Mental Illness - Mechanics and Role Playing

[Gaslampgenie]

Has anyone out there used or been a part of a campaign where a PC has had some form of mental illness?

I want to try exploring the idea of using characters with mental illnesses or serious madnesses. My biggest hang ups here are figuring out the mechanics and making sure I understand the disabilities before attempting something like that for role playing. Besides being a challenging aspect for the party I think it would be a valuable look into how such disabilities affect day to day life for those who have them (obviously not going to make you know what it feels like, but it's thought provoking)

For example I'm toying with the idea of making a character with schizophrenia. I was thinking mechanically that this would be represented by a flat -1 to INT and CHA, an additional roll for social interactions to determine if the character recognizes the entity in question as real, fake, or a threat. In addition to that, the constant struggle with discerning reality would give the character advantage (or some similar bonus for non 5e) against charming or mind dominating effects because seeing things that aren't there , feeling compulsions, and hearing voices aren't abnormal.

If you have played with or have any suggestions for mechanics and Role Playing with mental illnesses please share your experience.

[JeenLeen]

Two things to take into consideration
1) would these mechanics be offensive to those at your table
2) would these mechanics make the game not fun
3) if 1 or 2 are true, would trying to work around them negate the purpose of having the mechanics

#1 depends on those you game with, so I leave that to you.
For #2, my main concern is if a mental illness effectively renders a character either unplayable or unreliable. While this could be realistic (depending on severity of illness), it could make it hard for the other PCs to have any reason to tolerate this PC. If there's a chance they'll just ignore the dragon trying to eat the other players because they think it's fake, or a chance they'll attack the innkeeper's daughter because they think she's a dragon... that kinda renders that PC useless.
For #3, the main thing I think is that, if there's a way to bypass the bad results without a serious cost, why have the bad result in the first place? An example I could see is letting a PC spend some resource (dependent on system) to negate the effects of their illness, but if the illness is severe, the effectively means the PC must spend that resource most anytime things matter lest they wind up being useless
Part of the above is the idea that a PC should contribute to the party. If a penalty makes a PC useless, it doesn't just hurt that player, it hurts all the players since the others were relying on that PC.

That said, here's a couple examples I had in games based in old World of Darkness. The first is an example of a bad way to use it, the second a way that worked pretty well.
1. Had a mage who went into a fugue state when stressed (Will save to resist fugue, or spend a Willpower point to automatically succeed). The player choose that his actions in this fugue were to throw fireballs at the resulting source of stress. Almost led to a TPK when he failed his Will roll to not fugue at seeing our werewolf ally transform, but we retconned that since it was unfair to the rest of the party. In the boss battle in the same dungeon, he fugue'd and threw fireballs until he died from paradox backlash.

2. In a medieval vamp game, had a Malkavian. His insanity was a delusion where he though humans were animals and vampires and other supernaturals were supernatural creatures. I think he thought he was a unicorn. Unicorns were the epitome of virtue, and nightmares the epitome of evil. Whenever he saw a new creature, he'd roll to see what he thought it was.
Generally worked okay, with him thinking some people were good or evil because of what they were and being unable to be persuaded otherwise.
In one boss battle, he thought the boss was a unicorn, so he insisted we not kill it. The boss wound up being let go and caused some trouble. Fortunately, end results were pretty negligible and all-in-all was a fun game.


EDIT:
I had two Mage PCs that were effectively insane in one way or another. No mechanics, just how I played them. Putting this out here if you want to RP an insane/mentally ill person but not have mechanical impact.
One was a mage who believed life was a video game, normal humans NPCs and supernaturals PCs (presumably played by a real person), and that if you did well enough you could get into real life. This skewed his morality of things quite a bit, but wound up just being a fun worldview to RP. He objectively didn't care if mundanes died, but he tried to save them and be 'good' since that was more likely to help your reputation score and probably gave you a higher net score.

Another was a mage who, based on the deception we used so much, routinely has his memory altered. He did not know at any given time if what he believed was true or a ruse so his team could accomplish their goals, leading to some instability. It turned out his wife was Nephandi (evil mage worshipping demons), and I told the DM after the reveal that if she had just told him "Hey, it's time. We're both Nephandi, and we need to kill your allies," I may have flipped a coin to see if he believed her or not.

[Gaslampgenie]

Great input!
Regarding #1: that is something I am trying to be very conscious of. This isn't meant to offend anyone and I'd much rather play a normal character if it might be interpreted as insensitive.
I think the resource pool is a good idea and I would need to play with it a bit to get it right if I run with a randomized compulsion.
Valid point about making sure the PC is a contributing force on the whole.
Thanks for the response, this is why I posted instead of just running with it.

[JeenLeen]

Thanks.

The 'still contributing' factor is something I've thought about mainly based on games with morality systems or where there's a cost to using power (like a moral or control cost, not just spending MP/spell slots/willpower).
All too often, the negatives either don't matter at all OR they are so severely bad that it effectively makes the power a non-option, at least if you want to be fair by still contributing to the party. Even teh Paradox backlashes of Mage can be such that it hurts the party as much as or even more than the mage who suffers the backlash. So it's a delicate balance to think of a mechanic that is authentic but also 'useful' in the sense of contributing to fun.

For a game like 5e, I could see thinking of something basically like balanced flaw and trait (like the traits from Pathfinder... I think that's what they're called.) All in all the effect is minimal, but it could give a slight mechanical basis for your roleplay.
In the examples below, I'm assuming sensitivity is a non-issue to the those one is playing with. I'm sure these are (probably rightly) offensive to some degree to some people.
Depression -- you have a -1 to Cha-based skills. You gain a +1 bonus to Will saves that compel some action or strong emotion (such as going into a rage, mental confusion, compulsions to obey orders)
Manic -- you have a +1 to Cha-based skills. You gain a -1 penalty to Will saves.
Manic-Depressive -- at the start of each game, or day within a game, roll a d6. On an even roll, you use Depression; on odd, Manic.
(Replace +/-1 will advantage/disadvantage, if desired.)
Your schizoprenic example actually sounds fairly decent, but I'd change the negative from being unable to tell reality from truth to something like disadvantage on rolls when interacting with the outside world, balanced with advantage on those Will saves. The disadvantage can reflect not being sure of what is real or not, without rendering the PC useless.

In a d10 system like World of Darkness, spending a Willpower to suppress the negative effects for a scene seems reasonable. However, the mental illness in general in that system are NOT built to be a boon and a bane together, but rather punitive. It's the clan weakness of the Malkavians, or a flaw inflicted due to something bad. (At least, that's the case in oWoD. Maybe nWoD has a more nuanced approach.)

[Gaslampgenie]

Like the examples.
Good suggestion, that would make it a little less destructive to a party and I would imagine that if the DM was on board with the player you could construct/play out scenarios on a non-combat non-pivotal plot line situation that capture the difficulties of the condition without ruining gameplay for others.
I can't speak for the world, but I would say, coming from a family with a litany of mental illness through the generations that as long as the character isn't a cheap parody of a condition and the condition itself isn't the core of their identity, that it is not (to me) offensive. I would go further to say that exploring these sorts of things is what leads, over time, to awareness and understanding and this is just one way to start dialogues and spark curiosity.

[Jormengand]

I would suggest that the probability that it adds something to the game is fairly low and the benefit barely consequential, whereas the probability that something goes wrong is fairly high and the drawback immense. Would not recommend trying this, and certainly wouldn't try to add mechanics to it. If you want a game about mental disorders then Call of Cthulhu exists, but honestly I wouldn't try to do it in a game which is both somewhat simulationist (like D&D) and not equipped to deal with this kind of stuff (also like D&D).

[Gaslampgenie]

The discussion above was specifically about making the disorders more predictable in order to not affect gameplay in any significant or unpredictable way while still retaining some essence of how the disorder affects a psyche.
Given that would you still recommend not trying? And why? If it is predictable and does not hamper the PC in any significant way other than small stat changes and selectively conditional advantages/disadvantages to saves then what is the difference between this and say, a homebrew race?

[Jormengand]

To be quite frank, trying to imitate mental disorders in a game which is overwhelmingly non-abstractionist runs the risk of you displaying a somewhat insulting ignorance of the disorders in question (schizophrenia, for example, doesn't necessarily reduce your intelligence or your force of personality), and thereby making players justifiably unhappy with the way that a sensitive subject matter is being treatest.

If the game were abstractionist, it would be fine to represent a disorder as having certain mechanical effects - paranoia doesn't actually counter spells or put cards into a graveyard (http://gatherer.wizards.com/Pages/Card/Details.aspx?multiverseid=87924), but then again taking a city doesn't entitle you to an extra turn either (http://gatherer.wizards.com/Pages/Card/Details.aspx?multiverseid=201135). In Magic, what cards do is only thematically related to what they represent: in D&D, the jump skill is used to jump, people who are blind suffer the drawbacks expected of someone blind, and people with schizophrenia should have effects which actually correspond to what it does, rather than it making them dumber.

[Goodkill]

speaking as a schizophrenic, i don't like your schizophrenic example. to me, schizophrenia is a connection with the supernatural - i can't go into detail because of religious concepts, but it involves a connection with spirits and higher power(s). there are some schizophrenics, usually the stupid ones, who have beliefs that differ from this, like conspiracy theorist type beliefs.

i only once had an actual delusion (though non-religious folk would call many of my spirituality-themed beliefs delusional), and that was because i took geodon and it made me manic. that was a really weird day and i'm still not sure to what degree i was delusional, or whether some of my paranoid thoughts were accurate.

so schizoaffectives might have some trouble determining reality at times, because mania is weird and can really throw you through a loop, especially when you already have schizo tendencies.

sometimes i think my schizophrenia makes me a spiritual parasite of sorts but i won't go into detail about that. that's just my schizophrenia 101.

[Gaslampgenie]

Couldn't have asked for better insight! Beyond just trying to adapt mechanics I'm trying to better understand how these conditions affect people.
If you don't mind my asking, without getting into any specifics of your experience, is there a way you would better represent it mechanically in game?
If you're comfortable sharing a suggestion I would greatly appreciate the input!

[Composer99]

For D&D, I'm not sure that I'd recommend doing anything mechanically more complex than the 5e DMG madness variant rules, specifically pertaining to indefinite madness effects.

In short: PCs can have characteristics consistent with the illness as their trait, bond, or flaw. Playing the character in a manner consistent with such a characteristic can earn them Inspiration, which they can use as normal.

That being said, I'd strongly advise against using regular mental illnesses in play unless a player can develop a really good understanding of what living with such an illness is like, and the table as a whole is comfortable with involving them.

[brian 333]

Let's play Call Of Cthulu, where someone's insanity is the certain result of a single game session. And the characters might go insane too.

Rules for insanity are not nearly as fun as a player role-playing an insane character. In this complete freedom to act up and act out should be given. The results could be comic, but many players will give earnest effort to the task.

Begin by describing the condition. The unwitting klepto shoplifts and picks pockets without knowing, the pyro sets fires, the compulsive must perform some act repeatedly, etc. Give your player guidelines for the type of mental illness then let him ham it up. If you have a player who's been in a less public role, give him the condition.

Oh, and tell him his bonus exp depends on how long he effectively plays the condition before his party learns of it and restores his sanity.

[JeenLeen]

Let's play Call Of Cthulu, where someone's insanity is the certain result of a single game session. And the characters might go insane too.

Rules for insanity are not nearly as fun as a player role-playing an insane character. In this complete freedom to act up and act out should be given. The results could be comic, but many players will give earnest effort to the task.

Begin by describing the condition. The unwitting klepto shoplifts and picks pockets without knowing, the pyro sets fires, the compulsive must perform some act repeatedly, etc. Give your player guidelines for the type of mental illness then let him ham it up. If you have a player who's been in a less public role, give him the condition.

Oh, and tell him his bonus exp depends on how long he effectively plays the condition before his party learns of it and restores his sanity.

I think this is part of the all the players liking the idea. Let those who want to play a disorder play one, but those who don't don't, and make sure everyone is cool with how it is presented.
Also reminds me of a mage who went Jhor-crazy in a mage game (which is essentially losing empathy and compassion, and thinking everyone deserves to die). He got cursed with a ton of Jhor, but we never realized the curse was doing it, nor did the DM ever have to compel him to act in a certain way, since he was RPing it better than it was required.

On the other hand, I do in general agree with Jormengand that this is overall a bad idea -- I wouldn't do it if I were homebrewing a system -- but it sounds like the opening-poster and their group are okay with it, so if that's the case, it seems fun for them and no harm done, so homebrew for this particular table's game seems fine.

[Goodkill]

mania could be interesting to play i guess, giving a bonus to charisma and a penalty to wisdom. depending on how severe the mania is, it could cause some serious psychotic symptoms. like severely delusional beliefs about your self importance and whatnot.

an example of a schizophrenic "symptom" is thinking that a tv commercial is somehow about you specifically, like about what you happened to be thinking about at the time. this is called a "delusion of reference", or a belief of reference more generally - the people who experience these generally don't think they're delusions. it really depends on your belief system. other symptoms are voices - you could have fun with this! i believed that i talked to a spirit who i had known before he died tragically. he was nice and helpful at first but then things started to get a little poltergeisty. (i don't talk to him anymore except in dreams; to me, this is a spirit attachment, or haunting of sorts.) then there are hallucinations. i think my positive symptoms i had were mainly due to mixing alcohol with stimulants, but i might be wrong. i usually hallucinated while i was lying down, for whatever reason. you could roleplay this as spirits coming to the player and communicating telepathically through dreams or hallucinations.

depression just sucks to be saddled with i guess. it would probably give penalties to will saves especially but might be a flat morale penalty to a lot of things.

[Jormengand]

depression just sucks to be saddled with i guess. it would probably give penalties to will saves especially but might be a flat morale penalty to a lot of things.

I would say it would actually give a bonus to saves against fear, pain or emotion-based effects (like cause fear, symbol of pain and rage, for example), though. "Oh, you're trying to eat me, that's cute, I don't actually care." "Oh, I'm in pain? Good, at least I can actually feel something now." "You want me to get angry? Nah, can't be bothered mate."

Though again I question how most mental disorders could be fun to roleplay, except maybe Dissociative Identity Disorder (because let's face it you get to play as multiple people which can be kinda cool).