“Late again.”

At least she would be if my clock wasn’t set five minutes ahead.

“No matter.”

Gives me time to catch up on Rainbow Digest Quarterly. I pulled up the latest edition and readied my quill for the commentary barrage against the poorly described peer-reviewed journal of broad-spectrum disorders. To think that the Royal Canterlot School of Medicine gave a doctorate to somepony who could barely manage a double-blind case study still boggles the mind. His lead article was going to get earful from my scathing rebuttal.

Barely into the second paragraph, a knock on the door drew my attention. Perhaps I spoke too soon.

“Come in.”

The handle glowed and the door swung open. To my surprise, my least expected patient crept into the office.

“Sorry, Doctor Hooves, I don’t have an appointment.”

“No need to be sorry, Miss Sparkle. My door is always open for you.” Laying down the fiction, I made a gesture toward the couch. “Please, have a seat. Miss ‘eight-thirty’ is never on time, so you can take her spot.” I could see the panic from a mile away. Her mane showed obvious signs of neglect. The ruffling of her feathers indicated a dire urgency accompanied her unscheduled visit.

“I’m not sure where to start,” Twilight’s ragged voice sagged to a moan as she collapsed on the patient chair. “I think I’m having a relapse.”

“Let me get my notes and we’ll start wherever you feel comfortable.” I reached down and pulled open the long file drawer. Scanning past my more recent cases, the folder labeled P.T.S.D. stood out in bright purple highlighter. A veritable mountain of documentation rose from the drawer as I heaved the stack to my desk. I flipped to the general notes section and scrawled out today’s date in the margin. “Ready when you are. What seems to be the trouble?”

“It’s just awful, Doctor.” Twilight wasn’t exactly known for this sort of drama, but the way she held her foreleg across her brow signaled we were in for a doozy of a session. “I nearly killed him!”

“Now hold on there,” I stated calmly. Dropping the quill, I stepped around the desk and sought out the more personal refuge of the high backed chair facing the couch. “Try and settle down, Miss Sparkle. Remember, stick to the facts. Tell me exactly what happened.”

Tears bubbled to the surface on her grief stricken face. A gurgling sound escaped her muzzle as she fought back the tears and choked out her reply. “If he hadn’t slipped, I could be cleaning friendship-rainbow-fried bits of dragon brain off my wall right now!”

The poor dear! I might need to clear my schedule for this one. “Am I correct to assume you had another—incident?” Nearly forgetting myself, I reached over to snatch up my notebook and tableside quill. The chicken scratch flew across the page: patient severely agitated, emotional response bordering irrational levels. “There’s a box of tissues on the table…”

“Thank you,” she snorted pulling up a wad to her nose. “It’s getting worse. I’m having trouble controlling my friendship. I need help. The medication just isn’t working.”

Thinking back to the last entry in the journal—six months. Had it really been that long? “I haven’t seen you in a while, Princess. Have you continued with the treatment regimen as prescribed?”

Her glossy eyes swung back to face me. “It’s no use. The maintenance doses aren’t enough. I’ve run out of real problems and even had thoughts of artificial inflation again. You know what that leads to.”

“Of course. How could I forget?” The last time she tried to create her own dosing, the whole town nearly destroyed itself. Not to say that the normal course of treatment fared any better, but at least she kept the therapy within her own circle of friends for the most part.

Time to try a new approach. “Let’s start over. Perhaps we’re going about this all wrong. Wipe the slate clean and we’ll work our way through it from the beginning. What do you say? Shall we give it a try?”

Ears up. Head level. Eyes forward. Good start.

“I’m willing to try anything, but haven’t we gone over it before?”

I glanced up at the pile of notes sliding across my desk. “We could use a fresh perspective. It won’t hurt to explore the events leading up to now. Who knows, cathartic release has been shown to help in a number of other cases.”

“But I thought my case was unique?” Twilight wondered. She was right. I gave the disorder her name for that very reason.

“Of course.” I leaned back in my chair crossing my hind legs and tapping my forehooves together in steady measure. “Humor me though. Let’s start again and see where we end up.”

“Alright. You’re the doctor.” The patient rolled over and settled into a more comfortable position. “I was born on the first of day of—“

“Let me stop you right there, Miss Sparkle—may I call you Twilight, or do you prefer Princess?”

“Sure… Twilight’s fine.”

“So then, Twilight, could you begin at the part where the trouble all started. I think we can skip the early years.” Quill at the ready, I pulled back a fresh page.

“Okay.” Twilight fidgeted with her hooves. Her panic seemed to settle given the new focus. “It all began when I was sent to Ponyville during the Nightmare Moon incident.”

“Question: was that before, or after her actual re-appearance?” The difference was significant. Had she been sent because of the problem, or was it mere coincidence?

“I’m not sure how to answer that. When I inquired about the prophecy, Celestia sent me here and told me I should find some friends.” She glanced down at the floor while I caught up my notes. “It sure was good that I did. Without their help, I would have never found the Elements of Harmony. For all I know, Nightmare Moon could have destroyed all of Equestria if we didn’t stop her.”

“Yes, but how did that make you feel?” Here I go again, playing Tirek’s advocate. “It seems Celestia tricked you into solving her problem for her.”

Note: patient seems confused, disoriented

“Honestly, I wasn’t sure at first. I felt pretty bad.” Now we were getting somewhere. Peeling back the layers, the root of the problem lay exposed. “I guess I didn’t understand why she sent me away. The whole concept of friendship never really clicked before then. In hindsight, it felt really good when it was all over.”

“Describe that feeling for me. The part where you felt this friendship for the first time.” I think we skimmed over this part last time—no clue how I missed it.

“It felt… good.” Twilight shifted position, a telltale sign I wasn’t getting the whole truth. “Actually, it didn’t feel good. It felt great!”

“So, help me understand. Did it feel great like acing a test? Did it feel great like having second dessert? Work with me here.” I had a sense where this was going. Could explain a lot.

“It was the most wonderful feeling I ever felt!” She gripped the sides of her head. “That’s the whole problem. I can’t get enough of it now. I’m addicted to the magic of friendship!”

“Alright. Let’s slow it back down.” My writing filled the first page. Might be time for another quill as well. “I want you to focus on that moment. Really concentrate. What about that one event drew you in?”

“It’s hard to describe. I can’t really put my hoof on it.” Dead end. Try something else.

“We’ve established that the Nightmare Moon event set a trigger. Could you walk me through the next few months that followed?” I had to keep the ball rolling. We could come back to the trigger event.

“The next few months were pretty normal, I guess.”

“Try and explain what normal means to you, Twilight.”

“Just standard, everyday stuff. I’d run into a friendship problem and, you know, take care of it. Celestia had me send her weekly reports outlining everything. I could get her to send you a copy if you want to go over them in detail.”

“I don’t think that will be necessary. I’ll review my previous notes and if I have any questions I’ll be sure and follow up with her.” She did have a point. Her record keeping rivaled my own. Could be worth looking into, but it might be a red herring. Can’t get distracted here. “You’ve made the connection that solving friendship problems on a regular basis was, in your words, normal. Did you encounter any problems involving friendship that haven’t felt normal?”

Note: patient laughed at the mention of abnormal incidents.

“There’s always Discord. Things were pretty normal up until Celestia had us gear up to fight the Lord of Chaos.”

“So, once again, the Princess called on you to fight her own battles? How did that make you feel?” Back on track again. Definitely need another quill.

“Pretty terrible. He literally sucked all the friendship out of us.” Agitation noted. “Then it all hit me. Every single friendship report I ever sent came back and literally smacked me upside the head. It was a huge rush!”

“So you defeated Discord with the magic of friendship, and it made you feel… good?”

“Oh yeah!”

“So what was the problem? You felt good. Equestria was safe. How did it escalate from there?” I tossed the old quill into the wastebin and pulled a fresh one out the supply drawer. It was going to be a long night of washing black ink out of my hoof.

“I felt great, but that was my problem. I didn’t have any more problems.” Twilight sat up on the couch and hovered near the edge. “I couldn’t find any real problems to fix, so I had to experiment with artificial ones. I created my own problems so I could feed myself the solutions.”

“Okay, we both know that ended badly, so let’s skip over that part. Where did you go from there?”

“It wasn’t easy, Doc. There were still problems to fix. I just had to look harder to find them.” She’s breaking away again. Something needs to be said—I hope she can get it out on her own. Give her some time. “I bounced around from problem to problem until the whole wedding thing came around.” Good girl!

“And what made that special?”

“That was a whole different kind of problem. My brother was getting married to a changeling. I tried using friendship, but none of my friends would help me. It didn’t feel right at all. In the end it all worked out, but I didn’t get the same rush as before.”

“Diminishing returns, hmmm.” Quite the perplexing situation to be in. On the one hoof, I should encourage her unique and positive behavior. On the other, it seems to lead to a negative cycle. The inverse should be true, but somehow it isn’t. “Have you ever considered saying no to Celestia?”

“How about you try it and let me know how it goes?” Alright. Bad question.

“Point taken. Where did that leave you?”

“I-I guess I was okay with that. The problem was, it didn’t end there.” Flip the page, new heading. “Practically the next day, I got summoned to save the Crystal Empire. It came out of nowhere!”

“So you’re saying that Celestia sent you on another mission to save the world and the cycle continued?”

“That’s exactly what I’m saying. She even made it into a test of some sort. I had to find the Crystal Heart, defeat Sombra, and save an entire kingdom in the process. The end result turned me into a Crystal Pony for the day. Friendship isn’t magic, it’s a drug!”

Note: Gleam in patient’s eye suggests lingering effects of Crystal Pony Syndrome. Additional tests needed to confirm.

“I would have to agree. Still, that leaves us with a few unanswered questions. Do these smaller friendship problems have an additive effect on the larger friendship crises? It seems they may even have a synergistic effect.” I had no baseline to work with. How could I even start to quantify the relationship?

“It’s an interesting theory, Doc. I’ve debated it myself. One thing I know for certain is that everything seems to have culminated in this—“ Wings flared, the patient rose from her chair. “All the lessons. All the tests. All the magic of friendship combined turned me into an Alicorn.”

“That’s quite impressive. To be clear, you postulate that the drive to solve friendship problems, originating in the overthrow of Nightmare Moon and the discovery of the Elements of Harmony, gave you wings? Give or take a few major bumps in the road, every task and trouble you faced culminated in your Alicornification?”

Twilight sank back down in the chair. “Yeah, that’s what I’m saying.”

“You don’t seem to very happy about it.”

“If that’s where it ended—sure, I’d be happy with that. Fact is, I’m on another level now.” Back to the original pose. “Who needs the Elements of Harmony anymore? I’ve got Alicorn magic coming out the wazoo. I thought I had friendship problems before. Now I’m the freaking Princess of Friendship herself.”

“Is that such a bad thing? Aren’t you just solving friendship problems like before? I’d call that an improvement—a validation as it were.”

“Have you taken a look outside lately? Have you noticed how there isn’t a library in the middle of town anymore? Did the huge castle give you any indication of how big this problem has gotten? I can’t help myself. Friendship problems never stop, and they keep getting bigger and bigger. I’ve become my own worst enemy.”

Think Hooves, think. What am I missing here? How can I help resolve the conflict? That’s it! “Twilight, you need an outlet.”

“A what?”

“An outlet. Something to funnel all your pent up friendship into so that it won’t consume you or anypony else around you.” Brilliant! This is definitely going in next quarter’s Rainbow. “I’ll write you a prescription and you can be on your way. How does that sound?”

“Sounds too good to be true. I’ve been keeping with the maintenance doses of friendship problems you prescribed for the past six months following the Tirek debacle. How do you suppose another round is going to help?”

“This is something better—trust me, I’m a doctor.” Prescription pad, quill, illegible chicken scratch—done. “Take this to any reputable drinking establishment and follow the instructions. I’d hold off on any threesomes for now, but you might find them useful given extenuating circumstances.”

That smile says it all. Another satisfied client. “Thanks for the session, Doctor. I’ll be sure and give your treatment some thought. I’m not sure I’m ready for a coltfriend, but if it serves as an outlet, I’ll be sure and give it try.”

I’m riding on cloud nine here, but that knock at the door just had to bring me back. “I’ll be sure and send you the bill. Good luck with your treatment, Miss Sparkle. Come in!”

The door swung open and in walked my eight-thirty. “Sorry I’m late for my Flyer’s Remorse session, Doc. I got tied up wrangling some clouds on the other side of town. Oh, hey Twilight.”

“I was just leaving. Thanks for your help, Doctor Hooves. I’ll catch up with you later Rainbow Dash.”

“Anytime, Miss Sparkle. My door is always open for you.”