Personal Plot Seeds — Roleplaying and Mental Illness

Here is a handful of plot seeds for use when involving mental illness in a roleplaying game. Since I happen to believe that mental illness is often best used as a personal plot (which might be seen more as a “side plot” than an “adventure”), that’s the kind of thing you’ll largely find here.

There are two things you’ll want to do before throwing any of these plots into your game. First, create any relevant mentally ill NPC(s) in advance. Putting a few minutes of thought into such characters helps to avoid bad stereotypes. Second, do five minutes of research on your chosen disorder before putting it into a game.

Standard Disclaimer: If any of this offends you then please read this article to get a better idea of where this is all coming from.

The Frightening

Mental illness scares people. Deep down they worry that maybe they could end up like that some day, or a loved one could. After all, very little is known about the many causes of mental illness. It can crop up at any time in a person’s life–people who have led normal lives for 60 years can suddenly develop depression problems.

The unknown and the irrational also scare people. When someone says something weird to you, how do you respond? When someone says something bizarre, do you feel embarrassed? Scared? Do you wonder what the person might do to you?

Danger in the Darkness

#1. The Appearance of Danger

Play off of people’s fears. Prepare a non-player character (NPC) with one of the more disturbing mental illnesses, one of the ones that causes a strong break with reality. You might use the ever-popular Schizophrenia. But because you clicked on that link right there and read up on the actual diagnostic criteria (go ahead–it only takes five minutes), your portrayal won’t be stereotyped and silly, and you won’t mistake it for multiple personality disorder, which is something else entirely. (Really. Trust me on this.)

Let the NPC frighten the party. Let them see him at his worst, when he makes little sense and probably can’t communicate well. Let them assume the worst. Scare them! Then turn it around; let them see him when he isn’t at his worst. Get him treated or medicated and see how that changes the party’s view of him. Or if the party freaks out and they kill, harm, or incarcerate the character, have them meet up with someone who cared for the man–a friend or family member who has known him in his lucid moments.

#2. Fun with Delusions
Delusions can certainly make life interesting. Check out a few of the more common types (delusions of grandeur? Delusions of persecution? Delusions of poverty?) and see if any of them jog your muse. Try not to play them for laughs; remember that these are things that tear people’s lives apart. You don’t have to be a raving loon in order to be delusional. Let the party see that an otherwise normal person with a semi-normal life can have some very strange ideas about the reality around them. Show them that the line between sanity and insanity can be very thin indeed.

Too Close to Home

#3. A Relative or Friend

Go ahead and pick a relative or friend of one of the player characters (PCs) who will develop a mental disorder during the course of the game. First pick a mental disorder. Then make a list of mild symptoms the NPC could experience, little things that the PCs probably won’t recognize as symptoms. Go ahead and work those into the game gradually.

When you need a quick plot, trigger the worst symptoms. Have the NPC’s problems develop into a full-blown disorder and watch the PCs scramble to figure out what’s going on. If you’re really lucky they’ll assume there’s some outside force at work trying to screw with them, and they’ll spend a lot of time being paranoid and searching for enemies they don’t have. A good possibility for this disorder might be Dementia. Check out the diagnostic criteria and the list of associated features and start out with the milder ones, throwing in the truly difficult ones only at the last minute.

#4. A Player Character
Even worse: a PC starts displaying symptoms of a mental illness! (You can pick an illness that you can drop in fairly suddenly, whenever you need to introduce a plot on short notice, or you can truly frighten the party by starting slow and building up gradually.) Some possibilities might be Delirium, Brief Psychotic Disorder, Acute Stress Disorder, or Panic Disorder.

Things to Think About:

  • Unless this is meant to be a short-term plot with some sort of mitigating treatment, or the player plans to retire his character from the game (what a dramatic way to remove a character from the game!), you need to pick a disorder appropriate to a PC. This avoids the problem of inadvertently making the PC impossible for the player to play.
  • Unless this is meant to be a very short-term plot with some sort of solution (and possibly even then), you should talk to the player first to make sure she’s okay with having her character’s head messed with.
  • If a player wishes her character to have a mental disorder as some sort of quirk, flaw, or disadvantage, then this might be one way to introduce it, if the player is okay with that. Have the player start out relatively normal, and then introduce the disorder when you hit an appropriate moment during the game.
  • Make sure you know whether the disorder has a treatment, how well the treatment is likely to work, and how the PCs might find (and find out about) the treatment.
  • As always, do those five minutes of research. Mental disorders are scary things to find yourself developing; they color your whole world and perceptions. Don’t undercut that by being silly or pandering to bad stereotypes. In particular, if you’re going to work with a PC having a mental illness, you might find it very useful to read a few case studies. That list of research resources linked to above suggests a book or two of case studies.

#5. Misunderstandings

If your game world involves hidden supernatural creatures and factions, then perhaps a mental illness might be temporarily mistaken for insight or secret knowledge. A person who raves about being attacked by vampires might be mistaken for a genuine victim by PCs who know that vampires do exist. How do they come to realize that the NPC is ill, not in on the great secret? What do they do about it?

#6. Fixations

Someone with a mental illness (perhaps erotomantic delusions, Separation Anxiety Disorder, or Dependent Personality Disorder) becomes fixated on a friend (or even a member) of the party. He doesn’t seem dangerous, but he starts to cause more and more problems. He insists on hanging around when things are about to get dangerous (or when there are things going on he shouldn’t know about). He pushes his way into anything that’s going on around the person he’s fixated on. What to do?

The Misleading

Because there’s a sense that a “crazy person” might say or do absolutely anything, people have a tendency to suspect them of nearby crimes. After all, when asked whether a “normal” person might have committed a crime, you’re likely to say, “of course not!” even if they did; you just can’t imagine someone like them doing such a thing. When asked the same thing of a crazy person, you’re likely to think, “well, maybe.” After all, who can say what a crazy person might do, right? Not exactly fair to the person with the mental illness, but certainly not surprising either.

Didn’t Do It

#7. Play Those Knee-Jerk Reactions

Place a mentally ill person near the scene of a crime; work her into the description and events. Let the PCs come to their own conclusions. Many groups will automatically suspect the person simply because of her mental illness. See whether they stop searching for the killer just because they’ve found what they consider to be a likely suspect. Make sure that with additional searching, it’s possible to find the real killer.

Variation: If the party is smart enough not to pigeonhole the ill person simply because of her disorder, then play a different game. The NPC has a clue, or saw the crime happen, but her description sounds a bit… disjointed. Do they listen to her, and eventually glean valuable information when new evidence makes her words clear? Or do they simply dismiss her out of hand?

#8. Let Someone Else Play Those Knee-Jerk Reactions
An antagonist deliberately commits a crime in a place where she knows a mentally ill person usually hangs out, hoping suspicion will naturally fall onto that person.


#9. Guilty as Charged
On this particular occasion, the mentally ill person did commit the crime. Why? “Because he’s crazy” is a cop-out; there has to have been some sort of reason, even if part of it was biochemical in nature or fit into his delusions. Make it something such that it’s obvious the person wasn’t entirely under his own control when he committed the crime. Is he guilty? Is he innocent? What sort of sentence does he receive? How can he be held responsible for his crimes? How can he get the treatment he needs?

Issues of guilt and mental illness are complex, and despite what you may have heard, no one has yet come up with a good answer. A successful insanity plea does lead to treatment, for a limited amount of time. A conviction leads to jails forced to deal with people who really need treatment someplace else–jails are not mental hospitals. Either option causes problems of its own. Only use this plot if your players can handle arguing over issues that matter to them; this one often brings out strong opinions in people.

Many issues of mental illness can seem pretty hopeless. Many mental disorders become lifelong affairs once they start. Treatment is difficult at best, and can cause its own problems. There are hidden issues, too: psychiatrists are starting to realize that if you take someone off of a drug because they seem better, and try to put them back on it later, it might not work the way it did originally. Medications can cause permanent neurological changes. Even someone who seems better will often relapse later; disorders are generally permanent, and often cyclical in nature.

Important Tip: Many players feel that there must always be a way to solve any plot, and will find an un-solvable plot inordinately depressing and un-fun. Don’t run these plots for players like that; why depress them unnecessarily? Save them for people who are more interested in exploring characters and universes and don’t mind the occasional hopeless situation.

Treatment Problems

#10. It Can’t Be Treated
Sometimes a person just never quite finds the right set of medications for her own illness. Some people are on effective medications but the side effects suck, or although it makes their illness better, it doesn’t make it entirely better. Some people end up on complex cocktails of 7 or 8 drugs in order to control their symptoms. What works for one person’s illness won’t work for another’s, even if the illness is technically the same and even if the symptoms are largely the same. The brain is a vast and mysterious thing and it is very poorly understood. Apply one of these situations to an NPC the party is trying to help. Let the party realize that there just isn’t a quick answer to their friend’s problems.

#11. Treatment Is Worse Than Cure
Sure, the treatment works just fine. But this time it causes additional problems. The person loses all motivation, seems constantly “drugged,” develops painful medical problems, experiences problems with memory (electro-shock therapy can have this side effect) or some other such problem. Is the treatment worth all this? Or not? And what if the patient’s doctor recommends a treatment that sounds horrible–will the PCs go along with it?


For all the problems inherent in dealing with and treating mental illness, there’s still room for hope! Plenty of people find the right medication the first or second time they try something. Plenty of people end up with minimal symptoms and side effects. There are people with mental disorders who do a surprisingly good job of blending into society, because they have control (through whatever sort of treatments) of their illness.

#12. Things Work (Reasonably) Well
For once, things work out well. With some effort the PCs and the patient can find a way out of the worst of their problems. The treatment has acceptable side effects. The symptoms are minimized, even if they can’t be gotten rid of. Sure, the patient needs to take pills and/or therapy for the rest of her life (now there’s a future plot hook–what happens when she’s stranded away from her medication?), but by and large she’ll end up all right. Of course, now she has to face the things she did while she wasn’t well….

Hopefully these will give you a handful of starting points. I’d obviously recommend spreading them out a bit, using them here and there, rather than inundating your players with a sudden onslaught of mental illness-related plots.

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