On the baseline for mental health

I was going to hold off on a post about dominate and mental control magic, being that I’m still working through my spell lists, but I came across a forum thread that put forth an interesting notion: what does it take to produce extreme mental trauma?

EDIT: The rule concerning Morale was originally written incorrectly. I’ve made the proper adjustment below.

Specifically, the thread had a throwaway line about a dominated subject performing an act so horrific that the experience scars him for life, something like, “What kind of PTSD would an NPC experience if forced to murder his companions and friends?” I’m paraphrasing, of course, but the idea was put into my head. Then, just this morning, I found this podcast where the hosts discuss mental illness in the context of Call of Cthulhu. Finally, I’m reminded of a draft I started last year about the book On Combat and how we might apply certain lessons to NPCs in our world, in order to make the game a bit more realistic and to give the PCs a slight edge (not that they need it, necessarily, but a lot of my rule additions have made the game harder to survive, so I feel they’re due for some help).

So what do we know about mental stress, trauma and illness?

Mental stress occurs whenever the mind experiences an event that triggers a fight-or-flight response. Typically this is some sort of immediate danger, like the threat of harm or violence, and can come from another person, an animal, the environment, etc. In the past few decades, we’ve learned that the stress response is also brought on by any activity where your mind thinks it’s in danger. For example, military drone operators work in a relatively safe environment, being on a base that is far removed from the drone’s actual location, yet operators have displayed signs of stress commonly associated with actual combat and threatening situations. We’re not entirely sure why this happens; we just know that the mind can be tricked into perceiving something as threatening even when it might not be.

The stress response generates a physiological change that prepares the body (and the mind) to protect itself. Whether you ultimately choose to flee or face the threat, the physical change includes the same elements: increased adrenaline production, heart rate and breathing, which contribute to powering your muscles, making you faster and helping to ignore pain; decreased function in your stomach, intestines, bladder, kidneys and any other organ that doesn’t help during a fight; and the shutting down of higher level thinking, as the mind shifts gears into a sort of “lizard brain” state, where you’re operating on pure instinct. In On Combat, Grossman refers to the progression from no arousal to full arousal as stages or zones, where the green zone is a body at rest or relaxation; amber is a state of awareness or readiness; red is full on arousal, as you would experience in a fight; and black is a state of hyper arousal commonly brought on by being in the red zone for too long a period of time.

What I found particularly interesting in Grossman’s analysis is that prolonged exposure to stress can cause mental trauma. This intense/prolonged stressful state puts too much adrenaline into the body; keeps the heart rate and breathing too high and for too long; and generally exhausts the body and mind, pushing into a black zone, as opposed to green/amber/red. The long-term effects of trauma are difficult to assess but have been observed with greater frequency among veterans of wars such as the American Civil War, World Wars I & II and the Vietnam War; and even more recently with conflicts in Iraq and Afghanistan.

There’s one more detail relevant to trauma: less intense moments of stress, occurring with greater frequency, can add up and contribute to trauma. It’s as though the mind keeps track of all the stress it endures until it’s filled to capacity and that stress turns into permanent damage ~ but here’s the thing: you can overcome and mitigate stress by engaging in activities that relax the body and mind. A person might theoretically withstand a lot of stress, on a regular basis, with each moment being incredibly intense, so long as he has the opportunity to relax, decompress and otherwise recover from those experiences. For example, while war is hell (and always has been), we have far less evidence of PTSD in literature from the ancient world. This might be because the authors didn’t know what PTSD was (and didn’t have an equivalent concept, like shell shock); yet it’s just as likely that the way they waged war allowed for relaxation and decompression. Ancient armies didn’t fight at night, after all, which gave soldiers a chance to let their guard down.

(Mental illness is an entirely different subject, given that it’s much harder to diagnose and that we don’t always understand where it comes from, and so we’ll leave it off the table for the remainder of this analysis.)

We can model mental stress with the current system, using hit points and exhaustion levels. Hit points represent skill and conditioning, both physical and mental, so it’s easy enough to argue that any successful hit (one that deals damage) is as much about mental stress as it is about physical injury; the same applies to exhaustion and since each system has its own rules for recovery, we have options for adjudicating the effects of stress. We should also remember that NPCs are limited by morale, a system by which we can gauge whether or not they lose their focus, turn tail and run from the source of their stress ~ effectively a fight-or-flight model ~ which gives us three distinct means of measuring the effects of mental stress on characters.

Trauma, therefore, is the thing I’m looking to address as a new element. There are a few ways we can do this, but first I want to look at existing rules and other games, to see if we can cover these effects without reinventing the wheel.

Call of Cthulhu has a Sanity mechanic, which has been adopted for D&D in the past, and generally works like hit points: every character has a Sanity score which is depleted whenever that character experiences something traumatic. Sometimes there’s a saving throw to resist the Sanity loss and sometimes there isn’t. In some versions, a character can recover lost Sanity; in some, they can’t. I don’t mind having an extra stat to keep track of ~ though players may grumble, and they’re right to do so if the mechanic doesn’t bring anything meaningful to the game ~ but I’ve always felt that existing Sanity rules fail to properly reflect how trauma affects the mind.

The World of Darkness (and related games) has a Morality system where a character must make a check whenever he performs an act that is outside the limits of his current Morality score. With every check, there’s a chance that the character will acquire a Derangement, a sort of mental illness as a result of the trauma associated with his bad behavior. Obviously, the issue with this system is its reliance on defining good and bad behavior, something that I generally find distasteful because it forces the DM to police player behavior without the benefit of clear guidelines or rules ~ because morality is not so easily defined as it needs to be in order to have an effective system.

Either of these systems could work, with some adjustments, if I were aiming for rules that apply to player characters. The more I think on it, the less I’m inclined to go that route. Players already have a lot going against them ~ the world is a dangerous place, after all ~ and given my position on the player character as a psychopath, I don’t think it makes sense to demand that the player put up with mental trauma. If I were running a true horror game, maybe; but since my game only has horror-like elements (in the form of evil and alien monstrosities, hell-bent on perverting existence to their whim) . . . it just doesn’t seem to fit.

No, what I really want is something that will tell me if and when an NPC becomes traumatized because of some extreme experience (usually something the players are responsible for). That way I can create other rules, such as for magic spells and items, that play into the rules for mental trauma. And since I already have a mechanic that addresses when an NPC loses control of himself, I figure I should go from there.

Every NPC (and most creatures or monsters) has a Morale score ranging from 2 to 16. A Morale check is made with 2d8; the objective is to get equal to or less than the Morale score. Thus, a high score is good and a low roll is desired. Whenever an NPC fails a Morale check, he will usually become frightened, dropping whatever he is carrying and fleeing from the source of his fear as best he is able. Other results are possible depending on the circumstances that force the Morale check.

An NPC makes a Morale check whenever the situation demands it. There is no complete list but there are some common occurrences, to include:

  • Drawn weapons.
  • First blood in a fight.
  • First kill in a fight.
  • One-quarter of one’s allies are slain or driven off (and again at one-half and three-quarters).
  • A display of obvious superiority, such as the use of a magic spell or item against an opponent that has no such power.
  • The use of a magic spell or item that specifically calls for a Morale check.
  • The sudden or unexpected appearance of a beast or monster (or similar threat).

And so on. Certain NPCs always fail their Morale checks (typically those who have no combat training). An NPC that rolls “box cars” (the maximum result, a reference to double 6s on pip-face dice) (since I use d8s, maybe I can call the max result “infinity?”) has bolstered his resolve and automatically succeeds on the next Morale check (that occurs within the same scene). Finally, PCs have access to certain skills and abilities (appropriate to certain classes) that benefit NPC allies, followers and henchmen.

Following these rules as a guide, we can add a piece that covers mental trauma: whenever an NPC experiences one of the following events:

  • Travel to another plane of existence.
  • Physical or mental contact with a demi-god (or similarly powerful entity).
  • Physical contact with an alien being (an aberration).
  • Mental contact by a planar being (such as a demon or an angel).
  • Mental domination resulting in behavior that is antithetical to the NPC’s personality.

. . . he must make a Morale check. Failure indicates he suffers mental trauma which results in some sort of limiting trait or characteristic. I’m not sure what that list will involve, except that something like a phobia or obsessive/compulsive behavior seems appropriate. I’m hesitant to follow the WoD example too closely because I know that mental illnesses like schizophrenia and dissociative personality disorder aren’t really something you can link directly to trauma. Regardless, given that we’re only talking about NPCs and this sort of thing will only happen under specific circumstances and only when the character fails a Morale check . . . it’s probably fair to say that it won’t happen too often.

So why go to all this trouble? I started this by talking about domination magic and all I’ve done so far is discuss how we address mental health and wellness in terms of game rules ~ but it’s necessary because you need to know how something works without magic before you figure out it works with it. Now that I have the seeds of an idea in place, I can look at expanding my rules in a manner that’s internally consistent and offers the best opportunity for adventure.

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