Mental health in horror RPGs

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I’ve been playing a bit more Trophy Dark lately, and today I had the opportunity to play Cthulhu Dark (one of Trophy’s main precursors) as well. One thing both games have in common is the way they model harm, including mental harm, and this approach provides a fantastic model for other games.

Traditional games often have a Sanity score, an approach popularized with Call of Cthulhu and still seen in games like Mothership. When certain kinds of in-game events occur, characters make some sort of roll to see whether or how much Sanity they lose. This can additionally trigger specific conditions that the player is instructed to roleplay, like particular phobias or manias in the case of CoC or various actions commonly attributed to PTSD in the case of MoSh. This can feel bad for players, particularly those who have some real-world experiences with these things (e.g. folks with military experience confronting stereotypes they find problematic).

Cthulhu Dark and Insight

In the final version of Cthulhu Dark, characters have two mechanical components: an Occupation, used broadly to judge whether they might have expertise for a check, and an Insight score, which starts at 1 and can go as high as 6. Notably, Insight is not the same as Insanity (used in earlier versions of the game).


Your Insight shows how far you can see into the horror behind the universe. It starts at 1.

When you see something disturbing, roll your Insight Die. If you get higher than your Insight, add 1 to your Insight and roleplay your fear. (This is called an “Insight roll”.)

Is your Insight real? Can you really see a deeper truth? Or is it just insanity? Sometimes, it is hard to tell.

Cthulhu Dark by Graham Walmsley, page 12

No particular instruction is given to the player here beyond “roleplay your fear”. That gives them total agency in their reaction, which can be tied to whatever ideas the group may share about the role of sanity and mental health in cosmic horror.

As it climbs, the character may change.

Suppressing Knowledge

When your Insight reaches 5, you may now reduce it by suppressing knowledge of what you have discovered: for example, by burning books, defacing carving or destroying yourself…

Understanding the Full Horror

When your Insight reaches 6, you understand the full horror behind the Universe and leave everyday life behind. To the outside world, you appear insane. This is a special moment: everyone focuses on your Investigator’s last moments of lucidity.

Go out however you want: fight, scream, run, collapse or go eerily silent. Afterwards, either make a new Investigator or continue playing, but retire your old Investigator as soon as you can.

Ibid., page 13

Again, the game doesn’t say that the character goes insane but rather appears insane. If you understand something everyone else remains ignorant about, your actions (burning down a house to destroy the library within it) might seem perfectly logical to you when everyone else thinks your mind has broken.

The lack of prescriptive conditions for the character really helps here. You’re not told that the character must engage in self-harm, or to told to destroy property or hurt others, but you (as player) can choose what to do based on the fiction, the group’s preferences (and safety tools), and your own inclination. The game also explicitly does not tie this to real mental health conditions nor outdated models of them. No one else in the group (not even the Director / GM) dictates what your character does.

Trophy Dark and Ruin

Trophy Dark builds on Cthulhu Dark in many ways and has quite a few different types of rolls, but the underlying structure remains similar.

Ruin Roll

Your Ruin shows how much the forest has dug its claws into you, including the physical and mental harm you’ve suffered. It starts at 1, plus 1 for each Ritual you start the game with.

When you witness or undergo something disturbing, roll one dark die.

If you rolled higher than your current Ruin, mark 1 Ruin then work with the GM to define a Condition describing how the forest changes you—see Conditions below. When you mark your last Ruin, you are lost—see Losing Yourself below.

Trophy Dark by Jesse Ross, page 19

While Ruin includes mental harm, it also includes physical harm. The player and the GM collaborate to write a condition that the character will have to deal with in the fiction.


Conditions are physical and mental transformations you undergo when your Ruin goes up. When you mark Ruin as the result of a Risk Roll, Help Roll, Contest Roll, Ruin Roll, or other custom roll, the gm will offer suggestions for Conditions, but you can work with them to determine exactly how you are affected. Conditions are often tied to the theme of the specific incursion you’re playing.


These Conditions are not only thematic, they also generally have a supernatural cause: exhaling jade-colored spores does not reflect any particular real-life disability I’m aware of. Certainly, they can include things that seem like things we could experience (“persistent nausea and imbalance”) but the game doesn’t prescribe this. The text for “Losing Yourself” is very similar to the last half of “Understanding the Full Horror” above.

In fact, in general, players in Trophy Dark have so much ability to affect the fiction even outside of their characters (e.g. through the suggestions of consequences and Devil’s Bargains for other players’ rolls) that the group can quickly converge on what sort of game they want to play.

Respect for everyone at the table

The core idea behind these approaches is to ensure that every single player (including, in this sense, the GM / Director / Keeper) has control over what sort of discomfort they will experience as real-life people. As others have written, nothing in a game is more important than the people playing it. If you’re having fun with friends and something reminds you of a terrible experience in your life – or, worse, you’re forced to relive it in some way – then it won’t be much fun. On the other hand, choosing what to exclude lets us lean into the aspects of horror we want and can enjoy.

Even in horror gaming – I would say especially in horror gaming – we all should retain the ability to decide what to explore, and systems like the one outlined above give us the opportunity to do that.

2 thoughts on “Mental health in horror RPGs

  1. Hi Kyle! I’m JD / ‘Jorian Drake’ from Hungary. I haven’t followed online in a while and tried to look up Dan Gaston and Variant Roles, remembering how Dan had great tutorials for using Cypher among other things. I see not only VR disappeared entirelly, but Dan also from all places including Twitter and Twitch. Can you please tell me what happened, and if you know of any backups for the Cypher tutorials and sessions? You can email me the response, thank you.


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