On the Subject of Roleplaying Games, Safety Culture, and Mental Health

Content Information: This article discusses mental health issues and unpleasant situations regarding anxieties, psychosis, PTSD and related subjects.

*This is a repost form my old blog. Original here*

The Premise

I’ve been playing roleplaying for many years, and in my part of the community, “the safety debate” have always had a big role. I am talking about the nordic/international progressive LARP and tabletop roleplaying community and the ongoing safety discussion that has both become a staple in game design and an infamous subject of many heated debates within this milieu. Throughout this post when I refer to “the safety debate” this is what I mean. I am not going to go into the details of the many, many different emotional safety practices used within this subculture. I also primarily focus on the singular roleplaying experience that happens during play but there is a lot of other aspects to this subject concerning the cultures and communities surrounding the act of playing the games.

I am not claiming to be a professional and the following discussion is not an attempt to ignore or suppress anyone’s experience. What I am trying to say is that I have had a lot of experience dealing with many different approaches to mental health. A lot of my initial thoughts are based on ideas from Cognitive Behavioural Therapy (CBT), Dialectic Behavioural Therapy (DBT) and western medical clinical diagnosis praxis in general.

I primarily have my experience from tabletop/short chamber LARPs/freeform games, and some of my points might not apply to all forms of roleplaying. I also will not go into the subject of depression in this essay, it is long enough as it is.

At the bottom of this essay, you can find sources and further discussion on this subject.

The D&D Panic

Most of you probably know of the roleplaying scare the ran through the 70’s and 80’s, particularly focused on Dungeons & Dragons. I am not going to go into details, I just want to make a quick point. During that time the media painted a panic-inducing picture of the roleplaying hobby as really, really dangerous and the act of roleplaying as something that could lead to insanity. I mainly see this trend as an expression of Juvenoia (an exaggerated fear about the things that influence kids these days), its prevalence caused by the lucrative business that emerged from this panic and a lot of other factors that have nothing to do with the act of roleplaying itself. You probably do as well, at least on a conscious level.

However, a lot of us lived and grew up during this period and were exposed to this view on roleplaying not only through the media but maybe even through our parents, friends, doctors and teachers. My point is this: I am all but certain than the view that roleplaying games are dangerous was internalised into the different roleplaying cultures, and that we still see the effects of this internalisation today. I think this is a big part of the “why” behind this very prevalent safety debate. I know I have come across multiple examples of roleplayers claiming that the hobby can cause insanity and that it is a dangerous hobby. But apparently, roleplaying + insanity is a difficult subject to google so I could not find any good direct sources. However, Peter G Stromberg also mentions this tendency in his book “Caught in Play”.

“I am all but certain than the view that roleplaying games are dangerous was internalised into the different roleplaying cultures, and that we still see the effects of this internalization today.”

Roleplaying, Strong Experiences and Psychosis

Let us just engage with the thought for a while can roleplaying actually cause insanity? When I say insanity I refer to psychotic disorder. While the majority of psychotic disorders are believed to be caused by genetics, drug use, and other medical conditions the rather controversial and debated Brief Psychotic Disorder might be applicable to roleplaying although with a very liberal approach to the subject. The diagnosis is rarely used and is usually applied to people suffering from a temporary psychotic state not lasting more than a month that might be caused by an urgent and stressful life event up to 2 weeks prior to the psychosis. Under an assumption that gaming has radically different immersive qualities than other forms of media we might engage with the thought that a Roleplaying experience might cause a similar stress which might induce a psychosis.

However, most medical research on the subject seems to suggest this is not the case. Especially since the mere premise of being immersed so deeply into a fictional reality that it might affect you the same way a real life experience would possibly mean you are already suffering from some sort of psychotic disorder. And there is a lot of problems surrounding the Brief Psychotic Disorder one of them being that the diagnosis is partially based on psychotic patients own retelling of events and that is almost exclusively applied because no other known psychotic diagnoses fit the situation.

Another type of psychotic disorder worth mentioning and then quickly dismissing is the Shared Psychosis. Due to its rarity and that fact that many known cases involve people who are genetically related I will not go further into this diagnosis.

An important note here is that I distinguish between actual psychotic diagnoses and psychotic thoughts or unrealistic/magical thinking in general.

I personally do not believe that roleplaying experiences carry the potential to trigger a psychotic episode or disorder, at least in its medical definition. Now, I have no doubt that it is possible for someone who is already exposed to psychotic episodes might have a psychotic episode during a roleplaying experience and that might be wrongfully interpreted as the triggering event. And why would it not? If you have never experienced this sort of thing before and it comes up during an intense roleplaying experience it would seem rational to make that connection.

Why am I even spending time on this? Well, because psychosis is actually dangerous whereas negative and unpleasant experiences are not.

“I personally do not believe that roleplaying experiences carry the potential to trigger a psychotic episode or disorder, at least in its medical definition.”

Traumatic versus Negative

I believe it is very important that we actively distinguish between actual danger and unpleasant experiences. This is something that has already been noted and discussed by several other debaters on the subject. For me at least, this is not about semantics but rather about anxiety, behaviour, and mental health.

An important point is that most of the common emotional safety practices are in no way capable of nor designed to handle actually traumatic or dangerous situations. They may instead be used to create a certain social experience around and in both the games and the culture surrounding them or help establish/re-establish a social room for acknowledging feelings and reflexion that happen during and after the game. In the best cases, these practices might help to avoid unpleasant experiences both during and after the game (we will talk about avoidance behaviour a bit later and why this is not necessarily only a positive thing). In the worst cases, they do almost exactly the opposite. Other people have written better texts about this some of which I have included links to at the bottom of this page.

While I find a some of the practices that have emerged from the safety debate to be productive towards creating more positive experiences while we roleplay I believe these practices, the discussion surrounding them, and our collective behaviour towards this subject can also contribute to some problems one of them being anxiety.

“An important point is that most of the common emotional safety practices are in no way capable of nor designed to handle actually traumatic or dangerous situations.”

Anxiety and Cognitive Behavioural Therapy

Anxiety is a huge subject and we are getting into the land of analogies and interpretations now, but these theories fit the known facts pretty well. And they seem to be very effective when treating many types of anxieties and personality disorders. However, consider yourself warned.

The most prevalent view on anxiety is that is closely related to fear a feeling that is very useful for short-term survival in dangerous situations. In a lot of Cognitive Behavioural Therapy, it is generally believed that negative feelings are a form of danger signals that you need to react on in order to make them stop. It is based around the general idea that our senses and feelings can be described as our bodies’ and subconscious’ way of communicating experiences and needs to our consciousness.

Some anxieties might be caused by failing to act on or at least acknowledge the feeling of fear, but instead, the person suffering from these anxieties have consciously or unconsciously suppressed that feeling thereby turning it into the more chronic feeling of anxieties.

Fear and to a very small degree anxiety are useful feelings in handling or avoiding dangerous situations in real life like being attacked by a predator or a mob of angry people. But in many cases, anxiety and fear signals comes from common situations that are not dangerous like commuting to work going to a party or being close to a non-venomous spider and the symptoms can cause a lot of distress in people experiencing these feelings. Anxieties and fears are something almost every single human on this Earth will be faced with many, many times in their life and although is really not that dangerous it might be very unpleasant, even limiting people’s freedom and happiness, and in rare cases leading to dangerous behaviour or other medical conditions.

Applying fear to non-dangerous situations and failing to recognise and acknowledge these fears might lead to people experiencing anxiety in these situations. And engaging with this anxiety, acting on the situation as if the fears were real, further incorporates this behaviour into your automatic reactions ultimately making the anxiety occur more often and appear more intense.
E.g.: A war veteran suffering from posttraumatic stress disorder experiences anxiety whenever they hear footsteps behind them. The idea that someone approaching from behind is dangerous might be true in warfare, but it does not really apply to walking through a busy street in a peaceful city. Engaging with this feeling by starting to run away or even simply turning around to assess the source of the footsteps might further anchor this anxiety making it more likely to happen again in the future. However, continuously reminded yourself that footsteps are not a sign of danger and using various techniques (like mindfulness, commonly used in CBT and DBT) to positively cope with the situation often leads to the anxiety lessening and eventually disappearing completely.

Another common problem with anxiety is avoidance behaviour. A very normal and rational reaction to having negative reactions to a certain situation is simply to try and avoid such situations in the future. And that is an okay solution if the situation is avoidable without any negative repercussions on your life. However, if the situation is something that might occur commonly in your life or is related to something you actually really want to engage with avoidance behaviour can become a problem. This has happened to me in relation to the roleplaying community. Since I started experiencing anxiety around large crowds of people, loud noises, and a bunch of other common situations that might occur when attending a convention I have been avoiding them – and conventions are one of my primary ways of interacting with the roleplaying community. This avoidance behaviour might anchor my anxieties further and make it increasingly hard for me to attend conventions in the future. Avoidance behaviour is sometimes a great short-term solution to your anxiety but long-term it might be a problematic strategy.

“Applying fear to non-dangerous situations and failing to recognise and acknowledge these fears might lead to people experiencing anxiety in these situations.”

What Can We Gather From All This?

If you followed me this far you might see my point creeping up. I am a bit concerned that when we talk about roleplaying as if it were dangerous, design as if it were dangerous, and behave as it if were dangerous we might accidentally create and reinforce anxieties almost fulfilling our own prophecy. Almost but not completely because as stated anxiety is not dangerous but merely unpleasant.

The fact that many of these games simulate stressful and dangerous situations only reinforces this pattern further. And if we further engage in problematic behaviours like avoidance, which seems to be the goal for some emotional safety practices, we underline this problem.

Is this a problem? Well, yes it might be for some people. But most of us seem to be handling these feelings quite functionally and relatively healthy.
Is it dangerous? Hell no.
Can we do better? Of course! We can always do better.

It is nobody fault really, it is just a result of us being human.

“I am a bit concerned that when we talk about roleplaying as if it were dangerous, design as if it were dangerous, and behave as it if were dangerous,we might accidentally create and reinforce anxieties almost fulfilling our own prophecy.”

I Do Not Know What the Solution Is, But I Do Know What It Is Not

I am not going to try and come up with a bunch of solutions. That is not the point of this post. The point of this post is to make people aware of this perspective, and let us individually and collectively reflect on our approach to designing and experiencing roleplaying games.

I do want to touch on one important subject related to this: Trigger Content Warnings Information. Exposure towards anxiety triggering content might be the long term solution for many, but that does not turn game designers into therapist!  And it does not necessarily mean that everyone is ready to, and gain benefit from, facing these issues right now and in this specific situation. Effective therapy is provided by a professional, with mutual consent, and calibrated to the individual.

On a personal level, please be aware that if you are suffering from anxieties, PTSD, or in general feel that have some issues that roleplaying might help you to work through do not do this by yourself. Roleplaying is not therapy and game designers do not equal mental health professionals. Self-therapy and exposure to panic attacks do not mix well. If you want to do this, you should be in active therapy so a professional might help you deal with the fallout from these experiences. Otherwise, you will easily and probably end up making the problems worse and ruining a lot of other people’s experience in the process.

And on this note, the one safety mechanic I will mention and praise is the “Telling your players what the game is about and what content they will be exposed to before we play”-mechanic. The trigger warning, or the table of content, or whatever you want to call it. Because allowing your players, especially the ones with problematic anxieties, to take control of their experience might allow them to engage with the subject in a healthy way or to avoid it! If they are ambushed by the content in an intense situation you might end up undoing lots and lots of work sending them into a panic attack and further reinforcing their problems.

Do not use this essay to put yourself in unpleasant situations you can not handle on your own. And do not use this essay to justify your unethical and unpleasant game design. And specifically, do not use it to justify ambushing your players, neither as a game designer nor as a co-player.

“Do not use this essay to put yourself in unpleasant situations you can not handle on your own. And do not use this essay to justify your unethical and unpleasant game design.”

Take care of each other and take care of yourselves. <3.

Sources and further discussion:

In English:

On The D&D Panic and Mental Health:

The New York Times video “retro report” on the D&D panic.
The paper by David Finkelhor that coined the term Juvenoia
Michael Stevens video on Juvenoia
Article where Peter G Stromberg summarises a simple point from his book on this subject
The Merck Manual on Brief Psychotic Disorder, on Shared Psychosis, and on Anxiety Disorders in general
Wikipedia on Dialectic Behavioural Therapy
CrashCourse’s video on Anxiety (and OCD)
Alice Boyes’ article on avoidance behaviour and anxiety
PBS Idea Channel on Classroom Trigger Warnings and why they don’t restrict speech, they create it
David J. Morris’ article on why prolonged exposure therapy can be very problematic

On roleplaying, game design, and the international and nordic freeform community:

Markus Montola’s paper on “The Positive Negative Experience in Extreme Role-Playing”
Lizzie Stark’s primer to safety in roleplaying
Maury Brown writes about culture and trust through safety mechanics and design
Sarah Lynne Bowman’s article on consent culture and trust in roleplaying and on the use of debriefing after play
John Stavropoulos’ X-card, an example of a well-known, tried and tested safety mechanic
Johanna Koljonen’s talk on opt-in/opt-out safety design and I would suggest you check out her blog in general if you want to dive into this subject
Troels Ken Pedersen’s blog posts on how safety mechanics and culture is related, on when safety mechanics fail, and his essay that originally inspired me to write this

In Danish:

Morten Greis Petersen Fakkelskov’s blog post on the D&D panic.
Troels Ken Pedersen’s blog posts on how safety mechanics and culture is related, on personal versus communal responsibilities, and his essay that originally inspired me to write this
Oliver Nøglebæk’s essay on this discussion

The photo was provided by New Old Stock.

Published by Asbjørn Olsen

Mechanical engineering student and game designer interested in everything from behavior change and self-reliance to woodworking and surrealism...

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