After an incident where Monk was caught trespassing in Trudy's old house, he gets sent for psychiatric evaluation. Once in the asylum, however, the plot thickens — Monk seems to find evidence that the head doctor is hiding a dark secret, but the doctor alleges his mental state is deteriorating. Can Monk get to the bottom of this?
This episode contains examples of the following tropes:
- Afraid of Needles: The official story of Dr. Gould's murder is that Bill LaFrankie shot him, stole some drugs, fled into the woods, then shot himself up, and overdosed. Monk becomes suspicious and realizes that Dr. Morris Lancaster actually did it because of the fact that Dr. Gould's keys that accessed the medical supply cabinet were still in his pocket, meaning someone who had his own set of keys to the cabinet opened it. Furthermore, Monk breaks into Dr. Lancaster's office, finds LaFrankie's file, and realizes that he couldn't have committed suicide by overdose because his medical records show he was afraid of needles. However, Dr. Lancaster then catches him snooping in his office to dig up the records.
- Bad Santa: Dr. Lancaster dresses up as Santa Claus to go fishing for the murder weapon, as the chimney he hid his gun in can be seen clearly from one window in the asylum. He has specifically moved Manny, a patient who Still Believes in Santa, to be in that room, since if Manny sees him, anyone who hears him talk about it will just pass it off as a delusion.
- Cassandra Truth:
- John is a Compulsive Liar who likes to overempathize and make himself sound more important than he is, but he was right to believe that Dr. Gould's murder was unsolved and that LaFrankie couldn't have killed him.
- Manny did see "Santa Claus" on the roof, and it's his obsession that proves key to nailing Dr. Gould's real murderer.
- Chekhov's Gun:
- The asylum is shown to be undergoing renovations. This provides the reason for Dr. Lancaster to do what he's doing, as the renovations would likely mean the gun he used in the murder (registered to Lancaster), would be discovered.
- Benji turns the lights on and off repeatedly to show off his glow-in-the-dark ink. Much later in the episode, Sharona uses the same ink to smuggle a message to Monk in the asylum on a picture of Trudy. Dr. Lancaster inspects the photo, front and back, then has an orderly deliver the photo to the patient.
- Deceased Fall-Guy Gambit: Dr. Morris Lancaster killed the previous asylum director, stole drugs from a supply cabinet, then made it look like Dr. Gould was shot by a junkie who then fled and fatally overdosed in the woods.
- Everyone Has Standards: Zigzagged. Oliver the orderly becomes concerned when Dr. Lancaster orders him to give Monk an injection higher than recommended for his weight. However, he still follows up the order by getting the medication.
- Fall Guy: Dr. Gould's murder was blamed on an addicted patient named Bill LaFrankie, who Dr. Lancaster then overdosed to be sure he couldn't talk.
- Foreshadowing: John giving Monk a tour of the asylum sets up key aspects to the mystery, including (of course) the site of Dr. Gould's murder, the portraits of the asylum's former directors, specifically noting that everyone but Lancaster is deceased, including Dr. Gould, and the fact that part of the asylum is under renovation.
- Gaslighting: No prize for guessing what Dr. Lancaster does to Monk when he learns he's trying to re-open the murder case of Dr. Gould. In order to make Monk look insane, he steals evidence that Monk gathered during his personal investigation, plants Jamie's necklace on Monk's person (because he noted that it was the same kind of necklace Trudy wore), and goes as far as to make Monk think he drew a picture of himself burying Trudy's corpse.
- Green-Eyed Monster: The murder of Dr. Conrad Gould boils down to Dr. Lancaster being jealous that the former was to run the asylum over him.
- Klingon Promotion: Monk finds that the asylum director, Dr. Morris Lancaster, had originally been passed over in favor of Dr. Conrad Gould. He didn't like that, so he killed Dr. Gould, then killed a patient and framed him for the murder.
- Manchild: Manny, a mental patient in his 30s with a Santa Claus obsession. When Dr. Lancaster needs to recover a disposed gun he used in a murder several years earlier, he dresses himself up in a Santa suit and goes fishing on the roof outside Manny's window, making sure Manny sees him, since he knows Manny's claims will be treated as lunacy.
- Psycho Psychologist: Dr. Lancaster is a zigzag example. He initially seems to avert it, and he does show insight and care about Monk's case, which is probably what prompts Monk's end-of-episode praise for him as a doctor. But in order to get what he wants he's willing to destroy or even kill people, including patients, and very much including Monk.
- Spanner in the Works: Dr. Lancaster's plot to get Monk out of the picture likely would have succeeded if not for Sharona investigating the murder and giving Monk the person and motive he needs to tie the case together.
- Still Believes in Santa: Manny, one of the other adult patients at the asylum, still believes in Santa and is instrumental in solving the case.
- Surprisingly Realistic Outcome: Once Monk is through with his summation, Dr. Lancaster finally retrieves the gun he used to kill Dr. Gould and tries to shoot him. The gun has been spending the last four years in an old chimney, so the firing pin and other components have completely rusted, rendering it useless.
- We Used to Be Friends: In the span of the episode, Dr. Lancaster goes from being Monk's mentor and much-needed healer to his enemy. However, in the end Monk still admits that Lancaster is a good doctor.
