Beyond the Madness

Addressing mental health in horror RPGs

NB: As suggested above, this post specifically deals with heavy themes about mental health. While I do my best to avoid discussing particular triggers or trauma, the subject itself may be difficult for some readers.

With the severe and sometime critical mental health issues that my family and I have been through recently, I've gone through cycles in the last several years. I've gone from wanting to play all of the horror to none of the horror to where I am right now: I kinda like it but need to keep it as one element of a larger, more balanced approach to gaming and media. This is fine: we all come and go with things, and sometimes I like other kinds of gaming, whether science fiction or whimsical fantasy.

Photo by Thiébaud Faix on Unsplash

Playing through horrible things is one of the ways I process some of these uncomfortable feelings. I don’t mean that the games are therapeutic in any real sense, but it’s fun for me to explore that in a safe way. Limits still apply; for example, there’s a scenario in Cults of Cthulhu that I personally cannot handle.

Is it even worth it?

While I’ve written before about mental health in horror RPGs, a recent post from another Substack user brought this top of mind again:

psychosis is badly written in tabletop games.

What I took from Laskowski’s post was the idea that modeling mental health as declining purely due to external factors like being exposed to traumatic experiences and turning it into a slow loss of control feels very bad to the author. That resonates strongly with me.

I have read (though I don’t know how true this is) that the original designer of Call of Cthulhu, Sandy Petersen, first thought he could just use the mechanics of the Basic Roleplaying (BRP) engine for the game. Players, though, didn’t really roleplay their characters as being “afraid” so he included the Sanity mechanic to ensure that the game felt like horror.

In other words, maybe the portrayals of mental health in games are problematic and should be reconsidered, in exactly the same way as we have higher expectations for how games handle race and gender now than were apparent in the very early days of the hobby (or, in the case of some very large publishers, still are today). As game designers and writers, we can take a step back and look at our games to see if they’re harmful. Certainly we can hopefully agree that Trail of Cthulhu labeling their mention of this topic as a “Tediously Obligatory Disclaimer” isn’t helpful. That said, Paul Fricker (one of the co-authors on the Seventh Edition of Call of Cthulhu) has spoken with great sensitivity and thoughtfulness even if I didn’t fully agree with him.

Tropes are not bad in general, but ableism is, and mental health simulation almost always devolves into that. But the game still includes mechanics for exactly that sort of simulation, and not well, if that’s even possible. It's one thing to say that Sanity represents the mind's inability to deal with magic, monsters, and other phenomena that warp or break reality. It's another to then say that it might be fixed with psychoanalysis and staying in an asylum, or that someone coughing up blood (as happens very early in a starter set scenario) contributes to the slow corruption of the mind. CoC also models "intelligence" in part as the ability to understand the reality of the universe but not to handle it, with a successful Intelligence roll leading to “temporary insanity”. I strongly dislike the inclusion of phobias and manias in CoC.

An alternative approach

Cthulhu Dark does at least one thing better than Call of Cthulhu (although I would say more than one) in how it models sanity. More accurately, it doesn't (at least not in the final version). “Insight” as a mechanic and a term is both less ableist and, in my view, a better model for what happens in the genre than “Sanity”. In cosmic horror in particular, as characters gain more understanding of the horrifying nature of reality, actions that follow logically from that understanding seem "insane" to people who have no idea about it. Compare this to trying to explain the concept of vaccines to people who lack scientific knowledge (perhaps a bad example given that we don’t have to imagine that anymore), or how just a few years back someone talking to themselves in public seemed like they might be in crisis, before we had AirPods and ubiquitous mobile devices.

Graham Walmsley (the designer of CD) did an outstanding job of listening to feedback about the label “Insanity”and changing the framing to “Insight”, which both demonstrates more sensitivity and better represents the fictional inspiration. So I use Cthulhu Dark anytime I don't want to deal with Call of Cthulhu for whatever reason (e.g. I think it works better in one-shots and convention games just due to the ultralight rules). I've also written a few games in this vein, but so far I still like CD better.

I'm not anti-CoC, clearly; I play it every week and plan to continue. But, despite being an area where it gets so much focus and sometimes praise, it's something I'd like to see it improve in a hypothetical future edition. I’m confident that CoC 8e, which is a near certainty in a long enough timeframe, will continue to improve here.

Horror in our games comes from atmosphere and aesthetic more than modeling the slow erosion of mental health. Regular D&D can be horror if the whole group buys into it, especially lower powered editions like Original D&D. Once I even ran a light version of old-school D&D with the Insight die from CD, which doubled as a chance to interpret demonic runes and the like.

Another game that started as a hack of OD&D, Into the Odd, bills itself as “a rules-light, flavor-heavy roleplaying game of industrial horror and cosmic strangeness.” It has three primary character attributes: Strength, Dexterity, and Willpower, all treated as “saves”. If the purpose of a Sanity-type mechanic is to model the characters’ level of fear, a WIL save might also do the job. Liminal Horror, based on ItO, does this, more or less, although it renames Willpower as “Control”, calls mental damage “Stress”, and implements results called “Stress Fallout” that are somewhat analogous to Bouts of Madness in CoC. I haven’t played LH, though it does a few other interesting things that differentiate it from ItO.

Fear can be a healthy emotion in dangerous circumstances, and insight indeed matches the original source material’s genre implications. Both seem to me like more fruitful approaches than modeling “sanity” and “madness” in the sense of accomplishing the goal of conveying horror - but also in not reflecting poor attitudes towards those with mental illness. We can move beyond those approaches.

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This has been a tough one to write, and I largely assembled it from deep, thoughtful conversations I’ve had online in several different communities. I continue to welcome feedback and differing perspectives on the subject.

Related posts

Here are a number of other posts on this subject of mental health in horror gaming that I have appreciated and still go back and read from time to time:

• Mental Health and Lovecraft

• Lovecraft and Trauma

• A Survivor Looks at Trauma

What I’m Reading

In a dusty book shop standing in what was farmland not too many years ago, I chanced upon a curious tome…

Perhaps one night soon, I will follow the instructions for a dark ritual and pronounce the words of power.

I already have the full Classic box set but the preview of the Solo Investigator’s Handbook looked pretty good:

And finally, this is pulp perfection: