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A digital artwork with slices of five images arranged in a fan. From left to right they are: a photograph of a character sheet with blue dice and a green pencil, The International Symbol of Access (a blue background with a white stylized image of a person in a wheelchair), a chaotic pile of dice in many colors and styles, splattered rainbow paints with a black and white drawing of a brain on top, and miniature houses with figurines of people in action poses.

A digital artwork with slices of five images arranged in a fan. From left to right they are: a photograph of a character sheet with blue dice and a green pencil, The International Symbol of Access (a blue background with a white stylized image of a person in a wheelchair), a chaotic pile of dice in many colors and styles, splattered rainbow paints with a black and white drawing of a brain on top, and miniature houses with figurines of people in action poses.

 

What It Is

There are a number of cosmic horror tabletop role-playing games based on the Cthulhu Mythos that was originated by H. P. Lovecraft in the twenties and thirties (list of fiction in chronological order). This mythos has been picked up and continued by others.

Deeply rooted in this mythos is the idea that exposure to horrible things causes “insanity.” This idea is founded on incorrect and stigmatizing ideas of mental illness that were common at the time. Cosmic horror games like Call of Cthulhu are set within the Cthulhu Mythos and incorporate the concepts of “sanity” and “insanity” into game play as a sort of mental hit point system. Each character has a number of sanity points. When a character experiences terrible things they loose sanity points, causing various forms of “insanity.”

 

Why It’s a Problem

The concept of insanity is a stigmatizing historic concept that has been largely replaced by the more accurate concepts of mental illness and neurodivergence. Insanity is connected to a violent history of treating people with disabilities as less than human, including institutionalization, unethical experimentation, and forced sterilization. It lumps all types of mental divergence into a stereotype about people with divergent minds being dangerous, out of control, and disconnected from reality. This concept is so stigmatizing, outdated, and inaccurate that the medical establishment has long since left it behind. Tying a core game mechanic to the concept of “insanity,” and its opposite, “sanity,” gives this stigmatizing concept power that reinforces harmful stereotypes.

Game mechanics that randomly give characters mental illnesses, or that push players into depicting neurdivergence without giving them time to prepare, also cause problems. In order to respectfully portray a specific metal illness or neurodivergence, a person needs to either research it or have personal experience with it. Not every player who lacks personal experience with a particular condition is going to have the time or energy to do this research. That is why any game mechanic that automatically gives a character who failed a certain roll a mental illness (random or not) causes problems; it encourages players to portray mental illnesses even when they don’t know enough to do a respectful portrayal.

I want to be clear that it isn’t inherently bad to portray mentally ill or neurodivergent characters, but portrayals should be respectful and grounded in reality, rather than stereotypes.

 

Options for Addressing It

This is a list of different actions that can be taken to address the ableism inherent in sanity systems. Some of them are mutually exclusive, but many of them can be combined. The purpose of this list is to propose a range of options that can serve as a starting point for people to find the solution that works for them.

  • Shift language away from stigmatizing words like “sanity” and “insanity.” Instead of loosing “sanity,” a character can loose their “resiliency,” their “coping ability,” or their “cool.”
  • Switch over to a stress mechanic. Stress is a universal human experience that does not involve role-playing members of an oppressed group. The fight, flight, or freeze response is a great basis for creating appropriate in-the-moment stress responses. Long-term consequences can be chosen based on the specific situation.
  • Give players more control over the long-term mental consequences that their characters experience, especially if the options include mental conditions. This makes it easier for players to respectfully portray mental diversity.
  • Remove neurodiversity from the game mechanics. Instead, leave it to players to decide whether their character is neurodiverse and, if so, how they want to respectfully role-play that.
  • Conditions can be used as alternative short and long term consequences. Possible conditions are “shaken,” “jumpy,” “afraid,” “panicked,” “fatigued,” “exhausted,” “upset,” “angry,” “sad,” “desperate,” “hopeless,” and “frozen.”
  • Instead of eroding a character’s mind, erode their convictions, ethics, or core beliefs. This is an alternative way to lean into the horror theme that focuses on eroding the core of who the character is.
  • Use magical story elements to create fantastical and mind-altering effects. Having a character’s perceptions of reality and ability to function be affected by in-game experiences can add an important element that enhances the horror of a game. For those who want to take this to extremes, embracing the magical story elements of the story can provide an avenue for exploring strange and extreme experiences while avoiding stigmatizing mental diversity.
  • Make specific mechanics for each type of neurodiversity you want to include in game play. Some players feel that having in-game rules for portraying the neurodiversity of their characters makes it feel more real. In these cases, the best option is making up specific rules for each type of mental diversity. An example of how this can be done can be found in sleepyspoonie’s article on “D&D Disability Mechanics.”
  • Additional resources: This article takes a lot of inspiration from Episode 127 of the Mythcreants podcast, “Mental Health Systems in Roleplaying Games.” I definitely recommend it!

Experiences of neurodiversity and disability vary a lot. There is no one right way to address these things. If you have an alternative method to address this, please share it in the comments.

 

This is the first article in the Addressing Ableism in Tabletop Role-Playing Games series.

 

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[…] What I recommend is changing these mechanics so that each player gets to choose whether or not their character becomes disabled. If the player decides to give their character a disability, they should have a say in what that disability is. In addition, when a character suddenly gets a disability, a short break can be provided to give the player time to do a bit of initial research on how to respectfully portray that disability. For those players who aren’t up to portraying a disabled character, alternative long-term affects can be created. These can be things like injuries that… Read more »