Admission and Understanding — Roleplaying and Mental Illness

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!

Here are a few details about mental illness that will hopefully suggest some interesting plots, themes and dilemmas that you can explore in your roleplaying games. It will also give you a much better idea of how mental illness works, and some of the things that the mentally ill go through, which will hopefully help you to approach the topic. There’s more to come in later articles!


If you think other people are afraid of the mentally ill, remember that the mentally ill are often at least as afraid as everyone else is of what’s going on.

What’s Happening?

Try to imagine this for a moment: your life has been going normally. You’ve had a fairly average childhood. You go to college and suddenly everything starts going wrong. You get upset very easily. Sometimes you’re so tired you can’t get out of bed to go to classes for weeks at a time, and even a sad TV commercial will make you cry. Sometimes you’re enraged at people for no reason, or you feel “high.”

You have no idea that there’s anything wrong with you, so you try to figure out what in your life is causing all of this. You keep coming to conclusions that you’re angry because of some slight from your girlfriend, or you feel really good because you’ve been spending time with a new person. These extreme feelings are caused by a biochemical imbalance, but you’re left completely screwing up your life (breaking up with people, sleeping with people, yelling at people) because you’re certain that your feelings are caused by life circumstances.

Then the anger goes away, or you stop feeling high, or you can actually get out of bed in the morning again. You realize that you broke up with your boyfriend for no good reason, you slept with someone you shouldn’t have, or you failed your class because you slept through the final exam. And because you don’t know there’s something wrong with you (or even if you do realize it, it’s still hard to understand it), you blame yourself.

IN USE: An interesting plot or theme could be had from the concept of someone who’s newly developing a mental illness. Perhaps the onset is slow or gradual enough that no one realizes there’s anything unusual going on at first. Even once they do, they’re more likely to think the person is just being annoying or obnoxious — they can’t see that he or she has a real problem. This works particularly well with mood disorders, which are sometimes easy to mistake for “normal” emotional flare-ups (at least in the milder versions).

Such developments often happen in adolescence, when someone goes off to college, or when some other major life change happens. If a non-player character (NPC) close to the party is of an appropriate age, slowly work relevant details into the game. Allow your players to come to all the wrong conclusions before they realize that there’s a real problem going on.

I Can’t Admit It to Myself

Some mental illnesses are caused by traumas, abuses and difficulties that we faced during childhood. Some abuses leave their victims believing that everything bad in their lives is somehow their own fault. Going to a psychiatrist often requires being able to admit that you haven’t necessarily done something wrong.

Alternatively, the victim knows that in order to deal well with a therapist she’s going to have to admit to the awful things that happened to her. And she isn’t ready to talk about those things with anyone.

Or she might not entirely remember the traumas. All she knows is that things suck, and it must be her fault because she doesn’t know of anything else it could be. And on some level, she’s afraid of the memories that are locked away in her somewhere — she doesn’t want to talk to someone because that would mean remembering something terrible.

IN USE: Remember when experimenting with plots involving the mentally ill that many of them don’t even realize they have a problem. Many won’t even admit they have a problem when faced with incontrovertible evidence. Some people will go out of their way to find other explanations for their behavior. Others will shut out the very people who are trying to help them because they don’t want to hear what their friends have to say. If the player characters (PCs) think that helping a mentally ill friend is going to be easy, they might have a couple of surprises coming.

This is also a good place to remind you of the points made in the first article in this series–handle the subject of mental illness with a little seriousness and sensitivity. You never know when someone you’re gaming with might have a mental illness, might have suffered abuses, or might have had to deal with a relative or close friend’s mental illness. If your players ask you to stay away from a sensitive topic, then do as they request.

I Can’t Admit It to Anyone Else

There’s a huge stigma against mental illness. We’re all told that we must be responsible for our own actions. There’s good reason for this; a lack of accountability leads people to do all sorts of terrible things. On the other hand, it also means that many parents see their children as being responsible for their own mental problems, or their failure to “get over it,” and many don’t hide that attitude from their children. Crazy is a very derogatory term in our culture, and many people make fun of the mentally ill.

As a result, many people are so ashamed of their own mental illnesses that they won’t seek out very necessary treatment. Imagine for a moment knowing that you have an illness, but being unwilling to see a doctor because it would mean admitting that you’ve somehow allowed this terrible thing to happen to you.

IN USE: Play a bit with the differences between how the mentally ill are perceived and how they actually are. Base mentally ill NPCs on real-life case studies instead of movie and TV depictions of mental illness (and don’t automatically reach for the most wild and dramatic case studies you find). Subvert your players’ expectations; play off of the fact that they’ve seen the same movies and TV specials you have in order to surprise them. Undercut the bad messages that our society sends people; do a reasonably sensitive portrayal of someone who has a mental illness. This doesn’t mean that you have to walk on eggshells or be “politically correct” about it. Just avoid the temptation to automatically and unthinkingly depict the mentally ill as silly, laughable, or terrible people.

So As You Can See…

As you can probably see by now, it can be incredibly difficult for people to ever make that first step that gets them some help. It usually requires realizing that they have a problem, admitting to themselves that they have a problem, admitting to a complete stranger that they have a problem, and possibly admitting to everyone around them that they have a problem. Given this, sometimes I find it amazing that anyone ever gets the help they need. (Which could also make a great premise for a very unusual plot…)


Many “normal” people believe that a clinical depression is no different from the occasional mild sadnesses they feel in their own lives. They have no understanding that depression could be something deeper and much more serious. Imagine your girlfriend telling you that if you don’t cheer up she’ll leave you, as though it were something you could turn on or off like a light switch. Because of this, some of the mentally ill learn to fake something like normality. There are clinically depressed people who go around feeling completely dead inside, yet who appear almost entirely normal on the outside. It might become such a habit that they eventually can’t let down their guard and show their real selves.

IN USE: Play with some of the lines between reasonable expectations and unreasonable expectations. What’s reasonable when expected of a “normal” person? A mentally ill person? What about when you have trouble telling the difference between the two? What about for different mental illnesses, with different causes, different symptoms, and the different levels of self-control that are possible? If you really want to play with a hot topic, get into some of the issues of responsibility, liability, and guilt. Resist the temptation to provide an easy answer for your players.


One person’s insanity is another person’s bad behavior. The reason there have been so many versions of the DSM (Diagnostic and Statistical Manual of Mental Disorders) is that the definitions of what is and is not considered mental illness change all the time. People have trouble pinning it down. “Crazy” behavior is in many ways defined in a relative sense; it is behavior that is abnormal for the society and time in which the person lives. Some mental illnesses cause a clear enough break from reality that they’re obvious, but many don’t. Even the DSM-IV acknowledges that symptoms that indicate a mental illness for one ethnic group may be entirely normal for another ethnic group.

Or, let me put it this way. You probably think you have a pretty good idea of what’s crazy and what isn’t, right? You probably think there’s a pretty clear line. Just for a minute, think of a friend or relative who is, in your mind, pretty normal. Sure, they have “moods” just like everyone else, and sometimes they’re a bit argumentative. But that isn’t so different from you, is it? Now imagine that this person told you that she had a mental illness. I know this sounds random and arbitrary, but it isn’t. I’ve seen it happen quite a few times. Either the person hides their illness well, or they’ve found the right medication for their illness, or their behavior is close enough to normal for the group of people they hang out with that it doesn’t occur to anyone that the behavior could be considered odd.

One in ten people (last I heard) has a mood disorder, and mood disorders are only one category of the myriad of mental illnesses out there. With those sorts of odds, you probably already know more than one person with a mental illness, even if you don’t realize it.

Are you really so sure you know what “crazy” means, now?

IN USE: Play with the fine line between sanity and insanity. What’s normal? What isn’t? What needs medication, and what can be dealt with through some sort of therapy? What’s normal moodiness and what’s a mood disorder? If you really play this one right, you could leave your party wondering just how sane they are. (We’ll talk a little more about treatment issues in the next article.)

Not Really Understanding

Part of the reason there’s such a stigma against the mentally ill is that people cannot help but try to put the experiences of the mentally ill in terms that they can understand. This is great in theory; it would be wonderful if more people would try to understand rather than simply condemning. On the other hand, this causes its own problems.

When people hear “depression,” they think, “oh, like that time I was sad about my pet dying.” They think, “it hurt, I cried a lot, I talked to people about it, and then I pulled myself over the hump and got on with my life because that’s what you do when you’re sad.” This leads many of them to think, “so someone who’s depressed should take some time, cry about it, talk to his friends, and then pull himself out of it and get on with his life.” Many people are happy to be there for their friends at first, and then they get impatient when they find out that it won’t be over in a week or two, or that it’ll keep coming back over and over again.

IN USE: Bring the party to a point where they think they understand. They’ve put things into terms that make sense to them, and everything seems right with the world. Then let them see that they don’t really understand at all. Let them see the uncertainties, the complexities, and the lack of hard and fast answers.

Not Wanting to Understand

Other people are afraid to understand at all. A part of them is afraid that if they look too closely, they’ll see that the mentally ill aren’t so different after all. If they admit that their children are mentally ill and that some mental illnesses are genetically based, then they have to admit that they might have a problem!

It’s more comfortable for them to hold the mentally ill at arm’s length. It’s more comfortable to claim that the insane could pull themselves out of it if they really wanted to. It’s more comfortable to think that insanity is the insane person’s fault somehow. It’s because he’s defective somehow. That way you can rest safely in the belief that you couldn’t possibly be insane, because you’re an okay person. You do your taxes, go to your job, and participate in organized religion, so you couldn’t possibly have a mental illness, right?

Because of all of these reasons, many people see the mentally ill as shiftless, lazy, stubborn, good-for-nothing people who don’t want to be healthy and responsible. All they see is the woman who stays athome and seems to lie about the house all day; they don’t know aboutthe intense internal feelings that make just getting up out of the couch a monumental struggle.

IN USE: If you’re playing in a system that includes disadvantages, quirks, or flaws, perhaps one of your players lightly took a mental problem as a flaw, not expecting it to be that big a deal. Do a little research on that mental illness. Find out what it’s really like. Start working relevant details into the game. Unless it makes the player too uncomfortable, don’t let him hold the illness at arm’s length from his character. See how the party reacts to a mental illness that’s up close and personal.

Hopefully these ideas have given you a place to start from. There’s no need to work every major issue into every plot that involves a mentally ill character. Some people have no trouble admitting to themselves that they have an illness. Some people have very understanding families, friends, and mates. But certainly these issues exist, and odds are they’ve been faced on some level, at some time, by most of the mentally ill. Come up with your own twists on the themes. Work these ideas into your own plots. And come back next time for a few thoughts on treatment and stress!

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