Ptsd & D

[Arbane]

One of the other people in the game I was in mentioned offhandedly that if our characters were real people, they'd all be quivering wrecks from PTSD by now. And that got me thinking - she's probably right. Even allowing for PCs being HEROES, a lot of them go through more horrible trauma in one adventure than even most military veterans will in a lifetime.

Aside from Call of Cthulhu and Unknown Armies, any RPGs that do a good job of modeling this? Preferably in a way that doesn't leave the PCs completely unplayable?

[Slipperychicken]

You could give them will saves against Shaken whenever they're doing anything stressful, the Insomniac flaw (hard to sleep), and maybe have another will save when they're in extreme stress (failure means the character acts as though Confused for a few rounds).

You could utilize the Sanity variant rules, and assign mental disorders as that dictates.

You could say they're hardened enough that violence doesn't bother them, unless a player really wants to explore that.


Personally, I think it's an acceptable break in immersion, assuming you don't want to play Abuse Victim: The Therapy.

[Gildedragon]

Personally, I think it's an acceptable break in immersion, assuming you don't want to play Abuse Victim: The Therapy.

Such a bad ruleset; the devs just released the 5th edition (PTSD&DSM-Next) and fixed some dysfunctions I hear, but I'm skeptical, outside of the core there isn't much support to it, old editions got 0 3rd party support, dont think this one will. and it takes forever to learn the rules.
Also it favors one-on-one dming; which can be a pain.
Strongly advise against it.

[Harlot]

Preferably in a way that doesn't leave the PCs completely unplayable?

In my (D&D 3.5) group we had a druid that became schizophrenic: After harsh encounters, he would go to sleep and then go missing. When he was missing he would avenge himself on people who had somehow wronged the group, being borderline evil during this. After a few days or hours, depending on the size of the trauma, he would go back to his normal, good self. He would have absolutely no idea what he had been doing while he was away (but he would sort of guess, from bloodstains etc, that it probably wasn't good and lie to the group about it.) The schizophrenia was so complete that he had two Gods and two spelllists, totally separated from each other - thus when good he would not know of or have any access to the bad/evil spelllist and vice versa.

He was very playable and a lot of fun.

On RPG games taking this into account: Warhammer definitively! With the sanity point system staying sane is quite a challenge.

[Arbane]

The schizophrenia was so complete that he had two Gods and two spelllists, totally separated from each other - thus when good he would not know of or have any access to the bad/evil spelllist and vice versa.


Oh, you just reminded me - in one D&D game I was in, the DM decided to start things off by having us all be 0-level commoners who were kidnapped and tortured by Drow for a whole year. Fun!

Her husband's character was abused so badly that he ended up with a split personality - a LG Sorcerer and a CE Barbarian. (As a note to evil players: The barbarian was a vicious bastard, but he was OUR vicious bastard. CE doesn't have to mean _stupid_.) She'd been planning to use that plotline on any female characters in the game. (!)

In retrospect, our characters SHOULD have had PTSD to the point of unplayability. Probably for the best that we didn't....

[Arundel]

As a war vet, I can safely say that the character who most resembles a PTSD victim is a proper Tippyverse wizard.

Stay put in a heavily fortified area so as not to expose himself to tactical risks? Check
Refuses to deal directly with society due to fears of security concerns? Check
Sets elaborate traps and barricades to keep society out? Check
Uses impenetrable transportation methods to ensure safe transit from point A to B? Check
Possesses poor social skills compounded by near crippling paranoia? Check
Hypervigilence? Check (foresight)
Likely to respond with devastating force so as to limit future security concerns? Check

[JusticeZero]

Honestly, a lot of the precautions that adventuring parties will just start doing all the time will look pretty dysfunctional to everyone else who doesn't actually have to worry about the things they do.

[CowardlyPaladin]

PTSD is a major theme in my games, and most adventurers are broken. In fact one of my main villians has a spell that can instantly trigger PTSD, or give you PTSD without the traumatic event. most of the characters overcoming there personal trauma is a thing. I don't make it mechanical though, its more of a role playing thing

[BWR]

In my (D&D 3.5) group we had a druid that became schizophrenic: After harsh encounters, he would go to sleep and then go missing. When he was missing he would avenge himself on people who had somehow wronged the group, being borderline evil during this. After a few days or hours, depending on the size of the trauma, he would go back to his normal, good self. He would have absolutely no idea what he had been doing while he was away (but he would sort of guess, from bloodstains etc, that it probably wasn't good and lie to the group about it.) The schizophrenia was so complete that he had two Gods and two spelllists, totally separated from each other - thus when good he would not know of or have any access to the bad/evil spelllist and vice versa.
.

That doesn't sound like schizophrenia, but more like dissociative identity disorder (what used to be called multiple personality disorder).

Anyway, that reminds me of Farrow, a shadow elf Anarchist from Sigil who had no less than 15 different personalities, none of whom are aware of the other and, even more interestingly, manifest in different classes, different backgrounds and even different races. He literally changes to another race without the help of magic. One of the his personalities is evil, another is a paladin.

[Hiro Protagonest]

As a war vet, I can safely say that the character who most resembles a PTSD victim is a proper Tippyverse wizard.

Stay put in a heavily fortified area so as not to expose himself to tactical risks? Check
Refuses to deal directly with society due to fears of security concerns? Check
Sets elaborate traps and barricades to keep society out? Check
Uses impenetrable transportation methods to ensure safe transit from point A to B? Check
Possesses poor social skills compounded by near crippling paranoia? Check
Hypervigilence? Check (foresight)
Likely to respond with devastating force so as to limit future security concerns? Check

Quick, someone bookmark this post for when people complain that your average wizard adventurer won't be this prepared.

[BWR]

In my (D&D 3.5) group we had a druid that became schizophrenic: After harsh encounters, he would go to sleep and then go missing. When he was missing he would avenge himself on people who had somehow wronged the group, being borderline evil during this. After a few days or hours, depending on the size of the trauma, he would go back to his normal, good self. He would have absolutely no idea what he had been doing while he was away (but he would sort of guess, from bloodstains etc, that it probably wasn't good and lie to the group about it.) The schizophrenia was so complete that he had two Gods and two spelllists, totally separated from each other - thus when good he would not know of or have any access to the bad/evil spelllist and vice versa.
.

That doesn't sound like schizophrenia, but more like dissociative identity disorder (what used to be called multiple personality disorder).

Anyway, that reminds me of Farrow, a shadow elf Anarchist from Sigil who had no less than 15 different personalities, none of whom are aware of the other and, even more interestingly, manifest in different classes, different backgrounds and even different races. He literally changes to another race without the help of magic. One of the his personalities is evil, another is a paladin.


Regarding the OP, I don't really know of any system that does a good job of it. Thing about most of these mental illnesses, it makes functioning as a human quite difficult, and few people want to have characters that are so handicapped that just walking down the street is a challenge.
Kult (http://www.kult-rpg.com/) has a lot of info about mental illnesses and how they function in game, mostly because it's a part of character progression.


Edit: that's odd. Thought I'd hit edit. Sorry aobut that.

[Chronos]

Note that PTSD doesn't affect everyone who goes through traumatic experiences-- Some get it, some don't, and nobody's entirely sure why. Maybe the adventurers are just the lucky ones.

[Xefas]

Aside from Call of Cthulhu and Unknown Armies, any RPGs that do a good job of modeling this? Preferably in a way that doesn't leave the PCs completely unplayable?

'Don't Rest Your Head' does a good job making you wonder whether the fantastic elements around you are so traumatic that it's causing your characters to descend into madness, or whether their descent into madness is causing them to see the fantastic elements overlaid on a normal world in the first place. Without a SAN score, or outright giving you the answer either way.

And, far from unplayable, mental instability makes them stronger! But, as you might imagine, less stable.

I haven't played Jason Morningstar's 'Grey Ranks', but I'm fairly sure it covers this, or something like this. It's a game about child soldiers in occupied Poland during WWII. Expect to have fun, but not really have a good time, if you know what I mean.

'The Dresden Files' has Physical and Social stress, but it also has Mental Stress, specifically for those encounters with things men were not meant to see. Did you open your third eye, and gaze into the bleak heart of a fallen angel (or, amusingly, the glorious heart of an actual angel)? Mental stress! Mindraped by ghosts? Mental stress! Had sex with the Queen of Air and Darkness? Mental stress! It's quite telling that casting magic skirts the same psychological boundaries as being tortured by shark-shoggoths (sharggoths?) from beyond space and time.

If you're lucky enough to be a supernatural character, you might be able to get over it with only a few years of therapy. Just a mortal? Probably gonna bear those scars forever.

Usually a bit subtle, but not necessarily, in 'Dogs in the Vineyard'. Barely an adult, sent with gun and bible in hand to uphold the tenets of your faith in the rugged lands of the wild(ish) west(sorta), you will run into situations that are undesirable for your mental well-being. Conflicts have a 'Fallout' mechanic, depending on the nature and severity of the conflict itself, and the actions taken within. Sometimes you'll ruin a relationship, or injure yourself, or grow as a person, but sometimes you'll end up just a little mentally worse for wear than when you went in.

You can quit the Dogs whenever you want, and most members don't last very long.

'InSpectres' is a little bit Ghostbusters and a little bit Men In Black but, regardless, your Bill Murray expy can only get chased, beaten, slimed, and faced with the apocalypse so many times before the stress starts piling up. This game is a little bit lighthearted about it, as you might imagine, so you can just go on vacation to relieve stress. The problem being, of course, that your new hole-in-the-wall demon hunter business doesn't necessarily have the funds to fly everyone out to Hawaii after every case (and if you have an actual demon or ghost on the team? Jesus, that can get expensive). Stress will build up, people will lose their cool, and you may be faced with the choice of either retiring to live out the rest of your years as a nervous wreck, or be eaten by a rabid space-demigod because a life fighting the good fight has robbed you of the iron nerves, will, and lucidity you once had.

[SiuiS]

One of the other people in the game I was in mentioned offhandedly that if our characters were real people, they'd all be quivering wrecks from PTSD by now. And that got me thinking - she's probably right. Even allowing for PCs being HEROES, a lot of them go through more horrible trauma in one adventure than even most military veterans will in a lifetime.

Aside from Call of Cthulhu and Unknown Armies, any RPGs that do a good job of modeling this? Preferably in a way that doesn't leave the PCs completely unplayable?

World of darkness. As your mental integrity drops, you can develop conditions such as paranoia, delusions, egomania, and others that reflect more gritty, if not more accurate, depictions of PTSD. Dealing with post traumatic stress was actually a main theme of a Mage of mine; his base was hit by insurgents, he went from trying rogue down a Suicide truck to gunnin down charging stegosaurs, and when he stopped "hallucinating" be spent the rest of his tour able to see and talk to spirits/animistic expressions of objects. It was a slow spiral of soldiering through dysfunction to be a hero.

Note, though, mental integrity != sanity.


Such a bad ruleset; the devs just released the 5th edition (PTSD&DSM-Next) and fixed some dysfunctions I hear, but I'm skeptical, outside of the core there isn't much support to it, old editions got 0 3rd party support, dont think this one will. and it takes forever to learn the rules.
Also it favors one-on-one dming; which can be a pain.
Strongly advise against it.

I see what you did there


As a war vet, I can safely say that the character who most resembles a PTSD victim is a proper Tippyverse wizard.

Stay put in a heavily fortified area so as not to expose himself to tactical risks? Check
Refuses to deal directly with society due to fears of security concerns? Check
Sets elaborate traps and barricades to keep society out? Check
Uses impenetrable transportation methods to ensure safe transit from point A to B? Check
Possesses poor social skills compounded by near crippling paranoia? Check
Hypervigilence? Check (foresight)
Likely to respond with devastating force so as to limit future security concerns? Check

Yeah. Just gloss over the night sweats and you're done.


Note that PTSD doesn't affect everyone who goes through traumatic experiences-- Some get it, some don't, and nobody's entirely sure why. Maybe the adventurers are just the lucky ones.

Post traumatic growth also exists; it's all about whether you crack or bend. Allowing atrocious horrors to reaffirm your worldview is a well documented thing. Sometimes it's religious, and this dismissed, and sometimes it's because the person is horrible and and get glowy feel goods from mass murder. But there is an unaccounted for group of people who go through hell and come out stronger.

[ArcturusV]

I suppose the only ruleset I played that I actually liked insanity, break downs, and other such flaws came out of Palladium (RIFTS, Robotech, etc, they all used the same system pretty much). Most of the insanities, disorders, etc, weren't ungodly levels of crippling to the point where you're a gibbering pile of flesh incapable of any sort of rational thought or self determination. Some of them were in fact kinda buffs (Like the "I'm better on it" addition which gave you a slight bonus to your skills while under the influence for a sharp penalty when you weren't).

[TypoNinja]

This is (Sort of) covered in parts of the BoED. The sections on violence, Exalted Good doesn't require pacifism, and violence isn't inherently Bad, in D&D the use of force is far more common and socially acceptable than the real world, even on absolute morality scales a willingness to kick some ass is acceptable, even encouraged behavior. Paladins, Lawful Good, and violent about it.

That kind of social adaption long term has probably generated a race, or at least subgroups of the race (this might explain adventurers) who are extremely desensitized to the use of force in justifiable circumstances. The kind of mental breaking points that we humans have when exposed to certain situations that spawn conditions like PTSD just wouldn't exist, or be extremely diminished in this group of people.

This could give us a group who aren't sociopaths so would still have the normal social limits, like not punching somebody because its fun, but wouldn't have issues applying force to an invading army, or some freaky creature. The fact that most adventurers don't have to deal with attacking members of their own species probably helps. Just like most people will swat a mosquito without a second though, other non-human creatures are going to be easier to kill without generating psychological issues.

[Slipperychicken]

The fact that most adventurers don't have to deal with attacking members of their own species probably helps.

Ha.

I don't know about your games, but the ones I've been playing have us facing almost exclusively humanoid opponents, usually humans. Sometimes it's orcs, goblins, or kobolds, but they're almost all close enough that they should make people feel guilty for killing them.

[JusticeZero]

This could give us a group who aren't sociopaths so would still have the normal social limits, like not punching somebody because its fun, but wouldn't have issues applying force to an invading army, or some freaky creature.
Most sociopaths/psychopaths have social limits, they just understand them as a rule rather than a horror. Whether or not punching someone in the face might be amusing, the reaction would be just plain annoying, and it's just not worth doing it.

[TuggyNE]

The fact that most adventurers don't have to deal with attacking members of their own species probably helps. Just like most people will swat a mosquito without a second though, other non-human creatures are going to be easier to kill without generating psychological issues.

Although the various MonHu/Fey with very humanoid forms probably are less pleasant for that reason. (Medusa, harpy, etc.)

[ArcturusV]

Possibly complicated when (As sadly happens far too often in my experience) you run into something like a Lamia, Succubus, or a Dryad and your party is split 50/50 between "Lets kill it for XP!" and "Lets seduce it!"

I can't imagine the sort of weirdness that must cause.

[Rhynn]

Aside from Call of Cthulhu and Unknown Armies, any RPGs that do a good job of modeling this? Preferably in a way that doesn't leave the PCs completely unplayable?

Twilight 2013 has psychological damage rules that do exactly what you want. A high CUF (Coolness Under Fire) attribute helps to a degree, but not with nearly everything. Regular people (low CUF) accumulate stress just from being shot at, and in a postapocalyptic setting, there's not a lot of chances to relax (much less get therapy), so it slowly accumulates.


I've always been curious as to whether PTSD & combat stress existed in medieval times. The 20th century had it in several versions/under several names (shell shock, combat stress reaction, combat fatigue, etc.), but I've never read of older versions. No doubt it existed to some degree in the 19th century, and probably the 18th, because of the prevalence of cannon and gunfire on battlefields - as far as I can figure out, it's mostly caused by helplessness in the face of death (in WWI, sitting in trenches or bunkers being shelled was the big trigger, which gave the condition its name). But to what degree and in what form did, say, 12th century knights suffer from PTSD/combat fatigue? I've never read any accounts that suggest similar reactions. It could be that combat where you almost inevitably fight face-to-face, hand-to-hand, was very different psychologically.

[ArcturusV]

Maybe? But the delays and downtime might have factored into it too. I mean there was a higher number of cases in Vietnam compared to say, World War II. Then again a soldier in WWII, it is said, saw combat on average only 1 day out of 63. A soldier in Vietnam saw combat on average of every other day.

I imagine for medieval warfare, it was probably even longer, where a soldier/knight might have only seen battle one day a year. If that.

[Slipperychicken]

Possibly complicated when (As sadly happens far too often in my experience) you run into something like a Lamia, Succubus, or a Dryad and your party is split 50/50 between "Lets kill it for XP!" and "Lets seduce it!"

I can't imagine the sort of weirdness that must cause.

But... Dryads are made of wood. That's got to be painful, just imagining it makes me cringe :smalleek:

[big teej]

One of the other people in the game I was in mentioned offhandedly that if our characters were real people, they'd all be quivering wrecks from PTSD by now. And that got me thinking - she's probably right. Even allowing for PCs being HEROES, a lot of them go through more horrible trauma in one adventure than even most military veterans will in a lifetime.

Aside from Call of Cthulhu and Unknown Armies, any RPGs that do a good job of modeling this? Preferably in a way that doesn't leave the PCs completely unplayable?

personally, I would argue that this is a non-issue until A) the character retires from active adventuring, leaving them far too much time to reflect on their actions/suffering or B) a sufficient length of downtime during an adventuring campaign to cause this.


most people's brains will switch off the parts that cause this DURING the given circumstances.

some won't. but these are heroes.

/2 cp shortversion

[Rhynn]

I imagine for medieval warfare, it was probably even longer, where a soldier/knight might have only seen battle one day a year. If that.

Well, it only takes one tour of duty, and medieval/ancient sieges could last a long time. Otherwise, that makes sense - a lot of marching and maneuvering, punctuated by some hand-to-hand combat, with hardly any sitting and getting shelled...

I also wonder, now, if the way medieval/ancient warriors could/would behave is linked: atrocities and what we'd consider "war crimes" were fairly common, and I think there's some indication that's a sort of reaction to combat stress in itself? Crusaders, for instance, got up to pretty horrible things, which might be a result of the unusually stressful situations (a year or more away from home, in hostile territory) they were in.

Do you know any specifics about Vietnam War combat stress reaction? What was the usual trigger? Enduring guerilla action and necessary paranoia/hyperalertness?

[ArcturusV]

From what I remember it was a combination of: A lack of proper "Downtime", with men running patrols and seeing combat almost every day. Guerrilla action leading to paranoia and undue stress. And combined with a lack of decisive action. Not being allowed free pursuit, or to properly take down their adversaries, etc.

This was compounded by the quick return, where when they did finally finish their tours of duty you go from being On Mission to 18 hours later landing in your hometown being told "Go, have a normal life".

If you're like my cousin, it gets worse when on your arrival you had people throwing stuff at you and calling you out for being a murderer and such. :smallfurious:

[Arundel]

personally, I would argue that this is a non-issue until A) the character retires from active adventuring, leaving them far too much time to reflect on their actions/suffering or B) a sufficient length of downtime during an adventuring campaign to cause this.


most people's brains will switch off the parts that cause this DURING the given circumstances.

some won't. but these are heroes.

"Sleep" is enough downtime, trust me.

[Rhynn]

And combined with a lack of decisive action. Not being allowed free pursuit, or to properly take down their adversaries, etc.

I wonder how big of a part this is. I know from running and playing horror games (TTRPG and computer) that helplessness and the inability to act against the source of your stress/fear is essential. If hand-to-hand combat is less stressful in general (at least once you're inured to killing a living thing with your hands, which people in ancient/medieval times probably were more likely to be), it may also be more cathartic - a violent release of fear. That'd also tie into the atrocities as catharsis... especially when looting a city that you laid siege to (a lot of stress built up from inaction and getting peppered with arrows etc. from the battlements).

[Seffbasilisk]

Yeah. Just gloss over the night sweats and you're done.

We call it Premature casting of Nerveskitter 'round these parts.

[TuggyNE]

We call it Premature casting of Nerveskitter 'round these parts.

Why else do you think celerity dazes you for a round?

[Khay]

Adding to the list, the forgotten-then-resurrected German RPG Space Gothic (https://de.wikipedia.org/wiki/Space_Gothic) has (or had) fairly intricate rules for this sort of thing. Basically, you had SAN points, tables on which to roll for failed SAN points, and possible permanent consequences for rolling a critical failure on the SAN check, losing too many SAN points in too short a time span and so on. PTSD was explicitly one of the possible consequences, as were various phobias. (Or, if you were especially unlucky, a heart attack.) Dropping below SAN 10 made your character unplayable, at least until after an extended stay in a mental hospital.

What was not so nice was that you could roll PTSD as a flaw at generation time. So if you were making a combat-oriented character, you could basically throw out the character sheet. :smallannoyed: Yeah, we had a house rule agains tthat.

[The Fury]

PTSD is a major theme in my games, and most adventurers are broken. In fact one of my main villians has a spell that can instantly trigger PTSD, or give you PTSD without the traumatic event. most of the characters overcoming there personal trauma is a thing. I don't make it mechanical though, its more of a role playing thing

Yeah, I've handled it in a similar way. My most recent character is a conscript from a peasant militia and I thought she's probably wasn't prepared for some of the more traumatic events in the campaign. Later I decided to start roleplaying the character as having PTSD. Basically I started hinting at some minor symptoms, like mild paranoia and difficulty sleeping-- what I'd imagine a fairly minor case. Like yours, more of a roleplay thing.



I've always been curious as to whether PTSD & combat stress existed in medieval times. The 20th century had it in several versions/under several names (shell shock, combat stress reaction, combat fatigue, etc.), but I've never read of older versions. No doubt it existed to some degree in the 19th century, and probably the 18th, because of the prevalence of cannon and gunfire on battlefields - as far as I can figure out, it's mostly caused by helplessness in the face of death (in WWI, sitting in trenches or bunkers being shelled was the big trigger, which gave the condition its name). But to what degree and in what form did, say, 12th century knights suffer from PTSD/combat fatigue? I've never read any accounts that suggest similar reactions. It could be that combat where you almost inevitably fight face-to-face, hand-to-hand, was very different psychologically.


Maybe? But the delays and downtime might have factored into it too. I mean there was a higher number of cases in Vietnam compared to say, World War II. Then again a soldier in WWII, it is said, saw combat on average only 1 day out of 63. A soldier in Vietnam saw combat on average of every other day.

I imagine for medieval warfare, it was probably even longer, where a soldier/knight might have only seen battle one day a year. If that.

Yeah, those are factors worth considering but I feel that I should point out that soldiers aren't the only ones that can get PTSD. As I understand, anyone who's been a victim of violent crime or otherwise made to feel completely helpless can get it too. With that said in medieval times people almost certainly got PTSD but it was probably less common.