If you haven’t yet, then please read the first article in this series before reading this one. It will give you an idea of my attitudes toward mental illness and roleplaying, and the direction from which I’m approaching the topic. It will explain why I espouse certain viewpoints and attitudes. Keep in mind that some of this material is generalized for the sake of brevity; I don’t want to write a 200,000-word textbook on the subject. Various mental illnesses are quite different from one another, and should be taken as such. Obligatory disclaimer: this information is provided for roleplaying purposes only!
We’ve come a long way in this series of articles. We’ve talked about some of the issues that people with mental illnesses face in their day-to-day lives, as well as some of the ways to create a three-dimensional mentally ill character. We’ve dealt with finding research resources and we’ve talked about the reasons why it’s a good idea to treat mental illness a little carefully in roleplaying games. Now it’s time to talk about the players who want to roleplay a character that suffers from a mental illness.
It Isn’t Easy
We’ve talked a bit about the fact that some mental illnesses just aren’t workable for a player character (PC). The example we used was depression — clinical depression isn’t just a case of being sad. It often results in a person literally sitting in bed and not moving for days at a time. This doesn’t work well for a PC for what are hopefully obvious reasons, unless you’re prepared to go into downtime every time a character goes into a depression.
Mitigating Symptoms with Treatment
We’ve also discussed some of the ways in which the game master (GM) can alter reality. You don’t have to stay true to every detail of a mental illness; sometimes you need to alter things in order to work within a roleplaying game’s structure. In that article it was suggested that a PC with a mental illness might be on medication (or some other treatment) that partially mitigates the effects of his mental illness. If you decide to go with this route, I recommend taking a few things into account:
- Medication almost never works perfectly. Play with the ups and downs — today the PC is completely lucid; the next day some stress sends him off and makes things worse again. Most of the time he just has a (greatly or slightly) reduced form of his normal illness.
- Don’t use medication as a way to totally remove the effects of the illness. Otherwise there’s just no point to having a PC with a mental illness in the first place.
- Medications have their own negative effects.
- Read Treatment and Stress before using treatment to modify a PC’s mental illness. It will give you a better idea of some of the issues involved.
You can use treatment to turn an unworkable mental illness into something that a PC could conceivably have and still be a functioning party member. Think carefully before doing this; GM and player should discuss the ramifications of this route together. If you don’t want to add a whole additional layer of complication, then you might prefer to stick with illnesses that are workable for a PC.
Talk to Each Other
If a player approaches a GM about playing a character with a mental illness and the GM runs a reasonably serious game, then the GM should be sure to talk to the player before the game starts. Sometimes players will take mental illnesses in order to get more building points, freebie points, etc. with which to build up their character a bit more. They don’t actually have much of an interest in playing the mental illness, or they have a very ill-conceived idea of what the mental illness entails.
This sometimes results in the illness being played for giggles, or played as a mildly exaggerated personality quirk, and only when convenient for the player. So if the GM cares about the message he’s sending, he should talk to the player first and make sure she knows what she’s getting herself into. If not, the GM should help her to find some other flaw or quirk that would suit her character better.
Mental illnesses have a strong effect on a person’s life and work. In fact, that’s generally one of the criteria for the diagnosis of a mental illness — the problem must negatively impact a person’s life, work, and/or relationships. The exploration and use of these sorts of personality traits are usually best saved for games in which personal plots are encouraged by both GM and players. Some are more difficult to play than others, however.
Disorders for PCs
While many disorders can be turned into interesting PC characteristics with the aid of treatment, there are some that work comparatively well without such help. Here is a list of some of the more workable PC disorders, with links to further information on each one.
NOTE: The site I’d found that listed complete DSM-IV criteria has vanished. I’ve found another site that lists some simplified criteria. For in-depth listings, look for the DSM-IV in your local library or pick up a copy for yourself.
Anxiety Related Disorders
Acute Stress Disorder is perfect fodder for PCs. In fact, a GM might consider playing with a plot in which an in-game trauma causes a PC to develop such a disorder. In Acute Stress Disorder, a PC is reacting to a terrible trauma recently experienced. This is the short-term version (and thus not appropriate as a long-term PC illness); other versions are longer-term.
Adjustment Disorder is a reasonable possibility for a PC. Essentially, the character is stressed (due to a particular thing), but out of proportion with what should be expected. It can be a longer-term but less acute problem than Acute Stress Disorder.
Panic Disorder could, with a little care, be made to work well. (Panic Disorder with Agoraphobia, however, could be problematic.) Choose symptoms and stressors carefully–you don’t want to end up with a character who’s afraid to get involved in plots!
Posttraumatic Stress Disorder is a touchy choice for a PC’s mental illness. It’s a strong and difficult mental illness that is capable of ruining people’s lives. I only recommend exploring it in a highly personal game with players who are familiar and comfortable with each other. It will not be an easy thing to roleplay, and the player should be very much aware of this and feel that she is up to the challenge. You can find more information on: Child Abuse and Posttraumatic Stress Disorder.
Disorder could work out, particularly if one of the “major attachment figures” was another PC (and the other player felt up to playing with this sort of theme).
Social Phobia is appropriate as long as the source of the phobia is not something that will interfere with the PC’s involvement in the game. Think carefully about what it takes for a character to get involved in plots in your game.
Specific Phobias, similarly, should be chosen with thought to what will or will not interfere with the PC’s interaction with the game. The Phobia List is a great source of unusual and interesting phobias!
You can find more information on: Anxiety, Panic & Stress.
Disorders Diagnosed in Childhood
Conduct Disorder (scroll down the page a little after you click through) is likely to cause some conflicts with party members. How much of a problem this presents depends on the group’s preferences regarding conflict between PCs, the symptoms that are chosen for the character, and the severity of the illness. You can find more information on:Adolescent and Childhood Disorders.
Dissociative disorders include:
- Dissociative Amnesia: selective amnesia resulting from trauma.
- Dissociative Fugue: unexpected travel accompanied by confusion about one’s past or identity.
- Dissociative Identity Disorder (formerly Multiple Personality Disorder): the possession of two or more distinct personalities or identities.
Any of these could be made to work within an RPG structure. DA and DF are perhaps the most interesting and useful in terms of roleplaying, although DID is more popular (probably because it’s been treated in a sensationalistic manner by the media). However, it’s difficult to make use of DID without players falling back on stereotyped portrayals. If a player wants to make use of this disorder, some questions and research are definitely in order. More information can be found on: Dissociative Disorders — a list of links to sites on the subject. Several of them cover DID in particular.
Here’s an additional warning about playing a character with DID. That character is likely to take up a particularly large share of attention within the game. This will work out just fine in a one-person game, and perhaps in a game with only a few players where the other characters are similarly interesting and unusual. But be aware of spotlight time issues before you put such a character into a game.
Impulse-control disorders involve the failure to resist the temptation or drive to perform a harmful act. Obviously some of these might cause problems if directed at other party members, so they should be used with care. Try to come up with good reasons why the character doesn’t direct these drives at the rest of the party, or why the rest of the party puts up with it if he does.
- Intermittent Explosive Disorder involves periodic episodes of aggression and violence. (more info)
- Kleptomania involves the need to steal–not for personal gain. In order to avoid excess conflict between party members it is helpful to remember that kleptomaniacs often steal useless things, not their friends’ most treasured possessions. (more info)
- Pyromania is the need to set fires for pleasure or the release of tension. (more info)
- Pathological Gambling is the persistent need to gamble. (more info)
Bipolar Disorder Type I and Type II are not terribly useful as PC disorders. (Type II is generally less intense than Type I, and lacks any hallucinations, which can come with Type I.) The reason for this is simple — someone experiencing a clinical depressive episode is not simply “sad.” Someone suffering from such an experience typically ends up in bed for days at a time (if not weeks or months!), unable to get up and actually do anything. That would kind of make getting involved in plots a bit difficult, now wouldn’t it?
Hypomanic phases could be used independently as PC symptoms. If the PC has full-blown bipolar, however, he’ll pretty much need to be medicated in order to function as a party member. Luckily for those players who are bound and determined to play a manic-depressive (don’t ask me why it’s so popular), there’s another option: Cyclothymic Disorder. It’s sort of like a milder form of bipolar, with less intense mood swings and less extreme symptoms.
Avoidant Personality Disorder involves a certain level of inability to deal with other people. This would make it unsuitable for use in a game that involved a lot of politicking or other sorts of personal interaction within the game, but it might be suitable in other cases. Be sure to strongly connect the PC to the rest of the party, however, so that she does not feel that she needs to avoid them.
Borderline Personality Disorder is, if you’ll pardon the pun, of borderline use. If a player is tempted by it, remember that the diagnostic criteria only require a certain fraction of the possible symptoms to be present. Symptoms should be carefully chosen to work within the structure of a roleplaying game!
Dependent Personality Disorder is likely to work as long as the party is fairly coherent and close-knit, and the PC’s disorder comes to focus at least partially on the other party members. If the party is not at all close-knit then this might simply drive the PCs apart even further.
Histrionic Personality Disorder: like the Dependent Personality Disorder, this has a workability level highly dependent on which symptoms are chosen and how the group of PCs interacts. Symptoms involving sexual behavior should be omitted if there is any chance that they would make the players uncomfortable.
Obsessive-Compulsive Personality Disorder also has a symptom list that will have to be carefully sorted through. Some criteria will make working with others in a party situation untenable, and thus should be discarded. I’ve presented Obsessive-Compulsive Personality Disorder rather than Obsessive-Compulsive Disorder deliberately. People with full-blown OCD often spend large amounts of time on their obsessions and compulsions–time that PCs usually don’t have available.
You can find more information on: Personality Disorders.
Schizophrenia & Psychotic Disorders
Brief Psychotic Disorder could perhaps be useful; I recommend making use of the “With Marked Stressor(s)” criteria to give it some boundaries.
Delusional Disorder is a definite possibility. The listing includes several useful categories of delusions to give you ideas. One warning here, however. This sort of delusion is something that can easily become silly and ridiculous in the hands of someone who isn’t particularly interested in playing her character’s mental illness. Make sure that the player is willing to play it with a little subtlety and seriousness (unless, of course, you’re deliberately playing a humorous game).
Sleep disorders include:
- Primary Insomnia: Difficulty sleeping, or sleep that isn’t restful. (more info)
- Circadian Rhythm Sleep Disorder: A persistent mismatch between a person’s sleep-wake cycle and the demands on his schedule. (more info)
- Nightmare Disorder: Frequent nightmares that wake a person up. (more info)
- Sleep Terror Disorder: Abrupt awakenings beginning with a panicky cry, accompanied by intense fear. Followed by amnesia regarding the event after awakening the next morning. (more info)
- Sleepwalking Disorder: Movement (usually walking) during sleep. (more info)
Sleep disorders involving excess sleep (hypersomnia or narcolepsy) are not generally recommended. A character who is always falling asleep is often more annoying than interesting. More information is available on: Sleep Disorders.
Somatoform disorders involve physical symptoms that seem to suggest the presence of a general medical problem, but the symptoms just don’t quite match up with what would be expected, and a medical cause for the symptoms cannot be found. These disorders are best used in RPGs that don’t involve a lot of physical activity (such as combat), as they will often interfere with such activity. They include:
- Conversion Disorder: Impairment that suggests neurological or other medical condition, yet psychological factors are involved. Can include a dysfunction of movement, blindness, or deafness. (more info)
- Pain Disorder: Pain is the main focus of this disorder, in which psychological problems seem to provoke or exacerbate the pain. (more info)
- Hypochondriasis: The preoccupation with or fear of having a serious disease. (more info)
Substance Use Disorders
The generic criteria for substance dependence will serve you well. Substance abuse is a tried-and-true PC flaw that tends to work quite well in a roleplaying game. Keep in mind, however, that true substance abuse disorders do interfere with a person’s life and work, and should lead to significant problems eventually. This can make a great plot, but you need to be willing to work with it. You can find more information on: Addiction and Recovery.
Substance use disorders include:
Most of these resources take only 5-10 minutes to read, and they can add a lot to your games. I hope that this article will make it easier for roleplaying groups that want to explore mental illness to do so. GM and player need to work together to create a PC with a mental illness that will work within the context of a roleplaying game. You should establish ahead of time some guidelines for how the illness will be presented; whether the player has complete control over how it behaves; whether any rules, mechanics, or die rolls are involved; whether the GM will step in at times and determine the behavior of the illness. This sort of talk doesn’t take a lot of time, and it will make your game much easier.