Mental Disorder
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Basic Information

A Mental Disorder is a psychological or behavioral pattern which causes distress or disability beyond that expected of normal development or culture.

There is a somewhat blurred line between (allowing for ever changing nomenclature) "mental illness" and "personality disorders", which usually depends on how well integrated the disorder is into the sufferer's identity. In general a personality disorder is better integrated and may not even cause any distress to the "sufferer"1 - these can be difficult to diagnose and still harder to treat (not least because the patient may not be interested in being treated and may claim that the problem is not with them, but with a society which fails to account for their needs.2). More conventional mental illnesses are likely to be more obviously dysfunctional and will normally cause the patient distress and/or be noticeably disruptive to their baseline personality3.

A disorder may result from psychosocial factors (such as upbringing) or physiological ones (such as defective brain chemistry) or some combination of the two - these can be treated with drugs, social therapies4 or physical therapies5. There is a great deal of debate what works (best) for what. Combing therapeutic methods is also attempted from time to time - for example using psychotropic drugs in combination with talking therapy to allow access to deeper conscious states than can be achieved with the unadjusted mind (this is, arguably, the original way these substances were used in primitive medicine rituals6, was rediscovered in the 1960s and, following extensive re-evaluation, is being attempted once again in the 2020s. It has also been used in … non-therapeutic ways - see, for example MKULTRA).

Historically "madness" was also thought to result from supernatural causes including curses, demonic possession or malign astrological influences. In a supernatural campaign these may or may not exist in parallel to more mundane causes and finding the right tool for the right job will then be even harder. For a real challenge, place someone with a supernatural form of insanity in the care of medical professionals too clever to believe in the supernatural and require the PCs to arrange their cure.

List of Mental Disorders

See Also


2. Mental Health Guru - website has numerous short videos explaining various mental disorders

Game and Story Use

  • Enemies with visible mental disorders can be especially disturbing foes, since the PCs cannot expect them to behave rationally and predictably.
    • In particular, it may not be possible to rely on an insane opponent's sense of self preservation to prevent him from using forms of attack or routes of approach that a sane person would never even consider, or likewise to surrender or run away when it becomes a good idea to do so.
    • Also, someone with a detached view of reality may be capable of atrocities that someone more centred wouldn't contemplate - most mad people are more dangerous to themselves than others, but some can perform horrors without even realising that they are doing wrong.
    • …and then there are the dangerously sane. People who lack some or all of the comfortable, socialising illusions and deceits that help humans rub along together and entice them to cleave to some form of morality: "Hear me, then, too: I have seen robbers rule, and thieves go clad in gold - age after age - because, though sordid, ragged, rude, and mean, they saw, like gods, no law above their heads." This is generally written off as some kind of personality disorder.
  • They can also be pitiful, and introduce a note of black and grey morality when the heroes find themselves battling an opponent who is clearly delusional or otherwise not fully in control of his actions.
  • The line between madness and evil can be a thin one - and when they are fighting an enemy who became a monster because of some trauma that his victims inflicted on him in the past, or through being a hero who stared too long into the abyss, then the conflict takes on a very different tone.
  • A mental disorder can also be a quirk for a neutral or allied NPC, or a flaw or hindrance for a PC. This could be anything from compulsions to lost time to a full-on Unreliable Narrator.
  • As stated in the main article, many cultures have attributed mental disorders to supernatural causes. The PCs might need to figure out whether an NPC suffers from schizophrenia or possession… or his claims aren't actually delusional. And then spring him from the mental hospital, save him from the exorcists, or get him away from the wizard who wants to apprentice him.
  • Contact with the supernatural might well lead to (a diagnosis of) mental disorder - after all, since werewolves, vampires etc. are all well known not to exist, anyone who seriously believes that they do must be delusional and probably dangerous towards his fellow citizens. This is discounting any psychological harm the person in question actually did suffer when their worldview was turned upside down by an encounter with something that couldn't possibly exist…
  • The Call of Cthulhu RPG has specific mechanics for damage to PCs sanity caused by encounters with the various incarnations of the Mythos … this is often taken as a shorthand to mean "scary things make you crazy" but is also meant to reflect the source material's implication that the underlying reality of the universe is completely at odds with human understanding and cannot be comprehended by a mind that could be called sane by normal standards. The "completely insane" character may actually be fully adapted to understanding the higher realities of the world, but he is no longer in a position to interact with normal humans. The various disorders acquired along the path are best depicted as coping mechanisms adopted by a brain struggling with the cognitive dissonance necessary to remain functional or as radically shifted priorities resulting from the character's new outlook on life.
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