RPGs and Mental Illness

Do I dare?...

Of course, these are all older games I’m looking at. Surely more modern RPGs have seen the error of their ways and dropped these. I mean you wouldn’t find something like this for Pathfinder, right? Whoops, that’s a link to the PRD. I guess we can. It’s a much shorter write up, with only 5 conditions, no sexual kinks or transphobia mixed in, but we still have the TV versions of insanity and “MPD” plus it’s still a random chart you roll on after traumatic events. Although at least here the trauma in question is having one of your mental stats reduced to zero, something that only really happens as a result of encountering rare supernatural creatures and spells.

...

At the very least though, I’d love to see us move away from this mindset of “something traumatic happened, roll to see how crazy you go.” Maybe replace it with a note on how traumatic situations can affect a person, as a general bit of roleplaying advice. The realities of mental health just plain aren’t reflected by rolls on random tables.

The article is fairly kind towards Pathfinder, but even so, this may be something worth talking about.

The question is if it's worth trying to talk about on these forums. I don't particularly want another locked thread under my prodigious belt.

Screw it. I'll just go hide in NaNoWriMo if this thread goes south. Do you think Pathfinder's handling of mental illness is appropriate? Do you think they could do better?

Come to think of it, this might be on the wrong forum. Not least because people here are a lot crankier than average.

I don't think it's handling of mental illness is appropriate... but I do think it handles it better than many other games.

What? RPGs don't handle mental illness perfectly in line with the real world!? (which changes many of its theories every few years)

I mean - what happens when you get stabbed in the chest with a sword is PERFECTLY realistic! Whenever that happens to me in real life I get the guy who can only wield simple weapons to say random words and wave his hands around - and then I feel fine. Pathfinder simulates that perfectly!!

Why can't RPGs replicate mental health as well as they do physical health!?

[The whole premise is silliness. RPGs are designed to be entertaining - not to be psychological textbook simulations.]

Does anyone know what she is talking about at the start of the article?

"Lately there’s been a bit of a discussion about a rather shamefully sexist and childish book prominently displayed in a major PDF RPG store."

[rant]I hate it when people make this kind of reference without an explanation or a link.[/rant]

Does anyone know what she is talking about at the start of the article?

"Lately there’s been a bit of a discussion about a rather shamefully sexist and childish book prominently displayed in a major PDF RPG store."

[rant]I hate it when people make this kind of reference without an explanation or a link.[/rant]

I guess it's about the...*Sigh*...Tournament of Rapists PDF, an add-on for d20 (with Pathfinder in mind) that is actually more awful than the title suggests. RPG Drive Thru had it up for sale, and has been...lackluster in how they've responded to criticism about the game and how, essentially, the thing shouldn't even be sold.

Pathfinder's Mental Health rules could do with an overhaul. Given the pages written on spellcasting, I think a couple more pages on mental health issues wouldn't go amiss. Changing it from random to specific horrific events and adding some depth would go a long way.

I think that was with regards to a book glorifying sexual assault which she probably didn't want to name and offer any publicity. It featuredon RPGNow, I believe. I can't remember the name, myself, and don't really feel like Googling keywords. :P I am ninja'd and also wrong. Bad KC. Bad! *Gets spraybottle*

Also, CLH, the issue is that while being "funrealistic" is one thing, ableism is alive and well in this country and particularly strong when it comes to mental illness. So there's a difference between "Magic is real" and "Mental illness leads to you being transgender".

In fairness, KC, that's just my best guess based on the recent 'what the hell is going on?' events that I know of. It might be something else.

Yeah, I really dislike any 'mental illness' charts that include homosexuality of transgender as a possible result. Strange sexual fetishes are, obviously, real - but they're rarely going to be the result of anything that'll happen in a dungeon. Unless your Ooze encounters leaves you eyeing the jelly pot oddly.

My main gripe with Pathfinder's system is it need fleshing out, and the random element removed. After that it'll probably go much more smoothly.

Gisher wrote:

Does anyone know what she is talking about at the start of the article?

"Lately there’s been a bit of a discussion about a rather shamefully sexist and childish book prominently displayed in a major PDF RPG store."

[rant]I hate it when people make this kind of reference without an explanation or a link.[/rant]

I guess it's about the...*Sigh*...Tournament of Rapists PDF, an add-on for d20 (with Pathfinder in mind) that is actually more awful than the title suggests. RPG Drive Thru had it up for sale, and has been...lackluster in how they've responded to criticism about the game and how, essentially, the thing shouldn't even be sold.

Well that seems horrible. But thanks for letting me know.

Oh, JG, what you said was what I'm thinking of—I just got the store wrong.

So a third party publisher makes something awful that's compatible with something good.
And....?
....
....
...
..
.
Nothing.

You're going to have stuff like this pop up time to time.
Heck, consider what fan-art and fanfiction is generated from popular culture.
You can't control the bad things that other people do.

As to how Pathfinder handles mental illness and insanity... Pathfinder handles mental illness?
Honestly, I'm glad they don't.
I play this game to ESCAPE my mental problems.
I don't really need to have some hyper realistic representation of what I go through day to day imbedded in what I do for fun.

And before anyone asks: Clinical Depression, with a small side order of Attention Deficit Disorder, all professionally evaluated and diagnosed. I've been suicidal since I was 8; by now my suicidal tendencies can legally drink.
And a number of my players (at least in my Thursday group) have some degree of autism. At least one has full Aspergers. It's all good. This is how we socialize.

So a third party publisher makes something awful that's compatible with something good.

And....?
....
....
...
..
.

Did you read the The article is not concerned with that one fact. As the beginning of the article states, it's just the catalyst.

This got me thinking about some of the other shameful attitudes still alive and well in the industry, and I think it’s time we had a serious talk about Insanity Tables.

Thing there is that Insanity Tables are meant for specific creatures and happenstances that drive a person magically insane in a heartbeat.
Insanities that come about the "natural" way are factored directly into the stat block.
Now, what happens when I come face to face with a Great Old One and my mind stumbles in the shock of things that cannot be?
Will save.
I go insane.
What insanity possesses me when I stare at the eldritch horror from beyond the stars?
And while that table is on the PRD, it isn't in the DMG proper; they say to just pick one.

It takes a PhD just to BEGIN diagnosing someone of a mental disorder.
Even then, assessing mental health, and treating it, is less of a structured program and more trial and error.
Now, can you *really* expect for every mental health issue to be finely crafted to the point where it fits into the rules perfectly?
Here's a hint: you can't.

I've never met two people with Depression (and if you talk about having it, you'll find a lot of other people have it too) that have quite the same problems, who handle it quite the same way, and who are treated quite the same manner.
Now boil my mental disorder down to a perfect stat condition, one that fits MY Depression, my sister's Depression (which is different than mine), and my mother's (which is different yet again) all at the same time.
There's no perfect solution for stating a mental disorder.

And what about treating mental health?
In Pathfinder I can regrow a missing limb, overcome illness instantaneously, and even come back from the dead.
Introducing complex mental health disorders into a game where Heal pretty much fixes everything would mean that we'd trivialize them.
"Depression's not such a big deal. It can be fixed easily enough with Remove Disease"
Meanwhile I choke down another handful of pills just to keep my head on strait.

Mental health issues are best left out of the game, or if they are used, should be strictly role-play.
I'd rather NOT see my mental state become a game for people who THINK they have a clue what goes on inside my head.

If you have analysis or criticism of the material being discussed in this thread, please frame it constructively.

I have no issues with the rules written there specifically , but i do dislike things like it in general. It is always a very touchy subject to drastically change a PC like that.

Sometime in the ‘80s, if not the ‘70s, someone was working on a rulebook for an RPG, and decided that if there’s rules for everything else, there should really be rules for going insane. So this person sat down, and either looked up, or more likely just went off the cuff, describing every mental illness they could think of, with the accuracy of someone who clearly has no formal education in the field. This person then added a list of die ranges to the side, and stuck it in their book.

Odds are better than average that this book was some D&D supplement, but whatever the source, it was popular enough to quickly spread to more or less every RPG out there, largely unchanged, and usually stuck in the core rulebook under a heading simply reading “Insanity,” or possibly “Sanity.”

Historically incorrect and looking for windmills to tilt.

RPGs have a hamfisted way of looking at most real issues, although generally physical trauma is handwaved for ease of play since going into shock/infection/etc rules for every stab and poke would bog things down to the point where things were unplayable (for most people.)

Mental health issues are entirely different, especially due to the way they affect real life people. Really, there's no perfect implementation of them in an rpg due to (as stated earlier) the constant shifts in perception and awareness of mental issues. To be fair, medical illness is similar to physical illness in this respect (that respect being that awareness/treatment/etc advances at an incredible pace), but we're not trying to mirror physical health with a lot of things except for large abstractions, like how mental illness is treated.

Really, I'd remove the mental illness/sanity section from general games, leaving it to games that have a bit more time to dedicate to treating them more respectfully. I mean some games need a sanity mechanic, and sure in 10 years it'll seem terribly ableist since mental illness as a game mechanic is clunky at best, but I don't think it should be thrown into most games as a mechanic, at least without a lot of consideration due to how mental illness is viewed now.

While I do agree that “something traumatic happened, roll to see how crazy you go.” is in no way a good representation of real mental illness, I do think the random-crazy-tables have a place, for events like Cthulhu and such.

EDIT: The tables referred to in Pathfinder isn't even, I would say, an attempt at "real" mental illness. The few conditions given are some very extreme and only occure when you've reached a mental score of 0 in either of the three. Reaching a 0 isn't just "traumatic happened". When you reach 0, something have scrambled your brain.

Speaking as someone who has taken anti-anxiety medication every day since middle school, and who continues to struggle with clinical OCD;

"Insanity" is often used as a plot device, especially in the kind of pulp fiction Pathfinder likes to draw from. Rarely does it resemble any sort of clinical mental illness. I personally don't have a problem with any sort of "sanity" system in any RPG. The only issue I'd have is if the system were calling itself "realistic" or otherwise attempting to claim it's an accurate representation of any condition. Obviously opinions differ, and I can definitely understand taking offense to inaccurate portrayals of such personal things.

If you want to see mental illness (and its associating implications) done RIGHT in a fantasy setting (geared towards rpgs), look no further than Darkest Dungeon. A video game that finally asks the question "Hey, adventurers see some pretty f&%!ed up s*&*. Shouldn't they have like...PTSD or something?

Anyone played Changeling:the Lost? Any thoughts on how they handle this kind of thing? Part of the basic premise is that each PC has to learn how to deal with being horribly mistreated.

Anyone played Changeling:the Lost? Any thoughts on how they handle this kind of thing? Part of the basic premise is that each PC has to learn how to deal with being horribly mistreated.

I think changeling: the lost is an interesting example, since the lead designer of it's second edition made sure that 2e new world of darkness had it's insanity rules changed so that it wasn't "do something evil, become insane" anymore.

But he also made the impact of your characters main last with you more, since how you escape gives you different triggers that harm your will and had it so that Huntsmen are now bringing up your past.... in a violent manner.

Poorly Researched Tumblr Rant wrote:

Sometime in the ‘80s, if not the ‘70s, someone was working on a rulebook for an RPG, and decided that if there’s rules for everything else, there should really be rules for going insane. So this person sat down, and either looked up, or more likely just went off the cuff, describing every mental illness they could think of, with the accuracy of someone who clearly has no formal education in the field. This person then added a list of die ranges to the side, and stuck it in their book.

Odds are better than average that this book was some D&D supplement, but whatever the source, it was popular enough to quickly spread to more or less every RPG out there, largely unchanged, and usually stuck in the core rulebook under a heading simply reading “Insanity,” or possibly “Sanity.”

Historically incorrect and looking for windmills to tilt.

Painful read.

Could you clarify? The practice of "insanity tables" is a common one in RPGs. Do you know the actual source?

If you want to see mental illness (and its associating implications) done RIGHT in a fantasy setting (geared towards rpgs), look no further than Darkest Dungeon. A video game that finally asks the question "Hey, adventurers see some pretty f#+$ed up s~~#. Shouldn't they have like...PTSD or something?

I'm actually working on a series of stories based on that same premise. I'll have to check Darkest Dungeon out.

Auxmaulous wrote:

Poorly Researched Tumblr Rant wrote:

Sometime in the ‘80s, if not the ‘70s, someone was working on a rulebook for an RPG, and decided that if there’s rules for everything else, there should really be rules for going insane. So this person sat down, and either looked up, or more likely just went off the cuff, describing every mental illness they could think of, with the accuracy of someone who clearly has no formal education in the field. This person then added a list of die ranges to the side, and stuck it in their book.

Odds are better than average that this book was some D&D supplement, but whatever the source, it was popular enough to quickly spread to more or less every RPG out there, largely unchanged, and usually stuck in the core rulebook under a heading simply reading “Insanity,” or possibly “Sanity.”

Historically incorrect and looking for windmills to tilt.

Painful read.

Could you clarify? The practice of "insanity tables" is a common one in RPGs. Do you know the actual source?

Odds are better than average that this book was some D&D supplement. The 70's-80's book refers she refers to is the 1st ed DMG.

...quickly spread to more or less every RPG out there, largely unchanged
The only other major contemporary game (circa 81) that had a large list of a variety of insanity for characters was Call of Cthulhu - which had rules for indefinite insanity and phobias related to or derived from the source that caused the insanity. It wasn't a random list, the phobias were researched and for an early era in gaming, were executed well in implementation (as compared to the 1st ed DMG).

My big gripes with this poorly written and researched tumblr entry (not worthy of being called an article):
1st ed DMG Insanity list - not ported over to CoC (fact)...
-or-
If the two big games of the times were "not really the games I was talking about" in the article, then list the actual games/editions you are referencing so they can be fact checked..
-or-
If you don't really know what you are talking about, don't make falsehoods in an effort to start up something to get attention from others on the internet.

I stand by my initial assessment - poorly written and researched.

My problem with just about any D&Desque sanity or insanity rules is this:

Insanity can also be caused by exposure to particularly potent sources of unhinging horror, madness, or alien natures, such that the mind simply cannot withstand them.

In a world like Golarion where there are actual rifts open between the lower planes and the surface world, and where seeing an octopus swinging from tree branch to tree branch before it sucks on your face, can be described as "uncommon" but not unheard of, how do you define unhinging horror? I mean vampires and liches are things that your average townsperson will have at least heard about. And these rules are for the PCs primarily. We're talking about a group of people who would have no trouble running into an an earless cat that can peel back the skin over it's own skull while emitting a bloodcurdling scream, and that's pretty "normal."

So my problem with the Pathfinder sanity/insanity rules is not that they make a mockery of real mental illness. It's that they have them at all. The life of an adventurer is chock full of entire months where the most normal thing that happens is you get attacked by short reptilian humanoids.

While I may joke in character about adventurers having Post Traumatic Statue Disorder, (the need for an adventurer to smash and destroy any statuary or Topiary they come across because they are afraid it will animate and attack them), I simply mean this as a bit of humor and I hope I have not offended anyone.

I find ironically the more rules and definitions you write to "handle" a situation, the less you can find you can do with your character and as a GM your game.

For example:

I have an Indianna Jones character who for a while was using his whip and the "improved Disarm" trait to both disarm people, and disarm a cleric holding forth his holy symbol.

I was eventually told no I needed Improved steal......ok I got the feat.

Perhaps that was a poor example.

Anyways, I think some things are best left undefined. Not everything needs rules to "clarify" everything.

I for one would not really want to see a detailed wall of text telling me how to handle mental illnesses. As others have said up thread this is a game.

With out insanity rules, you really couldn't have Call of Cthulu.

Honestly, I think it's okay for pathfinder to contain offensive material.

The APs in particular contains heaps upon heaps of offensive material. Insane mothers who lost their children? Check. Beastiality? Check. Children born physically deformed, and cast out of society at birth? Check. Further, most of the named villians are at least in part motivated by sexual or amorous desires.
(T is, in theory, in a relationship with N, although she's more interested in her business. O is attracted to L, who's more into T, and is heavily implied to be working on a magical rape drug for him to boot. WR pretends to want N too. Meanwhile, B is mostly interested in his prostitutes.)

This is all off the top of my head, and contained within the first book of the first AP, mind you.

Other APs bring us such gems as a tribe of primitive humanoids kept in habitats for study by a more advaced race, suicide, self-harm, and homosexuals.

All of this is steeped in a long, continuous, unbroken line of bloody and inventive murders, commited by the 'heroes' and foes alike.

They've managed to stay clear of pedophelia and killing children(on-camera, at least), although the first book of RotR did contain a 'how to put goblin babies in this scene for moral conundrum' sidebar.

These things are all insanely offensive. Not all of them to all people, but all of them to some people. So why's your offendedness special? I don't suppose you'd like paizo to write the homosexuals out of the APs? Because that's what you get down at the end of that slippery slope you're walking on right now.

My take on it is that if someone made uncomfortable by some of the material in pathfinder, it should just be avoided in their gaming group. No reason to censor it for all the rest of the people.

Snip

You're attacking a strawman.

It's not "we are offended and insanity shouldn't exist in games" it's "these insanity mechanics don't actually reflect insanity in any way at all". No one has said "having insanity in Pathfinder is offensive."

You're attacking a strawman.

It's not "we are offended and insanity shouldn't exist in games" it's "these insanity mechanics don't actually reflect insanity in any way at all".

As far as I can see it went like this:

"Insanity mechanics are not accurate."

"Mechanics for being stabbed with a sword aren't either."

"Insanity rules are more offensive, because they're insanity rules."

And then my reply to that was "I don't think you being offended is enough to merit a change."

So yes, taken as a reply to the OP, it would have been a strawman. I did not mean to reply directly to the OP, however.

These things are all insanely offensive. Not all of them to all people, but all of them to some people. So why's your offendedness special? I don't suppose you'd like paizo to write the homosexuals out of the APs? Because that's what you get down at the end of that slippery slope you're walking on right now.

My take on it is that if someone made uncomfortable by some of the material in pathfinder, it should just be avoided in their gaming group. No reason to censor it for all the rest of the people.

Two things here:

1) Some people DO ask for them to remove all mentions and leanings of non heterosexuality from the game, so yeah.

2) You're comparing a rather progressive view of how Paizo has shown treatment towards the LGBT community towards the archaic way most modern RPGs treat mental illness? Also further, you're comparing mental illness to homosexuality?

The comparison here is so far off base that it's almost not even related. LGBT characters need more representation to normalize them, we need a larger amount that aren't stereotypes, and Paizo's done aces on that. The mental illness rules aren't representing anyone and come off as ableist, the neurotypical view of how mental illness would work from a hollywood perspective.

Rules for insanity? I'm pretty sure they just cribbed those from 3.5 (I don't blame them, that's where a lot of things came from), and those were...passable at the point that was published. As many have said before, the idea of randomly rolling on a table for what mental illness you now have is laughable, the causes of said mental illnesses is oddly specific compared to what other games would have (CoC you see a dead body and there's a sanity check, PF you see a dead body and you check to see if its boots of haste are in your size), making including them obtuse at best.

As I stated earlier, if a game treats the topic respectfully and researches it, I don't have a problem with them being included. Will they be dated rather quickly? Of course, mental illness research moves incredibly quickly, and I remembered looking back at Unearthed Arcana's sanity rules thinking "What were these jokers thinking?" until I realized the time frame it was being placed into for reference.

This isn't about offendedness being special, it's about a consideration for others, and it's also about business. ToR isn't what the majority of the customers wanted due to it's material being abhorrent to almost everyone, and the question being posited here coincides with that, asking "do you as a consumer care about the level of detail being given to mental illness in RPGs?" More and more people are becoming aware of issues beyond themselves, and so these people are scrutinizing things they previously hand waived, and that's leading to conversations like this, which I think is a good thing.

I feel more people getting angry about actually having to consider others than the treatment that other people have had to endure because of the lack of awareness on issues like this, and really that's just selfish and sad.

1) Well, their offendedness shouldn't be considered either, is what I'm getting at.

2) I'm comparing the two in one aspect only: Their prescence, and how they're portrayed, offend certain people.

I'm not saying that they're alike in any other ways than in that specific aspect. They are, however, alike in that specific aspect, only.

This is what I'm saying. I'm not saying that any of the other stuff has anything in common, either.

This whole thing is insane.

1) Well, their offendedness shouldn't be considered either, is what I'm getting at.

2) I'm comparing the two in one aspect only: Their prescence, and how they're portrayed, offend certain people.

I'm not saying that they're alike in any other ways than in that specific aspect. They are, however, alike in that specific aspect, only.

This is what I'm saying. I'm not saying that any of the other stuff has anything in common, either.

1) You're completely ignoring the reasons why the two would be found offensive. People who only want heterosexuals are doing it due to a fear and discomfort they experience due to people being different than them due to deep seeded bigotry. People who don't want mental illness portrayed in games are more likely because they understand the gamut that mental illness can run, and realize that such a complex issue can't be boiled down into a random table and chart without being horribly misrepresented.

2) Your comparison was inane. People are offended when they are represented in a way that lacks respect for who they are, hurtful stereotypes and such that only further ignorance. You could pick almost anything to make that comparison, so there wasn't any point to it. Not to mention how TERRIBLY offensive it is to compare mental illness to homosexuality especially with your lack of qualification to your comparison, like just wow.

GM Runescarred Dragon wrote:

1) Well, their offendedness shouldn't be considered either, is what I'm getting at.

2) I'm comparing the two in one aspect only: Their prescence, and how they're portrayed, offend certain people.

I'm not saying that they're alike in any other ways than in that specific aspect. They are, however, alike in that specific aspect, only.

This is what I'm saying. I'm not saying that any of the other stuff has anything in common, either.

1) You're completely ignoring the reasons why the two would be found offensive. People who only want heterosexuals are doing it due to a fear and discomfort they experience due to people being different than them due to deep seeded bigotry. People who don't want mental illness portrayed in games are more likely because they understand the gamut that mental illness can run, and realize that such a complex issue can't be boiled down into a random table and chart without being horribly misrepresented.

2) Your comparison was inane. People are offended when they are represented in a way that lacks respect for who they are, hurtful stereotypes and such that only further ignorance. You could pick almost anything to make that comparison, so there wasn't any point to it. Not to mention how TERRIBLY offensive it is to compare mental illness to homosexuality especially with your lack of qualification to your comparison, like just wow.

1) However, it is not your job to decide whether someones feelings are valid. Anyway, I still don't see how someone being offended is grounds for change. Someone being hurt, I could see that. Still, I contend the point that in-game illnesses are in anyway representative of OOC ilnesses.

2) You're once again supposing I said or implied that homosexuality is a mental ilness. I'm not, and I did not. That'd be crazy. However, I am saying that some people are offended by homosexuals. And their feelings must be considered too, even if it's just to decide 'nah, I like homosexuals, let's put them in the story anyway.' or 'Bigger parts of my customer base is progressive, we'll get more money if we throw them in.'

Anyway, personal story time: I'm diagnosed with a mental illness. Once, one of my good friends, who was not aware of this, made a joke about people with my mental illness. That hurt, a lot, not gonna lie. However, and this is important, he was not intending to hurt me. There's a big difference between people wanting to be mean, and people hurting you by accident. This guy doesn't make that kind of joke anymore, for example. The point, however, is that I was able to be hurt by him, because I'd invested in our relationship. People being hurt is important. People being offended is really not. And I don't think this existing within the rule book of pathfinder will hurt people. I'm certainly not getting hurt by it. I've even used those very rules for a couple of games. So long as it isn't played as 'Look, my character is insane! He so crazy LOL!' (which is hurtful and somewhat mean), why should I care what rules are being used? It's a fantasy world, after all, not even remotely intended to depict reality. Further, expecting random people, such as game designers, to be intimately familiar with mental diseases is silly. I certainly don't expect people who aren't either doctors or relatives to someone with Asperger's Syndrome to be familiar with it - that's like, at least 5 hours of study per relatively common mental disease for everyone. That's completely unreasonable.

Keep in mind that insanity as represented in the game is meant as a condition to be applied to a wargaming combat scenarion, not meant as simulation, any more than the game's economic systems are supposed to model real life or historical economies.

The basic rules of the game are about combat and effects such as insanity/confusion etc., which apply to a wargaming figure to change it's ability to wage combat. THAT'S ALL. It's not about roleplaying insanity, which when it does happen in the game will generally refer to a story condition which frequently will not map to a spell or class effect.

This feels like a non-issue

Keep in mind that insanity as represented in the game is meant as a condition to be applied to a wargaming combat scenarion, not meant as simulation, any more than the game's economic systems are supposed to model real life or historical economies.

The basic rules of the game are about combat and effects such as insanity/confusion etc., which apply to a wargaming figure to change it's ability to wage combat. THAT'S ALL. It's not about roleplaying insanity, which when it does happen in the game will generally refer to a story condition which frequently will not map to a spell or class effect.

Which is another reason I don't think they should even exist. In this game there are enough conditions to worry about, I don't want to have to worry about a character's mental state beyond what's already there: confused, frightened, dazzled, etc. Adding in these mechanics seems arbitrary and pointless, to fill some niche that some people might want in their game, but from my anecdotal evidence, the majority of players couldn't care less about. Granted there are other RPGs where insanity rules make a lot of sense. Cthulu for one, but in Pathfinder, and in its big brother D&D, insanity rules seem like a poorly thought out addendum designed specifically to not abandon some small segment of the gaming population.

I'd like to briefly interrupt this flamewar.

While I can sort of understand why people are bringing in other social issues to this discussion to attempt to compare or contrast, or make a point, i think it's sort of destroyed this well-intentioned thread. I also occasionally make this mistake and understand how this happened, but I think it has lead posters to become rather emotional and become insulted by real or perceived accusations of anti-homosexual bigotry. Reading most of these posts I believe the posters in this thread are all supportive of the homosexual community, and have been misinterpreted.

I respectfully recommend that, while discussing an issue you may disagree on (how mental illness is portrayed in games), you don't make contentious an issue you already agree upon (supporting sexual orientation/gender/identity rights).

I'd like to briefly interrupt this flamewar.

While I can sort of understand why people are bringing in other social issues to this discussion to attempt to compare or contrast, or make a point, i think it's sort of destroyed this well-intentioned thread. I also occasionally make this mistake and understand how this happened, but I think it has lead posters to become rather emotional and become insulted by real or perceived accusations of anti-homosexual bigotry. Reading most of these posts I believe the posters in this thread are all supportive of the homosexual community, and have been misinterpreted.

I respectfully recommend that, while discussing an issue you may disagree on (how mental illness is portrayed in games), you don't make contentious an issue you already agree upon (supporting sexual orientation/gender/identity rights).

Agreed. Imagine how reactions would be, were someone to compare mental disorders with, say, Jewishness, or skin colour. It's *that* iffy.

There are no official rules in PF, as far as I know, for losing an arm. Why not? Because, at the end of the day, it is something you don't want to put a character into, at least not in a non-storytelling way. It hampers the character too far to be an interesting handicap, and anyway, you can always choose to remove someone's arm because plot. Rules NOT NEEDED.

By the same token, insanity. Mental illness is a step too far for someone to function. Mild versions, sure - but put that to use through plot and roleplaying considerations, not rules. If someone gets schizophrenia, well, that's pretty much it for his adventuring career. Even Vampire the Masquerade put in Dementation as a "lost art" for Malkavians, who also typically spent their time beating themselves over the head with a fish.

IF we still get mental illnesses in the rules of the game... I actually PREFER it if they are stupid, wonky, cinematic and have nothing to do with real ones. That way, nobody has to think that is how they really work.

There are no official rules in PF, as far as I know, for losing an arm. Why not? Because, at the end of the day, it is something you don't want to put a character into, at least not in a non-storytelling way. It hampers the character too far to be an interesting handicap, and anyway, you can always choose to remove someone's arm because plot. Rules NOT NEEDED.

By the same token, insanity. Mental illness is a step too far for someone to function. Mild versions, sure - but put that to use through plot and roleplaying considerations, not rules. If someone gets schizophrenia, well, that's pretty much it for his adventuring career. Even Vampire the Masquerade put in Dementation as a "lost art" for Malkavians, who also typically spent their time beating themselves over the head with a fish.

IF we still get mental illnesses in the rules of the game... I actually PREFER it if they are stupid, wonky, cinematic and have nothing to do with real ones. That way, nobody has to think that is how they really work.

Skull and Shackles Player's GUide has alternate massive damage rules for disfiguring and mauling players.

Aso, the Grendel (a Mythic beast in Bestiary 4) rips your arms off and bats you with them. Fun stuff.

Pirates, sure. Add rules for it. As you say, it is the norm.

And then there was the grendel, a mythic monster. Yeah.

Pirates, sure. Add rules for it. As you say, it is the norm.

And then there was the grendel, a mythic monster. Yeah.

Just mentioning that such rules *DO* exist.

All rules in an RPG are optional. Some are just more optional than others.

Likewise, there are rules for losing an arm. Wielding a two-handed weapon requires the use of two hands, so you would not be able to utilize those weapons. I'd also give a situational penalty to certain skill checks (Climb, Disable Device, and Swim immediately come to mind), but that's a GM call.

Personally, I'm as ok with the way insanities are handled in Pathfinder as I am the way that diseases, wounds, and morality via alignment are handled - it's intended to be a huge abstraction and I don't find their insanity table any less realistic than a 3 foot tall halfling monk deflecting a bullet with their bare hands every 6 seconds.

About the ICD, you need to understand that there is a basic criterion that needs to be met before ANYTHING becomes a diagnosis: It must lead to suffering for the patient or others. Read that again. There are exceptions, mostly diagnoses that describe actions taken, such as a doctor writing a certificate that someone qualifies health-wise for getting a driver's license.

Thus, someone who suffered for being homosexual for some reason could conceivably seek help for it. Whether a cure is possible doesn't factor into diagnosis-hood. Similarly, someone who can only enjoy sex with green plastic shovels involved (fetishism) could go to the medical community for help. If there is no diagnosis, health care can't do much about it. A recurring problem in this is that pregnant women have a difficult time getting sick leave, because pregnancy is a part of the human lifecycle and does not have a diagnosis.

In the end, and with a greater understanding of human sexuality, homosexuality as a diagnosis was dropped, which was good. That doesn't mean the original reasoning was hateful or even wrong.

*Pokes head out of hiding spot*
We good here? Things going okay?

Okay. I'm short on time (did I mention NaNoWriMo already?), but I will say this much:

Tabletop RPGs aren't just a game.

They're also a media form. And, therefore, an art form. People who design mechanics are practicing a form of media and making deliberate choices. The same is true for video games, of course. That's why, say, racist first-person shooter video games have the potential to be problematic—yes, these games are "just for fun", but they're also media, and media carries influence—and tells people who is and isn't welcome within that mediasphere.

Often when watching murder mystery TV shows (mainly Midsomer Murders and Psych of late, though I'm proud of neither), I see "they were CRAZY" used as a motivation. "The killer was CRAZY" is the "My ex-girlfriend was CRAZY" of murder mystery resolutions—it's lazy, meaningless, and probably representative of some sort of problem we have in our society.

See, these mysteries don't have the killer be "CRAZY" because they want to explore the complex motivations of someone dealing with severe mental illness. They don't want to consider what problems (abuse by the murder victim, losing access to medication at the wrong time, etc) drove the person to this heinous act—that they were "CRAZY" is enough. This perpetuates two major ideas: Not only that mentally ill people are inherently violent, which is of course false but carries a lot of weight with a lot of people, but that mentally ill people who are violent are violent solely because their illness made them "CRAZY", and not because they've been driven to this act by a combination of difficult factors like any other ordinary human being.

Because this depiction in media perpetuates the idea that mentally ill people aren't like "any other ordinary human being". They aren't just people struggling with a problem they need help dealing with—they're something Other. Something that giggles and sings nursery rhymes and laughs weird. Something that might even be better off dead.

Yeah, murder mystery TV shows, I've had it up to here with all of you. For a lot of reasons, come to think of it. Why do I watch these shows, again?

Anyways, why am I talking about this? Because I want to drive home why I think inaccurate representation matters. I would much rather RPGs not try at all, or give brief summaries of these illnesses (Bipolar Disorder: "a mental disorder marked by alternating periods of elation and depression." Like that. Was that so hard?) than be "stupid, wonky and cinematic" in a way that is very easy and pleasant for people without mental disorders while helping to perpetuate stereotypes like those discussed above. There's nothing wrong with a Pathfinder book (like, oh, say, Horror Adventures which oh my god I am so psyched for) giving roleplaying tips on playing someone struggling with something as scary to deal with as a mental disorder. Pathfinder could do some real good, even.

Either do it right or don't do it. It's not "just a game", "just a book", or "just a movie". It's all still media. And all media, including, believe it or not, tabletop RPGs, does carry influence.

This is not something we should brush off as "a non-issue", or "looking for windmills". This is something that needs to be carefully discussed. And I am gratified that the majority of people here posting posts with any thought invested in them (i.e. posts larger than one sentence/one sentence missing any capitalization or punctuation) have been attempting to contribute to just such a discussion.

Carry on, all. This took about a half-hour longer to write than the one minute I had planned to put in. Whoops.

This fairly accurately describes my feelings on the matter. I don't want realistic portrayals of mental illness in my fantasy games, I live with that every. single. day. The mere idea that you can accurately portray the real effects of mental illness through TTRPG mechanics is ridiculous, and honestly more offensive than any "roll for schizophrenia" table I've ever seen.
I'll take my fantasy mental illnesses abstract and easily curable with a simple spell, because I wish it was that easy in real life.

In Golarion, you can restore a lost limb with a simple spell. There's a dream for my buddies who left pieces behind in Iraq. A woman born into a man's body can chug a potion, put on a belt, or take an herbal supplement and *poof* they've got the body they always knew they belonged in. Wracked with age? There's a cure for that! Scared of death and afraid of what comes next? In Golarion the gods are real, most everyone knows it, and miracles are performed on a daily basis.

I want, I crave, nice, simple, abstract mechanics, because my fantasy hero alter ego shouldn't have to deal with the things I deal with. Part of why I play is because the game lets me spend some time in a world where problems are straightforward and have simple, known solutions that I can achieve.
I already live in a world where mental illness is nuanced, pervasive, and can generally only be managed, never cured. I don't want that being shoved on me in my fantasy roleplaying game through some misguided attempt to be more PC.