Patient: Emily (F)
Characteristics: Brown eyes, medium brown/tan coat, dark brown mane, thirteen years old according to her parents, small for her age in terms of both height and weight. Parents are Willy and Mendy (Willy Whisps and Cloud Mender).
Report: Began visiting with Emily around 1410 when Bright Side, from the Ministry of Foals and Families Ponyville office, brought her to my attention. He described how he retrieved her from Ponyville General Hospital after she complained of dysphagia and acid reflux and interviewed her during that day. He described her demeanor being positive, and mature for her age before her true age came to light. He described her trying to downplay how mature she was, and how excitable she seemed to be, noting that she likely had autism or ADHD.
When I met her, she seemed surprised to see me, and showed acknowledgment for knowing who I was. She described how my being there meant things would turn out poorly, but initially declined to specify why. She talked about enjoying being in Ponyville, and described positivity in the wake of what she believed would be negative.
Bright Side previously described her habit of thinking out her responses and deflecting questions when she disliked them, which she showed to me on numerous occasions. For the most part though, she was willing to answer anything I gave to her. She described her parents as being okay, although Bright Side mentions that she described potentially abusive tactics, like pouring water on her head to get her to wake up. She described being sexually abused, but clarified neither friends nor family did this to her, and she highlighted that she didn’t ever feel suicidal.
She did describe not feeling like herself, saying that she normally is ‘ugly, terrible, and annoying’, but that she wasn’t anymore. She alluded that this wasn’t normal for her, but specified that these things didn’t cause her to engage in self harming behavior.
She describes having sensory issues, and shows it, too, namely to sensations of touch. Things like certain types of fabric or her coat keep her stimulated when she touches them, but describes things like napkins and drying towels giving her sensory overload. She definitely has a few subconscious stimming mechanisms, and shows repetitive traits, like singing songs with repetitive lyrics, as described by Bright Side.
She expressed that she didn’t know what her age was, and frustration when told that her parents were located, describing that she was upset because she ‘wanted this to last longer’. She went into further detail about how she didn’t believe she was actually a pony, describing how she was truly meant to be a ‘human’ and how she was taking over another filly’s mind. She described being in a story that she previously wrote, and yet, despite these things, knew who her parents names were and did describe them as a mare and stallion. She expressed frustration at these things, saying that it ‘didn’t make sense’ that she knew.
She admits going to a psychiatrist before, and says that she was previously diagnosed with autism and ADHD, although became upset by my questioning of what she remembers about being from ‘another world’. She was able to explain what she believes happened from a factual point of view, but when asked if she remembers specifically, struggled to come up with memories. She became frustrated by this, and suggested that I thought she had schizophrenia or another psychotic disorder.
Other things of note include either a subconscious or conscious attempt to downplay her maturity, although I lean towards the former, as well as her frustration over how she’s being perceived and her efforts to control this. Other than this, she presents a personality that seems to be a mix of a slightly younger and slightly older foal, and for a large part, has no issues answering my questions, although takes time to clarify things she believes might make her be perceived in a negative light. She generally seems like she speaks truthfully, and even goes out of her way to avoid lying, which are good signs.
Diagnosis: I do believe previous diagnoses of autism and ADHD stand, although I would also suspect her to have a dissociative disorder, perhaps either DID or OSDD from her behavior and her account of what she believes to be the truth. She admits to previous abuse, which is a good indicator of either this or PTSD, although the latter seems unlikely given how she presents and how she perceives the world. These things can’t be confirmed however in just a few conversations, and an assessment should be given tomorrow to gauge her dissociative experiences.
Evidence from this comes from her describing herself as ‘physically a filly, but mentally not’ and yet being unable to conjure up memories of any previous life she might have had. She couldn’t describe how she ended up in Ponyville, only that she teleported, and couldn’t describe what she was talking about or what she did the day previous to her arrival. As well, she said she was in a story she previously wrote about a foal who was abused and another foal taking their place in their head, which, from how it came across, nearly perfectly describes either DID or OSDD. She said she didn’t have a voice in her head like the foal in the story did, but ‘expected to’ and ‘wouldn’t be surprised’ if she did. I can imagine that she was disassociating up to getting to Ponyville, although as previously stated a follow up would be needed.
It should be noted that some of these things can be considered conjecture, however, I do think that, at least currently through my time with her so far, the symptoms fit well with what she displays and what she described. Other scenarios can't be ruled out however, like other disorders that fit the characteristics of dissociative disorders, or even the possibility that she's simply lying or mistaken about what she claims. So far though, it seems that what she says is both genuine and largely true, and she shows slight discomfort when presented with information that contradicts what she expects to happen, like her surprise at she being correct about her parents names, for example.
Outside of this, she does present as having autism, and has a lot of repetitive movements with her hooves and unconscious stimming, which she seems to feel bad about once she notices that she is. She keeps her tail tucked between her hind legs, although it’s unknown whether this is because of previous abuse or just an unconscious gesture associated with autism.
She clearly has fear or frustration about being made to return to the home she claims to be from, describing that she likes being a pony better than being whatever she believes she was before, although doesn’t seem to have any issues with her parents. Without getting too far into speculation or conjecture, I can imagine that any abuse she suffered came much longer before she left home and was both chronic and long term, and explains dissociative behaviors. She does acknowledge that it doesn’t make sense how she would know who her parents were if she was who she claimed to be, a fact that frustrates her greatly. Yet she does still cling to the theory that she’s not who she thinks she is mentally.
Treatment: An assessment for dissociative experiences will be given, and depending on the results, a follow up assessment once she's back in Baltimare will confirm or deny this potential diagnosis. Therapy will be needed for her in the long term regardless of assessment results. Consultation with the pony who was her psychiatrist should be done, as well as a general follow up with her to find the extent of dissociative behaviors. It’s still unknown at this time just exactly what she’s experiencing, and how deep it goes. She does display general fear and dismay that there might be something wrong with her, so a careful and caring approach should be taken.
Conversations with her guardians when they arrive in Ponyville should be done, as well as finding the source of previous abuse. A deeper dive into her history while in Baltimare should be done, as well, conversations with close friends should be undertaken.
As nothing can be ruled out and because of the nature of the town of Ponyville, IF no conclusive evidence of a dissociative disorder presents itself, a conversation with Princess Twilight Sparkle should be had to investigate any claims of truly being from a different world or any mind spells that might have been cast to cause her to believe that's she’s truly not meant to be a pony, or rather, was not a pony previously. The likelihood of this, however, is incredibly low, in my opinion.
As Bright Side reported in his notes, this does seem to be a complicated case, one that will require a great deal of work to resolve and a cautious pace to ensure every avenue of possibility is being properly followed. I do think an attitude of hopefulness is appropriate however, given Emily’s disposition and her understanding that the claims she’s making don’t add up. I think she will be able to heal properly and continue to move forward with her life. Given that she does reside in Baltimare, once she’s placed back into her guardians custody, I’ll likely be taking over her care from here on out.
-Doctor Ivory Spark