Psychosis in Games

Psychosis is badly written in games and will eternally be written badly. There is something appealing in including carefully mechanized psychosis as a punishment for your character’s actions or lack thereof, or as punishment for failure and success alike. That it always reacts to something, a brain-melt with a distinct source. Maybe containing the experience this way feels safer, with a clear cause-and-effect. The reality of psychosis does not matter to any creative medium as much as the expectation that the “psychotic” is violent, aggressive, dangerous, and manipulative.

It does not work that way. Framing psychosis and mental illness as a punishment or earned is another way of othering those who experience it. Though it can certainly happen, it is not depicted any other way. Where some things spring up from traumatic experiences, it is more likely conditions commonly depicted this way (OCD, schizophrenia, psychosis at large) do not. I did not become this way because I earned it. I did not fail my Sanity rolls until I became insane, and god forbid I was not corrupted into having schizophrenia.

Attempting to mechanize something so intensely personal, different, and mutable as mental illness is complicated. I think that makes these depictions bad! Not treating it with the care it deserves. No one with any mental illness or neurodivergence could possibly say, with their whole chest, they feel its effects in the exact same way as anyone else. No one could possibly say every thought and feeling they have is not, in some way, touched.

Psychosis does not work linearly. It is not a descent into madness. Episodes worsen over time as easily as they disappear. Even with schizophrenia, symptoms do not constantly manifest and it does not make anyone “broken”—just as it isn’t caused by being broken. Even individual symptoms don’t present uniformly.

You can’t mechanize psychosis if you do not consider how real people experience it. If all you see and depict are regurgitated tropes, you will never write it well and I will never believe you’re a good writer. You chose to depict something you refused to understand. Asking a therapist how someone might feel in a psychotic episode is not an attempt at understanding.

This is not to say it can’t be done! But you cannot shove in a troped-up symptom of one facet of hallucinations and claim good faith. It not only furthers the othering inflicted onto those who cannot escape psychosis when they are done playing, but is also incredibly lazy.

I can’t fathom how one begins broaching a topic so inundated in historical, religious, and personal relevance and comes back with mechanics as irrelevant and insipid as “lose control of your character.” It ignores grappling with these feelings, and how motivations shift and change with your perception of reality. Adding this into your game would necessarily involve these perceptual shifts, and the shifts-of-the-shifts, without demonizing the experiences. Psychosis is distressing. If you’re exploring it, it should not be comfortable and safe, cordoned off by methods of avoidance.

I’ve not read a good example of psychosis in a game, so I can’t use that as a jumping-off point. I think successfully mechanizing psychosis in a way that is at least interesting (all I can ask for) is figuring out why you want to include it. Is it relevant? Are you trying to incorporate a wide range of human experiences? Do you want to explore how and why people feel things, and how one can feel them so differently?

(As an aside, for the most part, the answer to these questions seems to be “no” in the texts including psychosis mechanics. It is out of sheer laziness and expecting the reader “gets what they mean” through well-known media tropes instead of an actual earnest attempt at depiction).

Figuring out why you want to include psychosis, and why it must be included in the rules text and not simply roleplayed at the table, is the most necessary step. It will inform what you want to include and research. Even I need to research if I want to include it in a system because I only experience a tiny fraction of what it can entail.

I wanted to elaborate more on how some systems can be fixed but, the more I read and researched, the more distressing it became. So, sorry. I won’t be explaining how to fix these things because I don’t even want to consider how my real life experiences are written about so casually in such popular books. I spent a few hours writing and deleting these parts, but there is so little empathy written into the systems surrounding these mechanics and I’m not getting paid for it. I can’t force myself to sit through it. Just remember: people dealing with psychosis are still people, even if they’re inconvenient.

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FAQ
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Will you tell me my favorite game isn’t bad at depicting mental illness/deserves an exception?

No.

Why don’t you name any games?

I have read a lot of systems for this essay. None of them were good, even games I like and enjoy playing. Listing specific games results in two things: people who disagree with me see it as a list of games they can now play to prove how much I deserve alienation/othering/stereotyping, and people who may agree or disagree with me see their favorite game and get mad at me about it.

How can you tell if a game is bad at depicting mental illness?

Short answer: it is. Long answer: it is. If you cannot figure out why, read this essay again.

How did YOU decide if something was good or bad?

If the text, description, mechanics, rulings, etc. made me feel like the writer saw me as a human worthy of respect even if I was dealing with the same things that they had mechanized, then it was good. (They did not.)