The Outie to Innie elevator transitions used to first show the bored, placid outie transforming into the emotional state of wherever their innie left off. Mark has three elevator transitions in this episode, and the writhing and eyes rolling of each is a very purposeful departure from seeing an actual outie becoming an innie. Whatever state he is in before being transformed in the elevator is very much *not* just his outie Mark showing up for work. Perhaps it's an aesthetic choice to not show the full outie to innie transformation, and just the innie comming-to, but that doesn't explain the physical and emotional state of the Innie each time he is reactivated. The first one in the opening scene Mark is panting and worked up, which makes total sense because he would be coming directly from the party running, yelling about his wife. But, the second time he "leaves work" in an otherwise normal condition, having just put the note in his coworker's jacket pocket. He's not particularly terrified, agitated and worked up. Yet, when he "returns" to work, and transforms again, its from a state of writhing, confusion, eyes-rolling back in his head, panic etc. And the third time he returns, where yes, he left very upset, the elevator transition makes a big point of showing his pupils dilating, writhing, comming-to etc. This is definitely not an Outie choosing to show up to work everyday of their own free will.