In college, I studied
English and psychology, a hybrid degree. My capstone project focused on analyzing
the portrayal of mental illness (or, more often and regrettably, “madness” or “insanity”)
in roleplaying games. It wound up more of a survey than a statement, beyond
pointing out some obviously flawed approaches that I will bring up again here. It’s
been less than two years since I finished that project, but I feel my
understanding of the medium of RPGs and the world of mental health both grow
every day.
First, I should differentiate
some terms. I use “stress” to mean tension brought on by circumstances. For
example, knowing a killer alien is hunting you is likely to put you on edge. “Trauma”
begins to get into a space where one ought to tread carefully, so I’m going to
outsource my definition. SAMHSA says: “Individual trauma results from an event,
series of events, or set of circumstances that is experienced by an individual
as physically or emotionally harmful or threatening and that has lasting
adverse effects on the individual’s functioning and physical, social, emotional,
or spiritual well-being.”
More contentious
yet is finding a definition for mental illness, or mental health. Even
establishing how those two concepts are related can be tricky. To that end, the
CDC says “poor mental health and mental illness are not the same. A person can
experience poor mental health and not be diagnosed with a mental illness.
Likewise, a person diagnosed with a mental illness can experience periods of
physical, mental, and social well-being.”
Personally, I don’t
believe in arbitrarily saying certain people’s minds are fundamentally “ill”
just because they deviate from societal norms and expectations. That is a judgment
which is inconsistent from person to person and cultural group to cultural
group, and which has been used in countless harmful ways throughout history. This
is what trips up even the RPGs that otherwise do a pretty good job, I think.
More on this later.
In the interest of
having a working definition, I will say that mental health refers to how well
one’s mental and emotional paradigms match the expectations of the society they
inhabit. Therefore, mental illness can be seen as paradigms that deviate from
those expectations to the point that existence in that society becomes challenging.
Let me bring this
back to RPGs with an example of where I’m headed with this essay. The first
time I played The End of the World, a game in which you play as yourself
in the context of an apocalyptic scenario, it was with university classmates. This
was for a class assignment, as a matter of fact; I didn’t really know any of my
fellow players outside of class.
The game began as
is typical for EOTW: we (our in-game selves, much as their real
counterparts) were sitting in an on-campus dining hall when concerning,
sporadic news reports began to filter in. Pretty soon, zombies attacked us. We
escaped narrowly to someone’s dorm room and began to plan our next steps. It
was at this point that I (the player) began to consider what I’d really do in
this circumstance, having just dodged a grisly death by a hair’s breadth. I decided
I’d call my dad. I had to know if he was safe, and if so, seek his advice on
what to do next.
As soon as I
relayed this to the GM, I realized the awkwardness of my choices. This guy
barely knew me, and I was asking him to roleplay as my father (who he knew nothing
about) in a fairly intimate conversation. It was a non-starter, and also took pretty
much everyone out of the game until I decided to just resolve the outcome of the
call myself and move back to the action.
I bring this anecdote
up not just for its cringeworthy humor, but because it represents an aspect of
roleplay that has always mattered to me: I want my characters, be they copies
of myself or something much more fanciful, to react in believable, human ways. One
way that manifests is a desire for trauma to have meaning in the game.
End of the World: Zombie Apocalypse (2014, Fantasy Flight Games)
Let’s move on to
another game example. Imagine a first-time D&D player showing up with their
debut character: a high elf wizard with the noble background. Level 1, fresh
from her mansion, with only a theoretical curiosity for the arcane and a
yearning for adventure in her head. Let’s say this character is running through
the 5th edition starter adventure, Lost Mine of Phandelver.
The adventure starts
with an ambush by goblins on the road. Just four goblins versus the party of adventurers;
simple enough. This fight can be pretty brutal if the GM plays their cards
right, though; the goblins can employ some pretty scary hit and run tactics
with their Nimble Escape feature. In this playthrough, maybe none of the PCs
die, but our wizard gets hit by a couple of lucky arrows and drops. The cleric
saves her with a Healing Word, but she comes to with the knowledge that she
almost died.
Personally, I would
imagine this fledgling mage would feel pretty freaked out. I don’t think it’s a
stretch that a brush with death would be traumatic for someone coming from a
life of pampered luxury. However, D&D has absolutely no game mechanics to support
this line of roleplay. I can decide she sticks behind the paladin from now on,
or learns more defensive spells as she levels up, but as far as the game is
concerned, I have no reason to act like that. My hit points are back to full
from a single spell or an hour of downtime; let’s get back to the killing – I
mean, the adventure!
To that end, the
same logic applies to the reverse: maybe my elf got some good attack rolls in
and killed three of the goblins herself. Goblins are unambiguously sentient
people with their own society and culture by D&D’s official lore (as well
as how they’re presented in Lost Mine). What if my elf feels remorse or
disgust at her actions? In this case, it would actively detract from the game experience.
This is because D&D is a violent power fantasy above all else.
Not to go on too
much of a tangent here, but D&D (in its current iteration’s base rules) allows
characters to improve through violence and nothing else. What’s more, the improvements
they earn are almost exclusively pertinent to killing and avoiding being
killed. This isn’t necessarily to knock that style of game, although I don’t
personally prefer it.
But this is the
reason D&D doesn’t model trauma, especially the mundane (as opposed to
magically inflicted) kind. If my wizard gets more and more distraught over her
bloodshed as the adventure continues, and the adventure is 80-90% about killing
more thinking beings, sooner or later I will have to roleplay a breakdown, a
sadistic change of heart, or a tearful departure before bringing in my next character.
This flavor of escapism
doesn’t work if you look too hard at the consequences of your actions, even on
your own character. There’s plenty of deconstructions of this in the hobby, such
as John Tynes’ Power Kill, which frames the characters as psychiatric
inpatients who have gone rampaging, thinking they’re murderous
adventurers.
As a last note on
D&D, early editions had explicit rules for characters being afflicted with real-life
illnesses such as schizophrenia, albeit gamified in a way that bears almost no
resemblance to the experience of those with the actual diagnosis, and far more
to harmful, sensationalized depictions from other works of fiction. This was
clearly an afterthought in the 70s and 80s, and is even more so now, with the 5e
Dungeon Master’s Guide retaining slightly smoothed versions of these effects without
the real-life name (because we can’t be insensitive, now can we?)
Dungeons & Dragons 5th Edition: Lost Mine of Phandelver (2014, Wizards of the Coast)
Let’s move on,
then, to a game that actually wants to explore these things. Call of Cthulhu is
no power fantasy. You are set up to play as ordinary people, and in some ways,
CoC investigators are actually feebler than your average joe. One of these ways
would certainly be their sanity. In CoC, sanity is a meter that starts at a certain
value and only goes down. Once it’s empty, your character is “permanently
insane” and you can no longer control their actions at all.
This deprivation
of player agency is at the core of CoC’s sanity system. Whenever you go insane,
be it “temporarily,” “indefinitely,” or, as mentioned above, “permanently,” the
manifestation of this debility in the game is determined randomly, unless the
GM wants to fudge it and pick an entry from the tables in the book.
The way this works
is not only horrendously inaccurate to any kind of real mental illness or
response to trauma, it’s so swingy that it’s often not even a fun gameplay experience.
Yet another example: I recently ran a prewritten scenario from the 80s, One in
Darkness. The investigation was a little slow at first, maybe, but heading
swiftly to an interesting climax when the central monster first reared its head
to the whole party.
Despite being depicted
in the art as a giant, demonic rat, this was an avatar of the god Nyarlathotep,
and so simply witnessing it cost the characters either 1d10 or 1d100 sanity
points (SAN), depending on if they made a singular roll. That meant losing an
average of 5 SAN and going temporarily insane if you failed another roll, or an
average of 50 SAN, which for many characters means permanent insanity and
automatic loss of your character.
Here's how it
played out: I had the avatar pop out of a sewer grate while the PCs were
driving to an NPC’s home. They were split across two cars. In one car, all
three PCs went permanently or indefinitely insane. They crashed into the avatar
(who, as a kicker, was immune to harm from nonmagical objects) and all died
because the driver’s madness manifested as, essentially, road rage. The other
car’s driver was also properly insane and drove into a house while her
passenger fainted from temporary insanity. Those two survived until the cops showed
up, but obviously that was the end of the adventure. The avatar simply walked
away.
Obviously,
reducing the numbers on the SAN loss would mitigate some of that fiasco, but I
still feel that CoC is regularly hamstrung by the simultaneously rigid and chaotic
way its characters react to trauma. This is to say nothing of the way it takes
a sampling of real-life symptoms and diagnoses and attaches them to game mechanics
completely haphazardly.
One more example
of the disservice CoC does to this subject is in one of the very few ways you
can regain SAN. Investigators who successfully unravel a mystery, protecting
innocents and apprehending no-goodniks in the process, regain a die or two of SAN.
This has the implication of moralizing the game’s attempt at portraying mental
illness. You might stop being crazy if you’re a good Samaritan – because that’s
how mental health and trauma work, right?
Call of Cthulhu 7th Edition Core Rulebook (2014, Chaosium, Inc.)
The next game I
want to touch on is Free League’s Alien RPG. This system chooses a broader,
perhaps more generic “stress” mechanic; every time your character experiences
something stressful or traumatic, or pushes themselves hard, they get stress
dice. Stress dice can make you more effective, but they can also make you
panic. This creates a neat little flow in which you start reacting effectively
to the dangers that surround you, right up until you’re so freaked out that
every little thing you have to do is almost guaranteed to cause a meltdown or
overreaction.
I feel this captures
the Alien movies quite well, and also seems a decent way to represent how
competent people would fold under such distressing circumstances. I also don’t feel
that it would be fair to criticize the game for its avoidance of the subject of
real mental illness or the more nuanced effects of trauma. This is because the
scope of the Alien RPG is focused on the encounters with the titular
creatures, not on deeper character interiority. The character sheet is simple and
focused on telling you what you’re good at when it comes to space exploration; Alien
PCs are meant to die far more than change and grow.
I would contrast
that with D&D because that game claims to have three “pillars” of gameplay,
all equally important, and roleplay is one of them. 5e D&D also tries to do
it all, with some mechanics included to flesh out your character’s personality.
Alien is up front about its intent to terrify and maul your character, and its
ruleset supports that.
Alien RPG Core Rulebook (2019, Free League Publishing)
Lastly, let’s look
at Unknown Armies, a game I love, and the one that gets closest to my ideal for
handling this subject. It actually has a lot of similarities to Call of
Cthulhu: eminently mortal characters, similar dice mechanics, a focus on what
skills your character is and isn’t good, and of course, a system for modeling
trauma.
The first thing UA
does better than CoC is splitting “sanity” into five “shock gauges.” These are
categorized as Helplessness, Self, Isolation, Violence, and the Unnatural: the kinds
of trauma you might encounter in UA’s occult underground. I might monkey with
this division a little (maaaybe combine Helplessness and Isolation?), but on
the whole I don’t feel it needs adjustment; it works well.
The next refinement:
a shock gauge doesn’t just decrement when you are subjected to a relevant
traumatic event. Rather, you either get a hardened or failed notch. The former means
you become more resilient to the trauma, but also develop a more detached or
warped relationship to that category. The latter means you are more frightened and
shaken for future encounters, and in the moment, you fight, flee, or freeze.
Notably, the player chooses which of these happens to their character, not the GM.
I find that this is
a much more believable model, and also lends itself to thinking about who your
character is and how their traumas change them. Characters are actually expected
to begin with some notches, allowing you to be someone used to killing others
(by adding hardened notches to your Violence gauge) if you want to be that kind
of murderhobo. There are tons of other ways you could assign notches, though,
and this leads to some really interesting characterization through the lens of trauma.
Where I feel UA drops
the ball is what happens when you gauges fill up, specifically the failed notches.
This is where the game brings in real-world symptoms, and under the category of
“ongoing madness,” no less. The game allows players to “work with [their] GM”
to figure out the specifics (unlike CoC), but you’re choosing from a list
including flashbacks, substance addiction, and so on. I do appreciate the designers’
conscious choice to leave out dissociative identity disorder and schizophrenia
(they include a half-page explanation on why they felt this would be going too
far), but I feel that if one or two diagnoses are better off left alone, you
should really question what is so different about the rest that makes it okay
to include them (and, again, label them “madness.”)
Unknown Armies 3rd Edition, Book 1: Play (2016, Atlas Games)
Okay. This has gone
quite long. Let’s end on some takeaways that I want to keep in mind as I think
about how I would create a system for stress, trauma, and/or mental illness in
a game of my own. First, I am not really interested in designing a power
fantasy, and I am interested in exploring these topics intelligently and compassionately.
This means I will want to at least acknowledge them in my thinking about the
design, if not include mechanics on them.
Second, I do think
mechanics would be wise. My reason for saying this is that mechanics are how we
engage with all aspects of a game. When you don’t address something you claim
is important through a mechanical lens, it won’t end up being important at a
lot of tables (see my comments about roleplay in D&D 5e – and this applies
for the exploration pillar, as well.)
Third, there has
to be nuance. A 1-100 meter isn’t going to cut it for such a deeply nuanced subject.
Fourth, as we learned from Alien, it has to be in line with the overall
scope of the game. Fifth, player agency must be preserved.
Sixth, avoid disrespecting
the real lived experience of people who have undergone trauma (which to some
degree is basically everyone) and who live with mental illness. This would
include not calling people “mad” or “insane” for struggling with addiction, for
example. This one is definitely easy to screw up, but it’s also very important.
Research, sensitivity readers, and so on are key.
And lastly,
seventh, is the point I’m still chewing on: how do you represent real mental
illness in a game, if that’s something you decide you want to do? I’ve
established that it has to be incorporated into the mechanics, at least to some
degree. But any attempt to attach real symptoms to mechanics that I’ve seen has
not looked good in practice.
Maybe separating
trauma from diagnosable mental illnesses is a place to start. After all, the
idea that you can develop schizophrenia from seeing a spooky fish-man has
always been a laughable flaw of Call of Cthulhu. If you didn’t know, you can’t
just “become schizophrenic” at the drop of a hat. That’s not how the illness works.
I still need time
to think on that one, so I’ll come back to it later. This is a 3,000 word
monstrosity as it is. I’ll sum all this up by saying that whether you’re writing
or running an RPG, you should give at least some thought to the depiction of trauma
and mental illness, because it’s probably in there somewhere, and if it’s a
focus area for that game, don’t make an ass out of yourself by doing the
subject injustice.
