive away.

The team reports to House that they found alcohol but no toxins. Chase thinks it's liver failure and tells House to wear a less flashy tie to dinner. Everyone seems to think it's alcoholism and Foreman wants to go for Thanksgiving and do the biopsy when they get back. House lets Foreman and Chase leave, but orders Taub and Thirteen to do the biopsy as soon as possible just in case they're wrong.

The patient denies being an alcoholic, but his wife wonders when he started drinking at all. They argue about how much he must be drinking. Taub does the biopsy.

House arrives for dinner at the address Cuddy gave him, but finds that she has misdirected him to the house of her sister, who's vacationing in Hawaii. The house sitter offers him a turkey sandwich on Cuddy's direction. Cuddy and Lucas are enjoying Thanksgiving with her family.

The biopsy shows no scarring or other signs of cirrhosis, but the blood tests show an elevated albumin level. Taub thinks it might be kidney failure. It would explain everything except the stroke, but that could be explained by a related condition. They realize they have to biopsy his kidney to find out.

Lucas arrives home to find that House, having broken in, is waiting for him in an inebriated state, having drank Lucas' bottle of tequila. They discuss Cuddy. House figures Cuddy's trying to figure out if he's willing to change, and he realizes she always has given him a chance, but he used up too many of them. Lucas offers a coffee. House stands up, says that he (House) is pathetic and doesn't deserve Cuddy, and collapses on the floor, telling Lucas he loves Cuddy.

The kidney biopsy confirms kidney failure. House has called in sick and the rest of the team tries to work it out themselves. Chase denies he had a bad time on Thanksgiving. He starts to focus on the patient's recent cough. Foreman suggests immunosuppressants and dialysis to treat the kidney failure. The rest of the team think he's trying to be in charge again, but he agrees to the treatment.

Sidas asks how long he has to be hooked up for dialysis. The wife is concerned about the changing diagnosis.

Thirteen speaks to Chase about Cameron and suggests counseling, but Chase just wants to be left alone.

Cuddy goes to confront House about what he said to Lucas last night as Lucas has broken up with her. Lucas told her he didn't realize how much there was between her and House. House can't remember much of last night or even how he got home, but admits he was drunk. Cuddy admits that she started feeling bad about giving him the wrong address, but has now realized House didn't deserve her sympathy. She tells him that there was never anything between them.

House is jubilant and brags to Wilson that he got Cuddy and Lucas to split up by lying to Lucas. Wilson says Cuddy probably hates him. When Wilson notes sarcastically that it's Lucas' fault for being so stupid, House thinks of something.

House goes to Sidas and tells him that he's stupid. He's realized that the cough syrup was his real addiction – dextromethorphan. Taken constantly, it lowers IQ. Although he's still smarter than average, he's a lot dumber than he used to be. However, dextromethorphan would also cause permanent brain damage, unless the patient used alcohol in moderation. He figures that Sidas was intentionally lowering his intelligence while maintaining his brain. Sidas admits that this was his plan – not being as smart made him less miserable. Dextromethorphan abuse explains all of his symptoms, even the coughing – a rebound effect. House orders a bowel lavage and activated charcoal to clean the drug from his system. When Sidas says he can't live without it, House tells him it's surprising what you can live without.

Sidas improves quickly and starts making physics drawings again. He tries to explain them to his wife, but he realizes it's too advanced for her. He asks for juice to get his wife out of the room and confides in Foreman that his wife is now so much less intelligent than he is, it's like having sex with a monkey and he wishes his wife could at least spell "applied physics". Foreman asks if he would be happier without her. Sidas admits that he wouldn't, and that he owes her everything, but being as smart as he is makes him a jerk who doesn't really feel like he wants to be with her.

Sidas' wife realizes he is treating her differently. Foreman tells her not to worry, but all of a sudden Sidas cries out – he has no feeling in his legs.

Taub is discussing his decision to work for House with his wife. He says he can always make money, but he won't always have the opportunity to work with someone of House's calibre. Rachel denies it's about the money or his decision to work for House again without asking her. Her real problem is that he went from being the boss to doing grunt work for House. That's what he did when they first got married (he was an intern), and she only put up with it because she knew it would lead to something better. Now, House makes Taub miss Thanksgiving dinner. Taub gets paged.

Thirteen thinks Sidas has vitamin B12 deficiency, but that wouldn't cause a stroke. Foreman suggests a problem with the bone marrow, but that wouldn't explain the schistocytes they mistook as a symptom of TTP. Taub suggest lupus, but the ANA was negative. When Chase has no suggestions, House threatens to call Cameron. Foreman tries to stop House, but he's gone too far – Chase slowly walks over to House and punches him in the face. House hits the floor, still conscious, and Chase leaves the room.

Cuddy finds House in her office and asks if he's going to press charges, but he claims he tripped over an ottoman. House asks Cuddy to dinner, but she says there are witnesses to the assault. House writes it off as mass hysteria. When Cuddy says doctors can't punch each other out, House asks who got punched. When Cuddy asks if Chase needs help, House says Chase couldn't have punched anyone as he was with Chase when he tripped over the ottoman. He asks Cuddy to a movie, but she says she's not going to play his game because it isn't fun. She tells him to just do his job.

House goes to Sidas, who asks about his face. He says that he wants to ask Sidas for a differential diagnosis. Sidas doubts it will work given his lack of medical knowledge, but House says he has no-one else to ask anyway. Sidas talks about how smart they are and how lonely it is. He admits that he started abusing drugs when he unsuccessfully tried to commit suicide by jumping and he was put on narcotics for his injuries. He started to feel more normal and less isolated. He met his wife at the hospital and fell in love with her when he was high on drugs. House gives him more dextromethorphan. However, House then thinks of something – he asks which ribs he broke in the fall – it was the bottom 3 on the left side, but that was 12 years ago.

House arranges an MRI with ferrous oxide contrast. Taub says this better be important because his wife is now ready to leave him. When Chase arrives, House uses Taub as a human shield. House explains that, in a normal patient, ferrous oxide is absorbed by the spleen, unless the patient doesn't have one, in which case it is absorbed by the liver and is toxic. Chase has already removed the spleen and wonders if House thinks he missed it. The scan shows that the patient has over a dozen more spleens throughout his torso. When the patient broke his ribs, the spleen ruptured, but then broke off and travelled to different parts of his body. It was TTP all along, but Chase didn't remove all of the spleens so the splenectomy was ineffective. They schedule more surgery.

Chase chases down House in the hall, and apologizes for doing so much damage. Chase says it wasn't about what House said, it was about everyone asking if he was okay about Cameron. He figured by hitting House, it would keep everyone else from talking to him about it.

Sidas recovers from surgery and plans to return to a life with his wife in it – back to dextromethorphan and being a courier. Taub wonders why House is okay with the patient's decision, and House tells him ignorance is bliss. Taub takes a picture of House's broken nose, saying he's going to put them on T-shirts and mugs. Instead, he shows the picture to his wife and says he did it himself. Rachel wonders if he's going to be fired or arrested, but he tells her not to worry. They make up.

House catches Cuddy leaving the hospital and asks if they can still be civil to each other. He offers her tickets to a carnival so she can take Rachel Cuddy. He says he bought them off a nurse, but she turns them down anyway.

House realizes that Cuddy hasn't really split up with Lucas. House tells Wilson that he's realized she just said they did so he would back off. House says he hasn't got anything else planned and that he's okay with that.

Cuddy tells Lucas that she knows that House figured out they didn't break up. When Lucas asks how she knows, she says she just knows. Lucas says maybe House isn't so bad after all. Cuddy admits that would be nice.

House starts asking about the patient's symptoms, which are vague, and all the patient's reactions are normal. The patient asks if he's always this rude and what he thinks she has. He asks, as an insurance company spy, if she shouldn't have a better job. She denies it, but he notes that the handwriting in her medical records is way too neat to be from real doctors, she's asking more questions than she's answering, and he's already searched her purse (he was looking for gum) and found the list of questions she was supposed to have memorized. He buys her silence and a show that she's pleased with $20 so he can impress Cuddy. However, Cuddy has left for the day and the patient runs out when House looks like he wants his money back.

TTP is a very rare disease, with an incidence of about 1 in a million. It is more common in pregnant females (see Kids) but almost unknown in white Caucasian males. Foreman got this one right on the nose because he saw similar systems in Kids and he's the one who treated it. Splenosis, on the other hand, does occur in a large number of individuals who suffer massive trauma to the left side of their ribcage- as many as 2/3rds of those with injured spleens might develop the condition. Although a large number of these secondary spleens would be significantly more rare, they do occur and are oftentimes benign and only discovered incidentally (assuming that they do not grow large enough over time to begin exerting pressure on the surrounding abdomen). It is also therefore plausible that Dr. Chase could have missed the additional masses while operating on the patient.

• James Sidas is based on William James Sidis. He was a genius who would only work in menial jobs later in his life.
• "MIT" is the Massachusetts Institute of Technology, one of the leading science and engineering universities in the United States.
• NOVA is a long-running science program produced by Boston PBS station WGBH.
• The purported photograph of a young Sidas on the back of the book is actually actor Jonathan Brandis, who committed suicide in 2003 at the age of 27.
• Thanksgiving is an annual holiday in the United States, celebrated on the fourth Thursday of November. Like many holidays around the world held at harvest time, it is often when extended families get together.
• Mike Tomlin is the head coach for the Pittsburgh Steelers. House was most likely referencing the common perception that Tomlin is Omar Epps' celebrity look-alike.
• House wears a Hugo Boss tie.
• Toroidal helicon plasma devices are used in fusion power experiments.
• The first scene of the episode opens displaying several physics books, the most noticeable of which is a book on quantum physics titled Discrete Energy States. This alludes to James Sidas - a physics prodigy.
• An ottoman is a type of upholstered stool used as furniture that usually matches the couch. It's named after the Ottoman Empire, where the concept originated.
• The fact that the ottoman "acted alone" is a shout out to common conspiracy theories about the assassination of President John F. Kennedy, particularly the common belief that Lee Harvey Oswald was involved in a conspiracy.
• At the end of the episode, when talking to House about Cuddy and Lucas, Wilson references the World War II Native American "code-talkers", using the name of the movie made about them, Windtalkers. That movie featured Martin Henderson and Holmes Osborne.
• Polite Dissent pointed out a trope unique to the series – an air vent that the team finds contraband in because the cover hasn't been properly replaced.
• "Peace in our time" is a reference to the British Prime Minister Neville Chamberlain who proclaimed it following the signing of the Munich Agreement with Nazi Germany in 1938. Fittingly, as in House's case, it was a ruse and it didn't end well.

A common theme on House that runs through this episode is treating self-destructive patients. Indeed, one of the parallels that Sidas has with House is their dependency on drugs. However, they are dependent for different reasons – House trying to be at the top of his game and Sidas trying to be at the bottom of his. In the scenes where the intelligent Sidas has a conversation with the newly clean House, we get a rare opportunity for House to talk to someone who mirrors his recent ability to cope without Vicodin.

However, House has always been on the side of treating people with self-destructive behavior, from the death row inmate in Acceptance to his own experience in Three Stories. Doctors face the same ethical dilemma on a constant basis. Over the past few decades, both the approach to patient treatment and our understanding of beating dependency have changed. In addition, it's not like only fictional doctors have substance abuse problems.

Despite House's tendency, even in this episode, to treat patients dismissively, with Sidas we see that House is ahead of the curve in dealing with a patient with a substance abuse problem. Many of the fellows, in contrast, are judgmental and want to intervene more. As a former druggie himself, House has a fuller understanding of the problem. Drug abuse is rarely a single issue problem. Many people who abuse drugs are trying to self-medicate to treat other problems, like clinical depression or bipolar disorder. Sidas is just lonely and anxious when he's sober, while on DM he's happy and relaxed. House knows better than anyone that the drugs aren't going to stop until the other problems do.

Physicians who specialize in drug abuse now realize that relapses are common, and usually inevitable. However, they cannot be treated as a sign of failure, just a roadblock to further success. Physicians in this field now collaborate with their patients, whose anxiety arising from sobriety is often exacerbated by their anxiety that they will once again lapse into drug use. Avoiding that takes more than psychotherapy or even medicine. Patients who succeed often have to leave their whole life behind. Many alcoholics, for example, don't know how to socialize without using alcohol and often become lonely when they abstain. That just makes staying sober that much harder no matter how much medical intervention there is.

In addition, many sick drug abusers face discrimination and the feeling that their medical problems are their fault even when their underlying condition isn't caused by their drug abuse. Here, Sidas' DM abuse may have made his TTP worse, but it's unlikely to have caused it in the first place. It's why he become so defensive when his alcohol use is revealed – like the overweight George in Que Será Será, the physician's diagnoses from that point forward become colored completely by a single issue.

• When House and Wilson get on the elevator together, they enter the elevator to the audience's left. However, the elevator they emerge from is on the audience's right.
• As House and Lucas talk to each other, the pillow next to Lucas goes from crumpled to upright back to crumpled again.
• When Taub takes a picture of House, it's clear that the lens is closed.
• Although it's a common belief that alcohol will offset the detrimental effects of dextromethorphan, this has never been proven. In fact, dextromethorphan abuse causes long term mental changes that take time to revert, and Sidas would not have returned to normal intelligence levels just from discontinuing it.
• Before operating on a patient to remove their spleen, it's usually a good procedure to run a CT scan. If they had, they certainly would have found the accessory spleens and removed them at the same time as the main spleen.
• If a physician suspects liver damage, a biopsy is not a good first step, particularly if a lack of platelets is going to cause severe bleeding. It's a much better idea to run lab tests and abdominal scans, which would be much more informative in any case.
• It is technically incorrect to identify the spleens created by massive trauma as "accessory spleens"- these are congenital and are present in an individual at birth. Rather, the autotransplantation of splenic tissue to other areas of the body due to trauma would more accurately be referred to as splenosis or polysplenia.
• The mnemonic " Otis Campbell " is for explaining the causes of a seizure, not a stroke. It's named after the town drunk on The Andy Griffith Show. It appears that House prefers the mnemonic MOIST PLLACEB.
• The effects of dextromethorphan aren't accurately described. One of the clear side effects is euphoria, which is why a lot of people abuse it.
• Although Sidas has thrombotic thrombocytopenic purpura, he doesn't exhibit either thrombocytopenia or purpura.
• Schistocytes aren't unique to TTP. They can also occur with DIC.
• A really good test for TTP is to test for ADAMTS13 antibodies. High levels are pretty much unique to the genetic forms of the disease. Although the test is mentioned, they don't appear to have run it or it would have ended the episode really early.
• Sidas' CT scan was clear even though he had extra spleens. Maybe they didn't CT his abdomen.