Spoilers ahead for Outlander Season 6, Episode 6, "The World Turned Upside Down."

Claire was dealt a lot of blows in the latest episode of Outlander when her apprentice-turned-antagonist Malva claimed she slept with Jamie. "The World Turned Upside Down," named for the A Breath of Snow and Ashes chapter title where Malva accuses Jamie of impregnating her, was a highly-anticipated episode for readers of the Outlander book series. And author Diana Gabaldon spoke about how Claire's feeling after Malva's accusation with The Dipp.

The sixth episode closely followed the Book 6 storyline. But readers may have noticed some differences, like Claire's response following Malva coming to the Big House with her father Tom and brother Allan in tow to drop that (false) bombshell. Caitríona Balfe's Claire slapped Malva and then fled the house in shock and outrage. When Jamie got to her, he shared how, even though he never slept with Malva, he had once slept with a woman while technically married to Claire — Mary MacNab in Season 3.

All of this is directly from the book, but Balfe's Claire was less angry when Jamie started this confession than her book counterpart — in A Breath of Snow and Ashes, Claire roars at Jamie to know "WHO?" he slept with and speaks to him through gritted teeth.

But this sort of adjustment doesn't bother the author since, as Gabaldon writes in an email, "This sort of thing — the direction/intensity of emotion — is something that's evolved among the actor(s) and the director, for the most part." Plus, she thinks that Balfe's calmer tone helped balance this crucial moment between Claire and Jamie.

"To have Claire being angrier would have derailed the trajectory of that scene, which starts with both Claire and Jamie being very upset, and then calms, then jolts upward in intensity again when Jamie tells her about Mary MacNab — but then eases back down, as she realizes who Mary was and what the circumstances were," Gabaldon says. "And the emotion needs to come back down, so the scene can end with Jamie and Claire in each other's arms, their unity (in the face of Utter Oncoming Disaster) re-established."

As Gabaldon pointed out, just because Jamie and Claire were united in the face of Malva's wild accusation doesn't mean it was smooth sailing from there. In a deviation from the books, Claire goes to Malva to offer her sympathy for her situation and get the truth from her. Despite her best efforts, Claire fails to reach the troubled young woman. But the scene did give Jessica Reynolds's Malva the opportunity to show that there is something else going on that made her claim Jamie's the father of her child. (In the book, she indicates there's something wrong to Roger, not Claire.)

While Reynolds and I discussed the possibility that the audience may be capable of some empathy toward her character, Gabaldon doesn't think that's the case — even with this added scene between Malva and Claire. "I don't think people will sympathize with Malva, regardless. Most viewers already thought she was 'creepy' and now they realize that she's actually malicious," the author says. "So, apparently, does Claire, going by the hallucination/conversation she has with Malva while in an ether-induced stupor."

Speaking of that "ether-induced stupor," Claire uses the ether again after another flash of Lionel Brown that happened to coincide with seeing Malva approach the Big House. In her ether vision, a particularly vicious Malva preys on Claire's insecurities. Claire menacingly holds a scalpel to Malva's face and claims, "You come near me or my husband again and I will fucking kill you." When she comes to, she finds Malva in her garden — murdered, with her throat slit.

As the ether is a well-documented Show-Only moment, this is another change from the book. "You can't go getting annoyed every time Claire uses ether; it's obviously an advancing habit, and done as an indication of her rapidly fraying sense of self," Gabaldon says. "It's Lionel Brown (or rather, her febrile evocation of him) that triggers the flight-or-flee reflex for her, but plainly it's the overall weight of threat that's making things worse."

Gabaldon admits, "I'm not a huge fan of the ether." But as she had shared with The Dipp before, she is satisfied with how this storyline concludes. And the fact that Claire has just envisioned threatening to kill Malva and then finds the girl with her throat slit in her garden seems like it will be another hit to Claire's emotional and mental well-being... and perhaps her physical well-being too since the Episode 7 preview shows that the people of the Ridge suspect that Claire's the one who murdered Malva.

"Having seen the whole season, I understand what they're doing with [the ether]; using it as a backdoor into Claire's subconscious," Gabaldon concludes. "As her subconscious starts rising toward the surface, though... things get interesting."

Images: Starz