So Dr. Gregory House (Hugh Laurie) is back for a fifth season of “House,” limp and Vicodin addiction intact, relationship with Dr. James Wilson (Robert Sean Leonard), the Watson to his Holmes, very much on the ropes. Last season’s finale, in which a drunken House inadvertently played a role in the death of Wilson’s girlfriend, Amber, left fans of one of the best and most popular shows on television scratching their heads as to how the two men could possibly reconcile.

If you thought House might go all soft on us, think again. The first words he utters to the grieving Wilson (who has been on leave for two months) are typically acerbic. Barging into his office, he doesn’t say “I’m sorry” or “Welcome back” or “I missed you” or even “How are you?” Instead, he goes off on a rant about the case he’s working on. “My patient is still fighting in the feminist trenches, but the war is over. Yesterday’s sluts are today’s empowered women. Today’s sluts are celebrities. If that isn’t progress … ” At which point Wilson interrupts the tirade to announce he’s leaving the hospital.

Clever writing is one of several elements that make “House” such a good show. Feminism is a theme in this episode, but House is guilty of a misdiagnosis. His patient may be in the feminist “trenches,” but she’s hardly a firebrand. Despite being the personal assistant to the head of a powerful feminist advocacy group called “Women’s Majority,” with whom she travels all over the world, she displays a disarmingly modest view of her life and professional status. House dismisses her as a “glorified grunt.” She seems to agree. “The world needs flunkies,” she concedes. “I have no problem with that.” In a society that practically demands exaggerated self-esteem, her humility is mildly stunning.

The patient — whose name is Lou, though it is rarely uttered, perhaps appropriately given her unusual lack of ego — has been admitted to Princeton-Plainsboro Teaching Hospital after hallucinating (during a business meeting) that she is being attacked by a colony of ants. Then the usual baffling medical complications on which the show is built ensue: She’s bleeding for no apparent reason, she’s pregnant but doesn’t appear to be carrying a fetus, etc.

Tonight’s episode is in many ways the mirror image of last season’s opener, when House, suddenly without a team of assistant doctors off of whom to bounce ideas, was trying to prove to his boss, Lisa Cuddy (Lisa Edelstein), that he didn’t need any help and could work alone. He ended up so desperate for someone to talk to that he finally enlisted the aid of a janitor. Then he gave in and started interviewing job applicants.

The team has long been in place, but House is less interested in saving his patient’s life than in trying to save his own friendship with Wilson, mostly by the unorthodox method of repeatedly calling him an “idiot.” Lou knows why she’s been admitted to Princeton-Plainsboro: Her boss told her that House was a genius. But where is this genius? As she careens from one medical crisis to another, she finds herself dealing almost entirely with the troubled but angelic-looking Thirteen (as the character played by Olivia Wilde is known), who as a feminist has taken a particular interest in her case and is keen to prove herself by solving it without House’s help.

Too polite to voice her skepticism about Thirteen’s diagnostic skills, Lou nonetheless knows instinctively from her own work experience that there is a difference between a natural leader such as her employer — and House — and people such as herself — and Thirteen. If last season’s opening episode proved that House was at a loss without his squad of dissenting voices, this one shows the team flailing helplessly without their overseer. He does finally make an appearance, of course — storming into Lou’s room and slamming his cane down on her bedside tray to wake her up — and the interplay between the two of them is a thing of beauty. The sleepy-eyed Lou, terrified of dying but also strangely calm in the face of her possible end, performs wonders with her eyes as she gazes upon the eccentric physician. Having spent years working for a brusque, manipulative woman, she has no problem with a brusque, manipulative man. “Not everyone,” she tells Thirteen, “is created equal.” Not only is she House’s patient, she’s also a fan.

Mr. Laurie has said that his character’s “adolescent streak” is a major part of what made the role so attractive to him, and it works for the audience, too. The people around House are constantly accusing him of being cruel and emotionally dead, and while there’s an obvious truth to that, it’s not the way he comes across on-screen. In fact, he seems more alive than everyone else. Germaine Greer made the excellent point that although you can only be young once, you can be immature forever, and that’s bad-boy House all over. Against the graying beard and cane, one must place the love of video games, the jeans and sneakers, the constant need for attention, and the penchant for Groucho Marx-like put-downs. (“Mind if I come in?” his boss Lisa asks, having tracked him down to his apartment at a time when he should be at the hospital. “Not at all,” he replies. “Mind if I leave?”)

As for House’s manipulative streak, this season will highlight it more than ever as Wilson resolves to stop “enabling” House and escape from his clutches once and for all. First, though, he must sit through Lisa’s inadvertently hilarious attempt to adjudicate an impromptu session of “couples’ counseling” so that the two men can iron out their differences. As you will have guessed, neither man — particularly the rumpled, disheveled House — is very keen on ironing.