CASE FILE: Wilson, James M.D.
CASE FILE: Wilson, James M.D.
DIAGNOSIS: Codependence Disorder
STAGE: 4; Progressive
ANALYST: Bettina Elvina

In many forums discussing the House/Wilson relationship, the two have been described as codependent with one another. However, codependency is meant to describe an individual, not a pair, for codependency can only exist in a relationship in which at least one person within a social unit is a dependent.

This topic is a highly relevant issue because, after some careful research, codependence disorder is the best explanation behind James Wilson’s social and psychological behavior. It also explains the nature of his relationship with House, which more often than not, has proven to be as self-destructive as constructive. Now, before becoming a skeptic, please bear in mind that this essay has been written for the sake of analyzing the character of James Wilson, and that it in no way poses itself as canonical. Nevertheless, the evidence presented here is quite strong, and it would be remiss to dismiss the possibility that Wilson indeed suffers from a psychological disorder.

The true definition of codependency is as follows:

“Codependency" is used to describe the condition where a person becomes the "caretaker" of an addicted or troubled individual. The individual can be addicted to alcohol, drugs, or gambling. Or, he or she can be troubled by a physical or emotional illness. Codependents can be this individual's spouse, lover, child, parent, sibling, coworker, or friend.” […] “The term has been widely applied to define spouses of chemically dependent or otherwise dysfunctional persons. More generally, codependency has been applied to individuals who suffer from constantly focusing on the needs and behaviors of others. It is maladaptive behavior that results from a stressful preoccupation with another individual's life. Without treatment, codependency leads to dysfunctional relationships.” [1]

The information above strongly suggests that House is the dependent in the relationship, whereas Wilson is the codependent. The susceptibility of an individual to codependency is highly related not only to one’s genetic make-up (one’s natural proclivity to care for others), but also one’s family environment. It is highly common for codependent individuals to have grown-up in family situations in which one individual in the family was or is a dependent.

In light of that last, it is imperative to recall the episode Histories from season 1 of House M.D. It is revealed in this episode that Wilson has (or has had) a brother who plunged into homelessness. Statistically, most homeless persons are either substance dependents or psychologically damaged dependents (i.e. Vietnam veterans). Regardless of whatever category Wilson’s brother might fall under, his situation has very likely left Wilson emotionally traumatized.

The trauma of losing his brother, however, did not start the codependent behavior. Codependent behavior usually starts when the dependent’s addiction and/or physio-psychological illness becomes visibly apparent. Assuming the role(s) of “enabler, rescuer, caretaker, joiner, hero, complainer, and/or adjuster”[1] is a normal reaction for someone who has a loved one who displays self-destructive tendencies. Unfortunately, the assumption of one or a number of these roles becomes in and of itself an addiction, the symptoms of which are difficult to detect especially in the early stages of the psychological disorder. In fact, many people suffering from codependency disorder never get diagnosed.

Codependents’ Anonymous uses the following as criteria for fulfilling the disorder. Please note that not all are required to be diagnosed with codependency disorder:

“Denial Patterns:
1.) I have difficulty identifying what I am feeling.
2.) I minimize, alter or deny how I truly feel.
3.) I perceive myself as completely unselfish and dedicated to the well being of others.

Low Self-Esteem Patterns:
1.) I have difficulty making decisions.
2.) I judge everything I think, say or do harshly, as never "good enough."
3.) I am embarrassed to receive recognition and praise or gifts.
4.) I do not ask others to meet my needs or desires.
5.) I value others' approval of my thinking, feelings and behavior over my own.
6.) I do not perceive myself as a lovable or worthwhile person.

Compliance Patterns:
1.) I compromise my own values and integrity to avoid rejection or others' anger.
2.) I am very sensitive to how others are feeling and feel the same.
3.) I am extremely loyal, remaining in harmful situations too long.
4.) I value others' opinions and feelings more than my own and am afraid to express differing opinions and feelings of my own.
5.) I put aside my own interests and hobbies in order to do what others want.
6.) I accept sex when I want love.

Control Patterns:
1.) I believe most other people are incapable of taking care of themselves.
2.) I attempt to convince others of what they "should" think and how they "truly" feel.
3.) I become resentful when others will not let me help them.
4.) I freely offer others advice and directions without being asked.
5.) I lavish gifts and favors on those I care about.
6.) I use sex to gain approval and acceptance.
7.) I have to be "needed" in order to have a relationship with others. [2]

It is most interesting to note the 6th patterns under Compliance and Control. Wilson’s sexual activities, and the conscious and subconscious motivations behind them, clearly match the maladaptive patterns described. He has went through, and rather quickly, three marriages, an unknown number of sexual affairs, and his own cancer patient. “Since many codependents avoid interaction with healthy, well-adjusted people, the codependency cycle usually continues with a series of damaging relationships.” [3]

It should also be mentioned that he exhibits several of the other patterns as well, particularly #3 under Compliance Patterns, and all of the patterns listed under Control. Other characteristics indicative of a codependent include:

An exaggerated sense of responsibility for the actions of others.
A tendency to confuse love and pity, with the tendency to "love" people they can pity and rescue.
A tendency to do more than their share, all of the time.
A tendency to become hurt when people don't recognize their efforts.
A compelling need to control others.
Lack of trust in self and/or others.
Fear of being abandoned or alone.
Rigidity/difficulty adjusting to change.
Problems with intimacy/boundaries.
Chronic anger.
Lying/dishonesty. [1]

When an individual becomes addicted to a codependent relationship, the individual expresses this addiction through more pronounced and observable behavior of all of the above. Although most codependents are not aware of their conditions, many reach a breaking point in which they realize they have confined themselves in a destructive, one-sided relationship. Yet their love for the dependent and their need to fulfill their impulse to care prevent them from breaking the connection.

Why, one must wonder, is codependency considered a type of addiction? The addiction stems from the “rewarding feeling” of helping a loved one and being needed. It is an addiction to a relationship that falsely promises permanence. The illusion of permanence comes from the belief that one will never be abandoned or left behind so long as the dependent needs a caretaker. Wilson’s relationship with House, it can be posited, is a ripple effect of Wilson’s relationship with his estranged brother. Once his brother became a lost cause and went missing (abandoning Wilson, in a sense), Wilson transfers his compulsion to rescue the hopeless to his career: oncology. When Wilson develops a bond with House, he might have found, as it were, a reflection of his absent brother. There is, therefore, such a thing as loving too much.

Having said that, the following excerpt explains, rather clearly, Wilson’s behavior during the Tritter Arc:
“[Codependents] have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating.” […] “The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the "benefactor." As this reliance increases, the codependent develops a sense of reward and satisfaction from "being needed." When the caretaking becomes compulsive, the co-dependent feels choiceless and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Codependents view themselves as victims and are attracted to that same weakness in their love and friendship relationships.”[1]

What needs to be examined, at this point in the analysis, is Wilson’s increasing codependency. Yes, it has been increasing rather than decreasing over the spans of the three seasons. This is because codependents reach the more progressive stages of their condition when their desire to “protect or rescue” an addict reach the “point of self-sacrifice.” [3]

Season 1: Wilson gives-up his job to save House’s from Vogler.
Season 2: Stopgap.
Season 3: Wilson lies about House’s forged scrips. Wilson tolerates the loss of his prescribing license, car, and bank account. Wilson decides to not testify, deciding to go to prison in House’s place instead.

Notice Season 2 is a stopgap, but in Season 3, the behavior returns exponentially. Creative drama within House M.D.’s writing staff aside, there are several significant events in Season 2, which may explain what has cause the fluctuation in Wilson’s psyche.

The proceeding will briefly outline the dynamics of House and Wilson’s relationship. This summary is necessary to better understand the timeline of Wilson’s psychological disorder.

In House M.D.’s backstory, Wilson’s childhood is a mysterious one, but the only clue behind any kind of childhood trauma may be found in his history with his now missing brother. Fast-forward about a decade, Wilson finds himself working at Princeton Plainsborough Teaching Hospital. There, he meets and befriends Gregory House, through circumstances that are still unknown.

Wilson apparently (based on episode 20, season 3 spoilers) had a fallout with his wife not because of his sexual affair, but because of his emotional affair with House. Presumably, this might have happened immediately after House’s infarction and loss of Stacey. House has suffered a debilitating physio-psychological trauma. Wilson acts as caretaker. Their relationship, it can be deduced, blossoms.

In Season 1, time has passed (about 5-6 years). In that time, House’s personality has changed due to his increasing dependency on Vicodin. Though Stacy claims that House was “always a jerk,” she was not around House during the 5-6 year gap. Wilson was, and is therefore more reliable to believe when he says, “You’ve changed.” The change causes deep-seeded concern, as Wilson has already seen how dependency damages a person. Unfortunately, he is apparently blind to how dependency damages the people who are emotionally close to the dependent. Consequently, Wilson becomes codependent with House.

Later, House has admitted himself as an addict, and Wilson has brought that fact -however manipulatively- forward. Yet House denies that his addiction is a problem, which seems to have caused Wilson to doubt his own judgment (note #5 under Low Self-Esteem Patterns). He does not push the issue after the detox, allowing House to continue his dependency on Vicodin. It is probably safe to assume that the one-week detox backfired in the long run, as House returns to his pills with more enthusiasm. This is exemplified later on in the season and the overall series.

Toward the end of the season, Vogler threatens their seemingly comfortable relationship. The threat on House’s career further activates Wilson’s protect and rescue habits. When the threat disappears, the dynamics of their relationship are further challenged with the reappearance of House’s ex-girlfriend.

In Season 2, Stacy returns to House’s life, and House temporarily becomes less dependent on his pills and less aware of his leg pain for a few episodes. Wilson, in contrast, becomes noticeably vulnerable when it appears that his position as closest friend and confidant has been so quickly replaced by an ex. Though Wilson has House’s best interests in mind, it is difficult to imagine not feeling insulted, and worse for a codependent, being temporarily forgotten as the most important person in House’s life.

But because of House’s chipper attitude and renewed sense of hope, Wilson has little need to protect House from his addiction. Instead, he shifts his priorities to protecting House from Stacy. This explains the stopgap in his codependency. Although shielding House from Stacy shows signs of codependent behavior, Wilson still has enough of his facilities to know not to directly interfere. As a result, the dependent-codependent bond lessens to a degree. Their friendship, nevertheless, remains intact and, it should be noted, becomes healthier. House confides in Wilson more openly, and Wilson offers his opinions rather than manipulating the situation to fit what he believes House needs.

When Stacy leaves House, House returns to his addiction once more, and again, with increased enthusiasm. The pain in his leg, furthermore, becomes worse for psychosomatic reasons. Wilson is needed again, and they return to the old habits of their relationship.

As soon as Julie exposes her affair, Wilson goes to House for refuge. This situation does not appear new to them. Note that, in the time Wilson cohabited with House, House’s leg pain became less pronounced and House was, for all intents and purposes, playful. Wilson, however, was distraught with his failure at yet another marriage. In reaction, he sought out a needy woman and slept with her. This is a self-esteem and security issue. Wilson hates not being in a relationship in which he is needed, and the rejection from his wife pressures him to find another dysfunctional relationship. His relationship with House, though consistent, does not provide him with a sexual outlet. For Wilson, sex represents the highest form of caring- love. It is ironic to point out that for all of Wilson’s prowess in understanding human behavior and relationships, it is House who understands that the actions of sex and love can be separated.

Because House understands this, he points out to Wilson that he has a severe, psychological problem. Emotionally threatened, Wilson does not take House’s offer to stay with him, and once Wilson is permanently gone from the apartment, House’s leg pain returns, as does the progressive pill-popping.

Finally, Season 3. House temporarily removes the leg pain with the ketamine treatment. Such a radical change in his quality of life makes House friendlier, more active, and more cheerful. The change also affects Wilson: he no longer knows what his role is in relationship to House. Consequently, he reacts in a fashion that is contradictory to his nature, but compulsory to his codependency: he forces limitations on House through manipulation and lies.

“Many people assume that codependency is a strictly passive condition, with the codependent only performing as a servant to the addict. In reality, codependency is a passive-aggressive condition, with the enabler controlling the addict through emotional and physical manipulation.” [3] In short, a codependent wants control over the dependent, control in the form of caring. When the dependent no longer depends, the codependent will find new ways to care in order to remain in control. Such behavior is counterproductive to the dependent, frequently causing the dependent to return to his or her addictions and re-establishing the status quo. This is exemplified when Wilson outright lies to House about the success of the Cortisol in order to ‘humble’ him. When House believes he’s failed his patient, he becomes depressed. It is suspect that the depression affects the condition of his leg.

This is not to say that Wilson tried to humble House with the intent of causing psychosomatic pain. No. Codependents do not realize their behavior for what it is, and often they see their behavior as a purely positive force. The ill that may come from their actions comes from good intent. The desire to be in control and wanted is, for the most part, subconscious.

For this reason, when a codependent realizes that he or she has caused more damage than repair, the codependent responds with extreme guilt. The guilt manifests itself in actions that hope to win-back the favor of the dependent. Such actions usually cause the codependent to harm one’s self for the sake of the dependent, and enable the dependent to feed their addictions.

In each and almost every encounter with Tritter, Wilson stands his ground before House. It can be assumed that Wilson feels he must prove his loyalty to House in order to likewise prove that his lying about the Cortisol was done out of compassion and concern rather than malice (and indeed, it most likely was). In protecting House, however, Wilson enables House to continue his precarious lifestyle. The tension is pushed when House misdiagnoses a young girl and punches Chase for being correct. Wilson, for the first time, protects House in a manner that may, in fact, actually force House to cope with his addiction: he cuts a deal with Tritter. Upon hearing this, House reacts like a true dependent: he feels betrayed- blind to the fact that Wilson has done something that will actually help him. In the face of House’s anger, Wilson takes back his deal. Out of knowing House’s importance in the medical community? Yes. Out of compassion? Yes. Out of friendship? Yes. Out of guilt? Yes.

Upon finding House ODed on the floor of his apartment, both parties in the relationship receive a harsh wake-up call. Both, not just House. Their later actions speak for this.

Currently, their relationship is uncertain. As it stands, Wilson is still coping with the ramifications of his disorder, and it shows. The effects of progressed codependency are not limited to the mind and behavior. The disorder also causes visible physical effects including: chronic depression, weight loss and weight gain, insomnia, anxiety, migraine, chronic stress, erratic sexual behavior, and highs and lows between energy and lethargy.

Fortunately, Wilson appears to be handling House in a better fashion than he has previously. There is still a certain air of distance between the two, and it is likely due to their inability to navigate their respective roles in their friendship post-trauma. They cannot return to the original dynamics of their friendship. Rather, they must both deal with their addictions, and redefine their roles in one another’s lives. They cannot hope to form a healthy friendship, much less a thriving intimacy with one another, otherwise.

For Wilson, it is highly necessary for him to seek psychotherapy and anti-depressant medication. For House, he must seek rehab and other methods to deal with his leg pain. The likelihood for the latter, unfortunately, is very low.

[1] http://www.homesteadschools.com/LCSW/Courses/Codependency/text.htm
[2] http://www.coda.org/patterns.php
[3] http://www.wisegeek.com/what-is-codependency.htm