Major spoilers ahead for the Outlander Season 6 premiere, "Echoes."

Claire is a healer. But what does a healer do when she's feeling damaged herself? In the premiere for Season 6, Claire seeks refuge from her traumatic thoughts on Outlander by using her latest medical invention, ether. It was an ominous ending to an already turbulent season premiere with the last image being Claire passed out from the anesthetic. As Claire's reliance on ether is a departure from the book series, I spoke with author Diana Gabaldon (who serves as a consultant on the Starz show) to see what she thought of this change.

"Book Claire probably wouldn't have done that," Gabaldon writes in an email to The Dipp. "For multiple reasons, including the not-inconsiderable physical risks of doing it, addiction being a notable one."

But Book Claire and TV Claire are not the same. And Gabaldon notes how the show tends to focus on Claire experiencing post-traumatic stress disorder — "God knows the woman is entitled to some." Similar to how she experienced WWII flashbacks in Season 2 while the Jacobites were training for battle, Claire is reliving her past traumas brought on by her recent abduction and assault by Lionel Brown's gang.

"We're always dealing with a big difference between books and shows — to wit, space and time," Gabaldon says. "I have all the time I need for Claire (and other people) to deal with trauma in various ways, and Claire's usual means of doing that is Jamie."

The show does still have Claire process trauma with and through Jamie. But some of the circumstances of Claire's kidnapping and rape in Season 5's "Never My Love" were handled differently by the TV series, particularly the direct aftermath of the assault. Gabaldon brings up how Jamie and Claire have a "long and violent conversation between them" in A Breath of Snow and Ashes after she's rescued. They have sex and Jamie "gives her the opportunity to fight back," Gabaldon says. "Just as she gave the same opportunity to him, post-Wentworth."

But like Claire's handling of her spouse's assault was altered ("In justice, I don't see any good way they could have filmed what happened in the book, especially given the time constraints," Gabaldon says of the Season 1 change), so was Jamie's handling of Claire's — a choice Gabaldon and star/producer Caitríona Balfe discussed with The New York Times after the Season 5 finale aired.

Gabaldon voices some concern about Claire's response falling into the "Strong Woman" trope. "Part of the whole Strong Woman trope is that said SW goes it alone and just stomps on, elbowing aside any show of concern from her family," Gabaldon says, pointing out how Claire insists she's fine to both Brianna and Jamie in "Echoes." But the author does add, "Giving credit where due, [that is] a nod to the books," specifically Chapter 29 in A Breath of Snow and Ashes, "Just Fine." In the chapter, Claire proclaims to a doubting Bree that she's "perfectly fine" following the assault.

There's also the fact that Claire would know the dangers of "huffing ether." But again, Gabaldon provides a caveat. "It's not at all unknown for physicians to abuse it," she says, citing the literary example of The Cider House Rules by John Irving. So even though Gabaldon may have her notes, she's still content with how the show handles this storyline overall.

"I have the benefit of having seen the whole season, and actually, I think they handle the whole thing pretty well within the framework they've developed. It works out slowly over the course of the whole season," she says.

So for book fans struggling with this change, take heart. Because just as Sam Heughan told The Dipp that Claire's dependency on ether led to an "honest and rewarding storyline," it seems Gabaldon agrees.

"It is very plausible and moving — the acting between Caitríona and Sam is amazing — and it does have a satisfactory conclusion."

This interview has been condensed and edited for clarity.

Images: Starz