With Astarion out, you can turn your opponents pain into more life for your self, but pair it with another card, Sanguine Bond, and you can start an infinite loop of life-stealing triggers until you win the game
While it costs a hefty six mana to get online, once it is in play you get to add twice as much mana when you tap any permanent for mana
In those environments, it will serve as a sort of value-generating card that sometimes just steals games by doing an Overrun impression, which leaves a lot to like
From Legacy and Vintage to Modern and Extended, and Standard and more, cards like Cabal Therapy and Dread Return have been strong additions to the Spike canon of power
The trouble is to really get value out of this you need a bunch of characters at a location and that requires a lot of resources to make happen
1 Foil (Any Rarity)