Mental Health in Roleplaying Games


Because of my personal and professional experience I know quite a lot about mental health issues. As you may well know I suffer from depression and anxiety disorder myself and since I work in a psychosomatic medicine department , I learned a lot about all kinds of psychological and psychosomatic disorders over the years. What sometimes bothers me, is how roleplaying games use mental health issues.

There are a lot of games which have rules for psychic disorders. The most prominent example is probably Call of Cthulhu. In most of these games your character gets a random disorder when he or she has lost a certain amount of mental health points. Most games don’t even bother to distinguish between different causes. Being confronted by unspeakable horrors from beyond has the same effect as seeing a loved one die or being close to death yourself. In one case my character in a Palladium Fantasy game was on the brink of death and got traumatized by that. What was the result? He suddenly had a phobia against fey creatures – no kidding!

This of course doesn’t make any sense. It might have, if the almost mortal wound had been caused by fey, but it was because of drowning. One other common mistake is that neuroses and psychoses are randomly thrown together – which doesn’t make any sense. Playing out a psychological disorder might be a very interesting and intense roleplaying experience. But in most games it’s handled so badly that it just becomes an excuse to play “crazy”.

I don’t expect total realism. But I would prefer it if game designers took these matters more seriously. Suffering from mental health issues is no laughing matter. And while some roleplayers can have lengthy discussions about how realisticly guns are simulated by roleplaying games, almost noone bats an eye when it comes to unrealistic “insanity” rules.

I have to admit I haven’t had the time yet to do some more research on the matter. I am sure there are a couple of games who treat the subject with respect. I faintly remember that the Trail of Cthulhu rules did a slightly better job when it came to insanity and mental stability than most games. But I have to double-check.

What is your stance on the matter? Are you bothered by the portrayal of mental health issues in RPGs, too, or do you just not mind? Do you know a couple of laudable examples you want to share? Feel free to post your thoughts below!

6 thoughts on “Mental Health in Roleplaying Games”

  1. I believe this issue is down to the individuals interpretation.
    If you have or suffer a particular ability or disability, then you have a whole different perspective. Trying to convey this same experience to a game mechanism is going to be difficult.
    Like the same why some players try to take on the mantle of an opposite gender. I for one will be happy to play the female. But, of course, I don’t really know or understand the importance of how to be.
    I can ask or watch women and go from there.
    If you can place your self into anothers shoes, that’s all you can do. Shoes do not make a person or the personal experience.

    A prospective of a mental health problems can only be used to a point of view. A misunderstood point of view.
    So that is as good as it could ever be. So what we have in games has to be limited to that. It has to reach a point where if you step beyond the scope of the game. Does it remain a game.

  2. Check out Unknown Armies, has the best “sanity” system I have ever seen.

    A quick summary; Sanity Slippage: A consequence of gaining “notches” on your sanity meters. Getting hardened notches makes you more and more emotionally dead to a given stimulus, culminating in a complete immunity to stresses of a given kind along with total sociopathy. Getting failed notches makes you more acutely sensitive to a given stimulus, culminating in a severe phobia and total madness.

    Its a bit more in depth than that, but gives you the general idea.

  3. Hey Michael,

    having been the host of said Palladium game i’d like to comment on this.

    Upfront: I’m really sorry if that roll on the random insanity table made you feel uncomfortable. I fully understand that you have a different perspective on the topic. But with relation to your article about social contracts, an important rule in my contract would be: “If something bothers you about the game, then – for crying out loud – please say something”. That roll was three months ago and I had no idea it bothered you. These tables are by no means vital to the game and I would happily have left that aspect out.

    On the tables itself: I see these random insanity tables just as an option and opportunity for the players to add another element to the character if thye chose to embrace the result of the roll. So in my pespective it is less a question of the random table itself but what the GM and the players make out of it. Therefore, as a GM I would never insist on a player to fully roleplay the insanity if he/she doesn’t want to (no fey creatures in the campaign unless you start looking for them). What’s on the character sheet is yours to work with. Furthermore, not rolling dice but chosing from the table as seems fitting would also be an option.

    Regarding realism in the cause of an “insanity”: Is it not the total randomness what makes the table interesting? If I knew from the start what I get from a certain cause why have the table anymore? And of course these specific tables are not very realistic. They were compiled by a group of early enthusiasts in the 70s/80s without internet trying to make a living and to create a fun game and they have just never been updated. If they would have created a system to actually simulate psychological diagnosis, I believe that would be overly complex and not entertaining at all. Same goes for the sword fighting rules. Having done HEMA several years myself, I can say that most RPG fencing mechanics are not realistic at all. But making them complex enough to simulate an actual sword fight would just not be fun anymore.

    So it all comes down to houseruling aspects of the game that are especially important to you and your players. Playing Palladium “by the book” would anyways really drive me nuts. 🙂


    1. Don’t worry, it really didn’t bother me that much, but it was one of the reasons that got me thinking about how mental health was handled in roleplaying games. Palladium Fantasy is not necessarily a totally serious game so some random weirdness can be expected. But there are other games where a more realistic portrayal would be beneficial to the experience.

  4. Topic near and dear to my heart. For our new edition of Chill, we do include a Drawback to represent an impairment (mental or physical), but we focus on the effect. And, if it’s not going to have a game impact, you just don’t take the Drawback.

    As an example, let’s say I want to play a character who, like me, suffers from depression. If I want that to have an effect on the game in a mechanical sense, I take the Mental Impairment Drawback. If, however, I want that depression to be part of the character’s backstory but *not* have an effect on mechanics (maybe it’s under control, maybe it’s just intermittent, or maybe I just don’t feel like playing it), I don’t take the Drawback.

    Mechanically, there’s a system called “Trauma” that affects a character’s attributes, but the player has a lot of freedom to determine how. Traumatic events in play, including injury and being horrified by supernatural creatures, can cause Trauma.

  5. I found this because I was googling to see if anyone had, like me, found real life experience with mental health issues suggested that RPGs might be an interesting way to communicate about and encourage sensitivity to those issues. I’m pondering creating a system that takes inspiration from the DSM-V. An example of a way I think such a system could be both engaging and informative is they way some trauma survivors look on their hypervigilence as a kind of superpower that happens to be maladaptive in less traumatic circumstances.

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