I was rather surprised when I opened the door to my waiting room and found two ponies standing before me. “Oh, hello, Twilight, Rainbow Dash,” I said to her in what I hoped was a bright tone before glancing at the light blue mare. “I must say, I didn’t expect to see two of you today.”
“I didn’t really expect to be here either, doc.” Rainbow looked slightly overwhelmed as she turned to face Twilight, “I thought that we were going to see him together next week. Not today.”
“That would have been better,” I said truthfully, “If you had told me that Rainbow was coming, I could have prepared more.”
Twilight looked chastised, her ears flicked back and her brows knotted. Her voice came out softer than usual, “I know, I know. It’s just that, well, I wanted to do this as soon as possible, and—“
“It's alright, Twilight.” Hopefully, Rainbow wouldn’t cause too many problems. “Hold on a moment, and I'll grab another chair. We can continue this in my office. Twilight, you can take the couch as usual, and Rainbow may take my chair.”
I moved back into my office, allowing the mares to enter ahead of me, before turning to the closet where I keep my spare, and rather uncomfortable, folding chair. It must have been a while since I had used the thing, as it was buried under a lot of junk. As I started to dig it out, I began to think about what was going to happen in the session ahead. I had a bad feeling that Rainbow was going to make this a lot harder than it needed to be. That mare was a mare of action, and I don’t think that she put much stock in talking her problems out. That was probably the reason why she had been invited, I realized. Rainbow Dash would never be comfortable with not knowing what course of action to take, and Twilight must have thought this was the best way to alleviate her fears.
So, I reflected as I pulled the folding chair from the bowels of my closet and set it up at my desk, this session will probably be a mix of getting Dash to stay calm, and explaining to her how to best interact with Twilight. A moment later, the three of us were sitting in my office. I was waiting for one of the two of them to speak first as I tried to make myself more comfortable in the hard chair. Eventually, Rainbow lost her patience and broke the silence. “So, is this all the two of you do every week? Just…sit around not saying anything?”
“Well, no, not really,” Twilight said. “Most of the time I tell him about what has been happening over the past week, and we discuss that.”
“Oh… then why don’t you do that?”
“I was trying to think about what to say!”
Rainbow rolled her eyes. “Then how about this,” she said, fixing me with a look that was halfway to a glare, “I want to know how to be a better marefriend for Twilight.”
Well, I thought to myself and forced down a huff of a laugh. She certainly knows how to get to the point. “In what way, Rainbow?” I asked aloud.
“Well, um…” Rainbow deflated and stumbled over her words. “Well, you know, with her, um, A.C.M.S. thingy, not that she can’t take care of herself, but just in case of, well…”
“You want to know what to do in a hypothetical worst case scenario. Does that sound about right?” I asked.
“There’s that word again,” Rainbow muttered under her breath, before nodding.
I shifted my attention back to Twilight. “Would it be okay with you if I shared the emergency plan that the Princess, your parents, and I have in place?”
Twilight opened her mouth to speak, but Rainbow cut her off. “Whoa, hold on a moment! Why do you have to ask her like that?! I mean, she obviously wants me to know. Otherwise she wouldn’t have brought me here!”
I almost groaned, but I managed to internalize it. This was precisely what I was afraid of. Rainbow, from what I could tell, took everything like a challenge. That could be an admirable trait in some situations, but in a setting like this… “Rainbow,” I said, doing my best to keep any tone of frustration out of my voice, “I need to make sure that Twilight is one hundred percent willing to go along with this, and I need to be sure that she wasn’t pressured into doing this against her will. It is part of my job as her doctor.”
Rainbow flushed and I could practically see the blue mare fighting back hot-tempered words in my direction, but Twilight leaned over and put a hoof on her forequarters. “Rainbow, like he said, it's just part of his job. Please don’t get into an argument,” her voice was soft, measured, as she spoke.
“But, but…! He just implied that I pressured you into doing this! Twi, that is so totally uncool! I—“ Rainbow said, before Twilight cut her off.
“It was my idea to have the two of us come here.” Twilight said to me, speaking over her marefriend, “Rainbow came to me wanting to know how to better help, so I suggested this, and she agreed. Dr. Hooves, you have my consent to speak about my condition with Rainbow Dash.”
I nodded at Twilight’s words and mentally breathed a sigh of relief. Yes. That was one potential problem off my chest. Rainbow Dash was such a forceful personality I had feared Twilight had only said her marefriend could come to this meeting out of intimidation. Knowing now it was Twilight's idea, and that I had her permission, I was free to speak more frankly. “Very well, Twilight. Just so you know, I will still need you to sign a release form saying that I can tell Rainbow all about this. Give me a minute,” I said, before turning to my desk and opening the cabinet that held all of my forms. “Ah, here we go,” I said, as I pulled out the papers in question. “Just put Rainbow’s name here, and sign here.”
Twilight nodded and took the quill and paper and set to work filling out the form while Rainbow watched with interest.
As soon as she gave me back the paper, and I had checked that it had been filled out correctly, I turned to the reason for the form. “So, Rainbow, what do you actually know about A.C.M.S.?” I asked.
Rainbow shrugged. “I know what it is, but, that’s about it. Twilight gave me a rundown of the symptoms when we first started dating. I don’t know what causes it, or what to do about it.”
“Well,” I put a hoof to my chin and offered lightly, “Would you rather I explain of the causes of A.C.M.S. or just skip straight to Twilight's emergency plan?”
Rainbow rubbed the back of her head. “I guess I have been a little curious about why Twilight has it, so, could you tell me the causes first?”
“Sure,” I said before closing my eyes; anything to better organize my thoughts in a way that would make sense to someone lacking the years of medical school training. When I opened my eyes, I set them gently upon Ms. Dash. “This will probably disappoint you, but the causes of Abstract Cutie Mark Syndrome are actually hard to pin down. Most scientists today believe there are a variety of genetic and environmental factors that contribute to a pony developing symptoms. Factors which are believed to occur both during, and after, fetal development.”
Rainbow’s eyes had, much to my amusement, glazed over. “So… You mean it's from your parents?” she ventured after a moment, “Does that mean that Twi’s parents have it too?”
“Ah, no,” I said, pausing a moment to think. I couldn't exactly speak for Twilight's parents exactly. I needed to tread lightly, “As far as we can tell, Twilight’s family has no history of mental illness, A.C.M.S. or otherwise. Although having a relative, especially the parents, with it does increase the risk, but it is by no means the only factor, one way or the other.”
“Okay, so then...why does Twi have it?” Rainbow queried me with slightly narrowed eyes. Her head tilted almost imperceptibly to the side and a brow stretching up into her forelock.
“In her case,” I explained, leaning back in my chair casually despite the discomfort of it, “it has more to do with environmental factors. A mother being stressed or malnourished during pregnancy, for example, seems to increase the chances of the child being born with A.C.M.S. More so if the child is born in winter or fall, as opposed to the typical foaling seasons of spring or early summer. Additionally, being raised in an urban environment appears to increase the chances of one having it as well. Keep in mind that there is no way to be certain. Even with all those factors, there is still only a small chance that a pony will be born with A.C.M.S.”
“My mother was very stressed when she was carrying me,” Twilight said, before Rainbow had a chance to respond to my explanation, “Our house was going through a time of difficulty. Mom's last book hadn’t sold very well, and the observatory Dad worked at was downsizing, so they were worried that he might be laid-off. Mom told me that she was struggling with a severe case of writers block at the time as well. Add to that the fact I was born near Hearth’s Warming Eve, and that I was raised in Canterlot…” she trailing off into silence.
She didn't say it, but I had a feeling she was going to add, “It was no wonder I was born with A.C.M.S.” as if it were her destiny... I made a mental note to ask what Twilight thought about her upbringing, parents, and how it was connected to her future later. It was something we could continue to work on in private.
“Oh…” Rainbow said, looking less doubtful now and more at a mere loss for words. “So, umm, it isn’t caused by drugs or anything? I heard that those things can screw with your brain.”
“Actually, it's the other way around,” I noted. “Scientists have discovered that ponies who have A.C.M.S. are, like others who suffer from undiagnosed mental illnesses, are affected by substance abuse approximately fifty percent of the time. Some of it goes into alcoholism, but roughly half of those suffering also have drug addictions. It can make diagnosing these conditions a lot harder, but we tend to think of it as more of a symptom, rather than causality.”
“But Twilight is too cool for that, right?” Rainbow asked, looking to Twilight for confirmation.
“Well, I...” Twilight said, penitently avoiding Rainbow’s gaze. “I did used to have an addiction to salt sticks...”
Rainbow's jaw dropped and I raised an eyebrow. I had known about her past with salt sticks, of course, it had been part of her medical history sent to me by her previous doctor. What surprised me, however, was that she had never ever discussed it in our sessions. I had assumed she was just unwilling to have the subject brought up at the moment. So, for her to so willingly tell Rainbow Dash like that showed just how much she trusted her marefriend. It was a rather remarkable breakthrough in my eyes.
“B-b-but,” Rainbow spluttered, her mouth hung open a moment as if she were completely shell shocked. “You mean the things with nicotine in them? Aren’t those bad for you? And addictive? And illegal? And really, really bad for you?!”
“Well, they aren’t throw-you-in-jail-illegal, but I did have to pay a fine when I got caught. And yes, the chemicals that give them their relaxing qualities do make them addictive and bad for your health,” Twilight said, not yet meeting Rainbow’s eyes.
“But you’re the Princess’ student! How in Equestria did you get away with that?” Rainbow exclaimed.
“I didn’t, not for very long anyway. And when I got caught...Mom, Dad, and Celestia were all furious. They paid my fine, but they took away my allowance and made me pay it off.”
“Allowance? You mean to tell me you were addicted to salt licks when you still had an allowance?! How old were you?” Rainbow asked wide-eyed.
“Um…mid-teens.” Twilight said sheepishly.
“...Wow. Ah, but you aren’t addicted any more, right?”
“Oh, no! I had to go to a rehab center for a little while. It wasn’t pleasant, but I kicked the habit,” Twilight said, a pleased expression flitting across her features.
“Good,” Rainbow said with a nod, still clearly trying to absorb the news.
I cleared my throat, both mares spun to look at me as if they had forgotten I was in the room. I smiled gently. “I think we might have gotten a little off track. So, Ms. Dash, does that answer your questions about the causes behind A.C.M.S.?”
The pegasus shrugged. “Sort of. I mean, it does tell me why it affects her, but I still want to know, um the why of it… er, I mean, not the why so much as the how. No, that’s not right either. Twi, you know what I mean right?” she said pleadingly.
Twilight giggled. “I think what Rainbow is trying to say is that she understands the causes, but wants to know about the mechanisms behind it. Is that about right, Rainbow?”
Rainbow nodded. “Yeah… I think.”
“Very well,” I said. “We actually know a bit more about what actually causes the abnormal behavior in a sufferer. It has a lot to do with brain chemistry and magic. First of all, it appears that the main chemical that affects sufferers is dopamine. In postmortems, it has been found sufferers of A.C.M.S. have a much greater concentration of D2 receptors in their striatum, but that has been subject to some controversy, and—“
“Whoa, dude, please don’t give me a full lecture,” Rainbow said, cutting me off. “Tell me about the magic side of it. I think I might understand that if you keep it, you know, simple.”
I hesitated. I needed to think of a way to phrase this so that she could understand. “All right, I think I can do that. So, um…how much do you know about how a pony’s brain is structured?”
Rainbow just stared at me in a sort of disbelief, as if to say; “What makes you think I know anything about that!?”
“Okay, bad question. To oversimplify, a lot, every pony of all three races has a magic lobe in their brain. In unicorns, it controls their magic, in Pegasi, it helps with flight, and in Earth ponies it gives them their extra strength and connection to the ground. That’s how it works in a pony without A.C.M.S. Do you follow me so far?”
Rainbow nodded.
“Good. So, in a pony with A.C.M.S. the magic lobe is much larger, sometime by as much as half. However, the membrane that acts as a barrier for the magic within the lobe is underdeveloped at the same time. This causes magic to flow into the brain disrupting the brain’s natural pathways. This, combined with chemical imbalances, causes the symptoms. That’s why dopamine blockers and magic suppressants are so effective in helping ponies with A.C.M.S.”
“Wait, wait, wait! You mean to tell me that Twilight is on magic suppressors? Is that true?” Rainbow asked, turning to Twilight.
“Well, yes,” Twilight said, looking just as puzzled as I felt at Rainbow’s sudden outburst. “Why?”
“You’re the strongest unicorn I know! Maybe the strongest in all of Equestria! And you're telling me that you are this strong when you are on magic suppressors?” Rainbow said, disbelief present in her voice.
“Yep. That’s why it’s so important for me to keep taking my medication. Aside from the withdrawal symptoms, well, just imagine if my ‘want it, need it’ spell had been even more powerful. It might have covered half of Equestria instead of just Ponyville. And that’s just one example! What if I—“ Twilight said, her voice becoming steadily more frantic. She was beginning to hyperventilate as well.
“Twilight. Calm down,” I coaxed, noticing the beginnings of a panic attack. “Please. That won’t happen.”
“But—“
“As long as you are careful, that won’t happen,” I said, firmly, before turning to Rainbow. The poor blue mare was sitting in a fret. “I fear that we have gotten a little off track once again. So, I hope that answered most of your questions. I was oversimplifying quite a bit, but that’s how it works in general.”
Rainbow shook the glazed look out of her magenta eyes. She sat there thinking for a moment or two and looked between myself and Twilight before settling back at me. “There's still one thing I don’t quite get yet. How come it’s called Abstract Cutie Mark Syndrome? I thought, well, I thought that the Cutie Mark caused it, but you said it's the brain...?”
“Well, I'll be the first to admit that the name is misleading. In fact, I think that the only reason it hasn’t been renamed is out of pure habit. It’s been known as A.C.M.S. for so long, it would be hard to change.” I thought briefly of just how many textbooks and medical guides would have to be revised... Not that they didn't as new information surfaced, but still. “As for the reason why it was named that, how much do you know about Cutie Marks?”
“Um…” She looked over to Twilight questioningly. When the purple unicorn merely nodded, apparently not realizing her marefriend wanted help, Rainbow turned back to me. “I know that Cutie Marks are caused by a surge in a pony’s magic when they realize what their special talent is—Oh!”
“I think you understand now,” I said with a warm smile, “The fact the magic lobe is bigger and the brain is not as protected from the magic as it should be, causes ponies with A.C.M.S. to go a little haywire when experiencing a jolt of magic. In essence, it could be compared to a seizure. So when a pony realizes their special talent, that extra burst of magic results in, well, an abstract Cutie Mark.”
The three of us glanced at Twilight's mark.
“Keep in mind,” I continued, “that is not the only way a Cutie Mark can become abstract, as there are just some talents that don't have anything definite to symbolize them.”
“Oh, and that magic surge is often what causes the first episode in a pony’s life! Mine literally happened the night after I earned my mark,” Twilight added, eager to help educate Rainbow Dash.
“Okay, I think I know more than enough about it now,” Rainbow said, rubbing the back of her neck as if to aid in the removal of a headache. “What I want to know about now is how I can help Twilight deal with it. After all, it's why we came here together in the first place.”
“True,” I said. “Twilight’s emergency plan is actually quite simple. All you really need to do is contact Celestia, and possibly use a magic suppression stone if Twilight’s magic is acting up.”
“Really?” Rainbow asked, looking a little disappointed. “I was expecting some sort of, like, huge checklist. You know, like the ones Twilight makes when she goes shopping.”
“Rainbow!” Twilight blushed with mild indignation.
“Yes,” I chuckled a bit. “Simple, is it not?”
“I guess. So, why is contacting Celestia so important?” Rainbow asked.
“Well, she is like a mother figure to me, so that should help me calm down some,” Twilight said. “But… well, the real reason is that she is one of the only ponies out there that could actually stop me forcibly, considering how strong I am.”
“Oh, I see what you are saying,” Rainbow said. “So, just contact Celestia, and use a magic suppression stone.” She paused, “What’s a magic suppression stone?”
I twitched slightly, resisting the urge to face-hoof. How could she not know what one of those were just based on the name alone? I was about to say something, when Twilight began to speak.
“Basically, a magic suppression stone is a lot of anti-magic dust compacted into an easily crushable stone. When it is crushed, it turns back into the dust, causing all ponies caught in the radius to lose their magic. I wouldn’t be able to cast spells, and you wouldn’t be able to fly. Anti-magic is rare, so it's hard to make the stones. It makes them very expensive, but having one is a basic part of living with something like this,” she said. “I have a small one in my nightstand, and Spike knows where it is, just in case.”
“Right, so use the stone, and let Princess Celestia know what is going on,” Rainbow said, more to herself than to us. She looked up after a moment. “What if I can’t get ahold of her?”
“That…that is actually a good question,” I said, but quickly worked out a solution. “What you need to do in that case is keep Twilight calm, and take her to the guard station. They could put a magic suppressor on her horn, and keep her until you can contact Celestia.”
“I understand,” Rainbow said, but she looked a little overwhelmed. I couldn’t blame her. Relying on the Princess like that wasn’t exactly a perfect plan, but it was the only one we had. With Twilight’s strength, the normal guards wouldn’t be able to help much, and trying to keep somepony in a fit of paranoia calm was like trying to get a cat to obey you: not much fun and almost impossible.
I resolved to come up with a better solution than just contacting Celestia and using a magic suppression stone. If not today, then I could discuss it with Twilight next week.
I started to say something, but whatever I was about to say was struck from my mind when I noticed Twilight chewing on her lip with her ears flat against her head. “Is something wrong, Twilight?”
“Sorry, Doctor. This is just a little weird for me. Talking about what to do with me if I’m not in my right mind…it never really feels natural.”
“I understand. I'm sorry this made you feel uncomfortable,” I tried to add a little more warmth to my voice to ease the tension.
“It’s nothing,” Twilight said, shaking her head. “It was necessary.”
I nodded, and silence fell over the room.
After a minute or two, Rainbow began fidgeting. She obviously wasn’t used to just sitting and talking. Now that I thought about it, this might have been the longest I ever saw her on the ground. Luckily, the conversation had taken up more time than I had originally expected, and it was almost time for our session to end. I found myself relieved that Rainbow would soon be out of my office and back in the sky.
Now that I thought about it, I wonder if she has claustrophobia? Well, unless she decided to confide in me about it, it wasn’t really any of my business.
“Twilight,” I called and the mare in question started a little. Huh, she must have been deep in thought. “Our time is almost up today. Was there anything else you wanted to talk about?”
“Not really, no,” Twilight said, taking a surprised look at the clock. “I haven’t been having any symptoms this week either, but I do need a refill on my meds, so…”
“Give me a minute and I will write up a prescription for you. You have not been having any symptoms, so I assume that you want to keep your dosage at the same amount?” I asked.
“That’s right.”
For the next thirty seconds or so, the only sound in the room was the scratching of my quill against the prescription pad. The thirty seconds after that were completely silent as I checked and double checked what I had written. At last I broke the silence as I ripped the paper off the pad and handed it to Twilight, “Here you go.”
Rainbow had watched the whole exchange with interest. “That’s it?!” she said, “I thought that it would be more of a process than that. I mean, don’t you need to know if she has any bad reactions to the meds? That sounds like the sort of thing that a doctor should ask about.”
“I did. I did the first time, the time after that, and every time we change up medication. We have found a dose that works well for Twilight, and I trust her to tell me if any of the side effects flare up. That way, I do not need to play twenty questions with her at the end of every session,” I said, feeling just a tad bit annoyed that Rainbow of all ponies was trying to lecture me on how to do my job.
Thankfully, Rainbow just nodded instead of fighting back.
“Thank you, doctor. See you next week?” Twilight Sparkle asked as the two ponies rose from their respective seats and headed toward the waiting room.
“I will be here. Just...Twilight,” I said, “next time you want to bring somepony along, please let me know ahead of time.” Twilight nodded, and as she and Rainbow Dash exited my office.
I turned then to my never-ending pile of paperwork.