An RPG of Clinical Depression

[ethan_greer]

This game's subject matter has been much on my mind lately, and has been a part of my life for many years.  But before I say anything else, I want to make one thing abundantly clear:

Personal comments of any nature (including condolences, encouragement, or suggestions of any kind) are not welcomed in any capacity, in public or in private.  Just don't do it.  You don't know my situation, the specifics of which are not open to discussion.

On the other hand, I'd love to get comments about the game.  Specifically, does it do what I set out to do?  If you have any knowledge or experience with clinical depression, I'm particularly interested in what you think of the game.  Is it too obviously specific to the author's realm of experience?  Should I spell out concepts to a greater degree to make them easier to understand? Is this whole post just too much information?

Without further ado, but with a bit of trepidation, here's the game.

*  *  *

A Role-Playing Game of Clinical Depression

What you need to play:
White dice - d4, d6, d8, d10, d12
Black dice - d4, d6, d8, d10, d12

You suffer from clinical depression, and you're having an episode.

The white die represents you.
The black die represents your debilitating affliction.

At all times, you will use one white die and one black die.  The die type for each color may shift up or down as a result of events in the game as well as in the mechanics.  Both dice start at d12, unless modifiers prevent a die from being that high, in which case the highest permissible die type is used for that color.

Whenever you want to do anything more strenuous than continuing to breathe in and out, roll dice.  Seriously.  Roll dice to sit up in bed.  Roll dice to walk across a room.  Roll dice to not cry.  Sometimes it will be appropriate to roll dice to breathe, as well.

Task resolution works like this:
Roll both the black and white dice.  If the black die is greater than or equal to the white die, you fail, and your white die is reduced by one die type (to a minimum of d4).  If the white die is higher than the black die, you succeed, and your black die is reduced by one die type (to a minimum of d4).

If at any time you roll the maximum value on the white die, increase it by one die type (to a maximum of d12).  This cancels out the reduction in die type that results in a failure.

Triggers:
Each character has two or more triggers.  A trigger is something that, well, triggers a depressive episode.  Whenever a trigger is encountered in play, the black die jumps to d12 (or its maximum allowable level).

Sample Triggers:
The lawn needs mowed. (You don't mow it because you're a bad, irresponsible person.)
You're late for work. (The reason you're late is because you're lazy, and you lack the self-discipline of the average 6th-grader.)
You hear someone laughing. (They're laughing at you.)
Someone calls and leaves a message on your answering machine. (You don't call them back because you're a lousy friend.)
Something good happens to you. (You don't deserve it.)

Modifiers:
If you are in any kind of therapy (counseling, anti-depressants, etc.), your white die cannot go below d6.  If you are not in any kind of therapy, your white die cannot go above d10.

Self-medication:
If you use drugs such as alcohol, tobacco, marijuana, heroin, etc. to self-medicate, your black die cannot go above d10.

NPCs:
NPCs have two stats.  Both are measured in three levels (High, Medium, Low).

Understanding: This is the degree to which the NPC recognizes that depression is an actual medical condition. Understanding is usually Low.

Sensitivity: This is how the NPC treats you.  Sensitivity is usually Medium.

When dealing with an NPC, each Low stat decreases your white die by one die type and increases your black die by one die type. each medium stat increase your black die by one die type.  High stats have no effect.  These modifiers are not "permanent," but only in effect for rolls when dealing with NPCs.  Although changes to dice as a result of rolls are permanent.

How To Play:
A scenario is a single day.  The game should be played 1-on-1, with a GM who suffers from or has knowledge of clinical depression and a player who does not.  The day starts with the character waking up, and the first thing that the character thinks about is one of his or her triggers.  Start rolling.  GMs should remember to incorporate the character's triggers several times during the course of play.

Ending the Day:
A day ends (for the purposes of the game) in one of two ways, either in an anxiety attack or in transcendence.

Transcendence:
Whenever it happens that your white die is at its maximum possible die type and your black die is at its minimum possible die type, the day is over for the purposes of play; you can function normally.  You may start a new day immediately, resetting the dice to their maximum die types, or you may end the session on this positive note.

Anxiety attacks:
Whenever it happens that your white die is at its minimum possible die type and your black die is at its maximum possible die type, you have an anxiety attack.  Your character cannot do anything (except breathe with difficulty and maybe cry) for the next twenty minutes of in-game time.  If your character was standing up or walking, he or she slumps to the ground.  If your character is driving, or engaging in some other life-threatening activity, he or she stops doing this activity in a moderately safe fashion (at least safe enough not to kill yourself or others).  When an anxiety attack occurs, you the player are required to sit still and say nothing for twenty minutes of real time.

After an anxiety attack occurs, just reset the dice and go to the next day, or end the session.

Why?
The point of this game is to make someone viscerally aware of the degree to which clinical depression is a real, serious, debilitating, and potentially life-threatening condition.  It attempts to model a depressive episode in a frank and unexaggerated fashion.

[Gwen]

I really love the concept here and the dice mechanics fit perfectly.  It certainly would give somone a better grasp of clinical depression and I think you've well succeeded in that respect.

The mechanics easily translate to other mental ailments, which might help players experience more than just clinical depression first hand (i.e. insanity, drug addiction, tourettes syndrome.)

Using those examples could provide players with insight to these conditions, while certain examples could also provide a light hearted alternative.

[Ben Lehman]

Rules Hack:
The GM need not have suffered clinical depression to run this game, just have had adequate experience with treatment or study of depressed people.

Thoughts:
This is, essentially, more of a theraputic role-playing tool than a role-playing game -- in that it is not so much "fun" as "educational and theraputic."  I don't mean this to belittle or dismiss it -- I think that theraputic RP and recreational RP have a lot to learn from each other, and this is a great idea (taking the dice from recreational RP and putting them into theraputic RP to represent the subconscious / uncontrollable aspects of mental illness.)  That said, it might be a bit heavy handed, system-wise.  It seems to me that people are much more likely to have bad days than good and, at least among the depressed people that I've known, it seems to be more "one good day / one bad day."  But that basic idea is sound, and I think that this one make a great training tool for people who professionally deal with depression and depressed people.

[AnyaTheBlue]

I have to agree with Ben and Gwen's comments generally.

On mechanics, I have a couple of slight critiques.

First, I think you need to be more explicit in providing guidance for what sorts of actions require dice rolls.  I'm not so sure about rolling for breathing, for example.

On the other hand, there are times when you will need to roll NOT to do something, like NOT self-medicate, NOT avoid people, NOT flee into escapism, NOT daydream, or NOT injure yourself.

It might make sense to balance every action.  There's what you are trying to do (which you succeed in attempting if you roll well on the white die), and what you do instead (which happens if you roll high on black).  Sometimes, what you do instead is nothing.  Sometimes it's negative or harmful in some fashion.

I'm not so sure that self-medicating (with alcohol or anything, really) should keep your black die from getting higher.  There have been a number of depressed people I know who are in AA, and Alcohol certainly didn't keep them from being depressed, and ultimately had other negative effects that made things difficult -- I think it's at best a wash, doing no more harm than good.  Frequently, though, I think it does more harm than good.

Finally, the worst anxiety/panic attack I had caused me to pass out and lose bladder control.  You might not want that much verisimilitude.

I'll just repeat Ben's comment about this being far more appropriate for theraputic/educational purposes and less 'fun' than a traditional RPG.

I certainly wouldn't want to play it, nor would I be interested in running it.  Too painful either way.  I almost didn't want to read it...

[ethan_greer]

Hi folks,

Somewhere in the posting process I missed including text to the effect that this is definitely more therapeutic/educational than recreational.  It seems that comes through clearly in the game itself, and it was intentional.  For purposes of this post, I'll call it a teaching game.  I've never written a teaching game before, and am not aware of any RPGs that are designed as teaching games.  Anybody know of any others?

Gwen:
Thanks for the compliments. As for other mental conditions, I'm afraid I don't have much knowledge of the ones you mention.  When I go forward with the project I'll do some research on them; don't know if I'll include them or not, but thanks for the idea.

I'm curious about your ideas for a light-hearted alternative style of play - what did you have in mind?

Ben:
No, the GM doesn't need to actually suffer from depression, and the "knowledge of" wording in that paragraph was intended to convey that.  First draft and all that. :)  Thanks for the tip.

You refer to "therapeutic RP" as if it were an established, uh, thing.  Is RP a technique commonly used in therapy?

As for the heavy-handedness, yes. I wanted to model the bad days, not necessarily every day or even most days.  Therefore the mechanics are negatively weighted to produce anxiety attacks.  However, note that basically the GM is in charge of when the black die shoots up to d12 by controlling when triggers are encountered.  Which is why the GM needs to have some knowledge of how depression works.

Dana:
The "rolling to breathe" comment needs to go, I agree.  First draft and all that.  More guidelines will be forthcoming, as well as a clearer presentation and such.

I thought about the idea of rolling to avoid harmful behaviors as you suggest, but decided against it.  Here's why: It's too easy for people to come to grips with the concept of compulsion, and dismiss it.  "Okay, I failed my roll.  Now I'm toking up a spliff.  How long will that take?"  On the other hand, it's waaaaay more in-your-face for people to try to do things, to try to be proactive, and to be categorically denied.  "Whaddya mean, I can't pick my car keys up off the dresser?"

On self-medication: that section isn't too explicit.  For that matter, neither is the rest of the game.  But here's the reason the self-med rule works the way it does: Self-medicating actually does make you feel better, if only for its numbing effect.  People live fix to fix.  (God help the poor bastard who goes off self-medicating, though.)  That's why in the mechanics, self-medicating reduces the black die instead of modifying the white die.  It's not really helping you; it's simply decreasing the depression by a small degree.

As for verisimilitude, I don't want that for the anxiety attack mechanics.  What I do want is for the player to sit there and do nothing for twenty minutes to emphasize a couple things: (1) Twenty minutes is a long freakin' time.  (2) During both the anxiety attack in the game and in real life, you accomplish nothing.

[Ben Lehman]

You refer to "therapeutic RP" as if it were an established, uh, thing.  Is RP a technique commonly used in therapy?

BL>  Good heavens, yes!  Possibly not much used much in mental-illness therapy (like treatment of depression) but used very heavily in relationship therapy (marriage, family, child stuff).  Usually, members of a dysfunctional or poorly functioning relationship will play each other in some moment of conflict, with the therapist refereeing allowing the participants to
1) See how the other person sees them
and
2) Put themselves in the other person's shoes.

This is a wildly common therapy technique -- it's probably the widest application of role-playing, actually.  There are a gazillion and a half variations thereof, including allowing the therapist to take a role, reliving past bad experiences and role-playing them with a "better outcome" and exploring the nature of decision making.

For the record, it's all "systemless."  The introduction of systematic constraints to model mental illness is very interesting to me.  I would show it to a therapist and see what they think.

As for the heavy-handedness, yes. I wanted to model the bad days, not necessarily every day or even most days.  Therefore the mechanics are negatively weighted to produce anxiety attacks.  However, note that basically the GM is in charge of when the black die shoots up to d12 by controlling when triggers are encountered.  Which is why the GM needs to have some knowledge of how depression works.

BL>  This is fine, but you need to be quite explicit about it, otherwise it does come off having a bit too much bathos.
Honestly, titling the game something like "Bad Day" might solve that problem gracefully.  And I think it's a good name.

yrs--
--Ben

[AnyaTheBlue]

I thought about the idea of rolling to avoid harmful behaviors as you suggest, but decided against it.  Here's why: It's too easy for people to come to grips with the concept of compulsion, and dismiss it.  "Okay, I failed my roll.  Now I'm toking up a spliff.  How long will that take?"  On the other hand, it's waaaaay more in-your-face for people to try to do things, to try to be proactive, and to be categorically denied.  "Whaddya mean, I can't pick my car keys up off the dresser?"

Makes perfect sense, now that you mention it.  Perhaps doing destructive things, or *certain kinds* of destructive things (like vegging in front of the TV) become easier to accomplish?  Or, perhaps *changing* what you are doing is something you have to roll for?  So, you have to roll to start watching TV, but then you also have to roll to STOP watching TV?

Anyway, more guidelines on what to roll for and when to roll for it will probably clear this all up.

On self-medication: that section isn't too explicit.  For that matter, neither is the rest of the game.  But here's the reason the self-med rule works the way it does: Self-medicating actually does make you feel better, if only for its numbing effect.  People live fix to fix.  (God help the poor bastard who goes off self-medicating, though.)  That's why in the mechanics, self-medicating reduces the black die instead of modifying the white die.  It's not really helping you; it's simply decreasing the depression by a small degree.

Sure, but it adds a layer of extra dysfunctional behavior that puts extra, different, problems into the life of the 'self-medicator', if that makes sense.

I think I understand what you're trying to do, I'm just not sure if it really reflects my own experiences or those of people I know.  Your Depression May Vary :/

As for verisimilitude, I don't want that for the anxiety attack mechanics.  What I do want is for the player to sit there and do nothing for twenty minutes to emphasize a couple things: (1) Twenty minutes is a long freakin' time.  (2) During both the anxiety attack in the game and in real life, you accomplish nothing.

Agreed.  Again, makes sense.

[LordSmerf]

I like the basic mechanics.  It keeps things simple while being (to my experience, fairly accurate).  However, i think you're going to have trouble using this in any sort of generation of specific understanding because from what i've read from clinically depressed people anxiety attacks can range in time.  Twenty minutes seems to be the low end (i've seen 8+ hours).

Of course in terms of helping people understand clinical depression in a more general sense i must say that this seems to facilitate that...

Thomas

[Ben Lehman]

Rules Idea for Self-Medication:

Keep present rules, however, the act of self medication is always a trigger.

yrs--
--Ben

[J B Bell]

This is interesting.  I have to admit, as a past sufferer, I found it kind of amusing.  I know that wasn't your intention, but there you are.

I would love to see something that mechanically captures the extremely noxious property of depression that causes the sufferer to retroactively re-evaluate their entire past history in a negative light.  Also, I loved having something good happen as a trigger.  Hoo boy.

This could get pretty interesting with a bit of resource management, along the lines of a store of hope/positivity/whatever, which can be seriously wiped out by a couple triggers and some tightly looped neurotic thought-habits.

Though, as it stands it's probably perfectly adequate; lots of rules probably would not make for a therapeutic/educational game so much.

--JB

[failrate]

I have experience with psychotherapy, both in sessions and in college courses.  I also have cyclothymia, a form of bipolar disorder.  In addition, I have a few comments.

NPC Sensitivity-->  I'd have the average NPC either have Low Sensitivity or be even lower than Low.  People who have not experienced depression often write it off as laziness or sadness.  This is not because they are bad people, but because they have never really experienced prolonged bouts of depression and don't understand how it feels.

Self-Medication-->  I instantly came to the same conclusion as everyone else in that self-medication does NOT decrease depression.  It may seem to the self-medicator that their depression is helped by taking drugs, recreationally or otherwise, but the usual effect is to either make the depression worse directly (In the case of things like sedatives or depressants) or compound them by making their lives more chaotic and hostile.  In game terms, this would be represented by the GMT (Game Master Therapist?) either let the player think the black die was at most a d10 but secretly rolling the true numbers behind his GMT screen; or the player would find themselves having to roll much more often than usual.  Also, many drugs suffer hangovers that dramatically increase the depression of the person for a longer amount of time than the alleged "benefits" of the drug.  This includes both prescribed pharmaceuticals such as Ritalin (often given to bipolars misdiagnosed with ADHD, myself included) and proscribed chemicals (such as cocaine, alcohol, and illegally procured pharmaceuticals).  The only pseudo-anitdepressant value of drugs often comes from the addiction to and procurement of said chemical.  This will usually only motivate the person enough to get the chemical.  So, if they have a job, it might be just to get money for crystal meth.  If they leave the house, it might just be to get cigarettes and microwave burritos from the gas station.

Transcendence-->  If used as a way to provide an endgame for the player who will likely be exhausted at the end, it is fine as left.  If making for a series of sessions or "days" as a means of demonstrating a prolonged depression (sometimes these things last for years), then I feel it is appropriate for a player to be able to make preparations for the next day.  That being that they pay their bills and rent, go grocery shopping, make sure their affairs are in order so that tomorrow, they will have fewer hassles to deal with.  This is a very realistic assumption, I believe, as many people who suffer from varying psychological disturbances are very familiar with what they will need when an episode occurs (like people in California may stockpile canned goods and bottled water in case of an earthquake).

Finally, I'm glad someone brought up roleplaying in the context of therapy.  Despite the vilification of D&D, many contemporary therapies (like Primal Scream...  not the band) used the same techniques.  The difference was that the psychotherapeutic techniques did not deal with swords, trolls and magic.  I can say that I value games mostly because the rules are better structured and make more sense than much of real life.  This also brings to mind Reality Therapy, which a social worker friend of mine told me about the other day.  This is a confrontational technique that has been successfully used to treat people with autism.  The idea is that people get instant tangible responses to their behavior (ie, if you break something of the therapist's, the therapist will break something of yours).  As such, it makes perfect sense that a RPG, properly implemented, could actually help someone's mental state, given that the game was fair, well-GM'ed, and the subject matter was kept appropriate.  Exactly what is meant by appropriate is difficult to guage, as I never finished my psyche degree.

[ethan_greer]

Failrate:
I agree with what you say about self-medication.  But in that last sentence in that paragraph, you wrote

So, if they have a job, it might be just to get money for crystal meth. If they leave the house, it might just be to get cigarettes and microwave burritos from the gas station.

That's exactly the sort of thing I'm trying to model -- the person who can get out of bed, but only to go get their stash.  From your and Dana's comments it's becoming clear to me that I need to figure out some way to model it better than limiting the high end of the black die.

On NPCs:
I think you may be confusing Understanding with Sensitivity.  Understanding is how the person views depression, and is low by default.  Sensitivity, on the other hand, reflects how the NPC treats the character, and defaults to medium under the rationale that most people aren't total insensitive pricks. :) Does that clear up your concern?

Thanks for the ideas on how to handle Transcendence. I'll plan to incorporate guidelines for it in a future version of the game.

JB:
Amusing? Heh, yeah, from a darkly comedic standpoint I guess depression is pretty silly.  Or would be if it weren't so insidious.

Systemically, I can't think of a way to model that "negative rewrite" thing, but it's a cool idea.

LordSmerf:
Further compounding the anxiety attack issue is the fact that not all sufferers of depression have anxiety attacks, and vice versa. Like all RPGs, I had to compromise a bit.  20 minutes seemed like the longest period of time I could expect anybody to sit there and do nothing, and still get the point across.

Ben:
Thanks for the info on therapeutic RP.

[ethan_greer]

Oh, and I almost forgot:

So, you have to roll to start watching TV, but then you also have to roll to STOP watching TV?

I love it.  I'll definitely include this concept in future versions. Thanks!

[lpsmith]

What if self-medication reduced *both* the white die and the black die?  So it would only provide a mechanical benefit if the white die was already at its minimum, but would seem like it was doing something at other times?

Also, it would be a clear detriment if the black die was already at the minimum.

[RobMuadib]

Ethan

Maybe I am reading to much into what you mean by anxiety attack. But in
my experience (Type II biplar disorder and/or Clinical depression with
Dysthmia, depending on the doctor) I don't see the anxiety attack as
being result of depression. More like intense desire to withdraw from or
quit activity, complete loss of motivation to do what you are doing.
Perhaps anxiety attack just comes across as the wrong motivation.

As an additional comment, it seems there would be a darker version of
this problem, if I was to make this game. Basically dealing with suicidal
episodes and fear of ending up in hospital after acting out. WHich is the
cycle I am familiar with. You are beset by the 'pain' of the depression,
uneasiness, difficulty concentrating, restlessness, irritability, listlessness,
lack of affect, etc, etc, even changes in your sense of contrast, perception
of noise levels. In order to alleviate this feeling you act out by doing
various things, any thing to alleviate the hurting , sleeping, drugs, sex,
withdrawing or you eventually fail to cope and start planning a suicide.
But that would be a game more representative of my experience I guess


I like the black die/white die concept.

best

Rob
(Whose black die feels like a d100 most of the time.)