Fate Accessibility Toolkit

The Nitty Gritty of Specific Disabilities

In this section we talk about a lot of different disabilities, how to play them, and what to look out for.

We’ve presented them in the most straightforward way—divided up and addressed one at a time. But the fact of the matter is, disabilities intersect; they don’t just intersect with each other (Elsa is deafblind, which means she’s both!), but they also intersect with other identities. Disabled people aren’t just disabled; they’re also PoC, cisgender, transgender, and as many intersections of identity as you can come up with.

When you’re working through this section and creating a character, you shouldn’t use this as a menu to say, “Oh cool, my character can have ALL these disabilities.” It should be approached as a tool for building disabled characters thoughtfully.

A few questions to guide you along the way:

  • How did my character acquire this disability?
  • What kinds of adaptive devices does this character use? What have they used in the past that didn’t work for them?
  • Is the condition complete (totally deaf, totally blind) or is it on a sliding scale?
  • How does my character relate to their disability? How do they relate to people asking them questions about it?

Despite media portraying most disability narratives as stories of tragic acquisition, whether it be a car accident or a random illness, not all disability narratives are like that. Some people are born with their disability, others experience a slow decline in their senses because of aging. The decision of how your character became disabled is just as important as what the disability is, because it will inform their entire history.

If you’re interacting with a disability that you’ve never thought about before, it’s probably worth doing the tiniest amount of research outside of this book to find out how people deal with diagnosis and adaptation; regardless of how your character got their disability, they will have ways of seeing the world that you have never thought of.

In each of these sections, we talk about how the disability manifests, how it could work mechanically in Fate Core, and how it might make itself known in play. Each section also gives tips on how to play a character with that disability, with suggestions on how to avoid tropes that are often considered offensive or problematic by people who live with those disabilities.

Hi, Elsa here—I may have mentioned it before, but I’m blind. Specifically, I’m completely blind in one eye, and partially sighted in the other. I have used a white cane to navigate and I recently started working with a guide dog.

Living with Blindness and Low Vision

Blindness is a disability frequently portrayed in media. Whether it’s a superhero like Daredevil, a victim like Reba McClane in Red Dragon, or a soccer player like Marina Datillo in Arthur, we see a lot of different blind people throughout our media.

What we don’t see are the variations of blindness that are the reality of the world. Ten percent of all blind people in the world are actually totally blind. For the rest of us (myself included) it’s a liminal space. Some of us are fully blind in one eye and legally blind in the other. Others have shades of grey, where the colors drain from the world they see. Yet others see through pinholes or toilet paper rolls, a telescope to the world that others see fully.

Legally blind is a term used to define blindness under the law. Someone who is legally blind either has a visual acuity of a certain level (how sharp your vision is) or a field of vision of a certain level (can’t see peripherally.) People who are legally blind are restricted from the use of motor vehicles and might be eligible for disability benefits.

Blindness isn’t a static condition; when creating mechanics and fiction for gameplay, be specific about what your character does or doesn’t see. Can the character see out of one, both, or neither eyes? What does the character see out of the eyes that are sighted?

When you create a blind character, you need to work out for your character:

  • Depth perception: It helps you do a lot of things. See stairs, catch a baseball, gauge how large something is at a distance (turns out a spaniel on a hill can look a lot like a Great Dane if you’re not careful). It lets you know when to stop before you crash into a glass door, and is probably the key factor to driving a car or playing bumper cars. Characters without depth perception will struggle with several day-to-day tasks that you might not think of because they’re unable to see where something is in their world.
  • Color: When it comes to color and definition, do you see only in shadow, or do you see the world in colors? Are those colors dulled, or are they bright and shiny? Do people’s faces have definition, or are you seeing them as balls of fuzziness?
  • Field of vision/peripheral vision: These are almost the same thing. Field of vision is how much you see when looking straight ahead—can you see everything that’s in front of you or is it like looking through a tube? Peripheral vision is what you see out of the corners of your eyes. If you don’t have peripheral vision, you can only see what’s straight ahead of you—and depending on the cause of your blindness, that too might be compromised. Both of these things let you and other players know what you see. Can you see the entire desk that you’re sitting at or can you only see what’s right in front of you?

The world can be as fuzzy as a 1950s-television set, or clear as day out of one eye. What it can’t be is magically enhanced for no reason. Playing a blind character only makes sense if you’re willing to invest your characterization in it. For example, people often argue that Daredevil isn’t really blind, because his powers allow him to “overcome” that disability without having sight. Basically, if his powers let him “see,” is he really blind? Depends on who you ask. Playing a character with blindness means acknowledging and playing out the effect it has on how they experience the world. If you don’t want to do that, then don’t play a blind character because then it’s just color. It’s fine not to reflect the blindness in your character’s stats—but if it’s just a disability for roleplay value, then it needs to be done carefully and respectfully.

Blindness and Aspects

Your aspects related to blindness will link to how blind your character is. Once you know the answers to the questions in the previous section, you’ll have a better idea of how to pick your aspects. They should illustrate the ways in which your character is disabled, and probably at least hint at how your character deals with that disability. And although you may pay more attention to sense like hearing or touch, blindness doesn’t give you supersenses to accommodate for the lack of vision.

Consider how situation aspects representing dim light or darkness affect your character. Here’s where the details of your character’s blindness are important—is she completely blind, or does she have limited vision? If she isn’t relying on sight at all, it makes sense that Poor Lighting can’t be invoked against her by opponents! On the other hand, if she’s hoping her limited vision gets the job done, Poor Lighting might dramatically affect her.

Some blindness-related aspects include:

  • One-Eyed Pirate. Invoke to: intimidate, bluster, sail, swashbuckle, etc. Compel to: miss a flanking attack, misjudge distance, etc.
  • Thickest Glasses This Side of the Mississippi. Invoke to: keep a poker face, intimidate with a stern lecture, etc. Compel to: lose a trail in the rain, require concentration to follow a rapidly moving object, etc.

Trouble aspects can be a bit more one-sided:

  • Can’t See in the Dark: Compel to complicate things during twilight, make nighttime navigation impossible, make a power failure that much more challenging
  • Peripheral Vision? What’s That?: Compel to make spotting that ambush harder, visually chaotic scenes that much more challenging
  • Lack of Depth Perception Makes Stairs My Worst Enemy: Compel to slow movement through a building or aboard a ship, fail to notice the curb, etc.

Blindness and Skills

One of the important things to remember when working with blind characters is to not assume incompetence. Mr. Magoo and his stats are not what we’re going for, because that uses disability for comedy. This is Fate and we’re going for highly competent blind people. People who know how to use their adaptive devices. So perhaps your character has a low skill when it comes to observation, but their sense of observation when they use their cane is different. Flexibility in how you perceive the capabilities of blind people will help you here.

Blindness and Stunts

Unlike aspects, which work in both positive and negative ways, stunts are always in your character’s favor. Think about ways in which a character’s blindness could become an advantage in specific circumstances.

In the example below, maybe we’d want to have Elsa’s directional sense in relationship to her blindness represented as a stunt instead of an aspect. She could have the high concept Blind Jewel Thief and the stunt Directional Sense Tied to Memory, Not Sight:

Directional Sense Tied to Memory, Not Sight (Notice): Because Elsa is blind and her sense of direction is tied to memory, not sight, she gets +2 to overcome or create advantage actions using Notice when maintaining her orientation in poorly lit conditions.

Blindness and Conditions

Consider taking the conditions Without My Device (page XX) and Low On Charge (page XX).

Player Advice

So your character is blind. Let’s just use me as an example; it’s easier that way. If it’s part of the character’s high concept, your description might look like this:

Blind Jewel Thief: Despite being a world-class jewel thief with several daring heists to her name, Elsa is completely blind in one eye and partially sighted in the other, with no depth perception. Invoke to: Plan a theft, evaluate security measures, estimate a jewel’s value, move in complete darkness, etc. Compel to: Be recognized by a former associate, lure with a jewel too tempting to resist, miss fine-print information, etc.

But maybe blindness is not central to your concept and it’s part of your character’s other stats instead. For example:

You’re trying to break into a dark warehouse to steal a jewel. Great, but what can you do in the dark? With the stunt Directional Sense Tied to Memory, Not Sight, Elsa knows how to quickly escape the building when the cops arrive, because rather than relying on her eyesight, she’s relying on her mental map of the warehouse.

GM Advice

Compelling blindness ultimately depends on the kind of blindness that your player has chosen to give their character.

Back to Elsa and the jewel heist in the warehouse. Let’s say Elsa didn’t manage to run fast enough, and she has to hide out. If her trouble is Peripheral Vision? What’s That? it could be invoked against her in this situation because the cops can come at her when she’s not looking.

Uh oh.

The trick here is to always use it with empathy—you’ll see this a lot in this book. It’s not about Mr. Magoo and making blind jokes; it’s about portraying disabilities that are real. So, a blind character might fall down some stairs, but if they do, it won’t be for comedic purpose. Your goal here is not to use the disability because it’s funny.

Antagonists with Blindness

You know the White Walkers in Game of Thrones? The zombies of The Walking Dead? The witches in…almost everything? Most of them have cataracted sclera. It’s pretty exhausting to have to share an eye or eyes with every evil protagonist or chorus on the planet. Remember that blindness isn’t an indicator of personality or of moral alignment.

It’s also not an indicator of powers—not all people who can see ghosts should be blind, not all psychic characters should be blind. Not all blind characters should be able to subvert their blindness using superpowers (or at all).

While these aren’t necessarily antagonist approaches, they might be, and it’s best to avoid these tropes.

Negotiating the Sound Barrier: D/deaf & Hard of Hearing Characters

Here’s Elsa again. I’m deaf and I use a hearing aid.

Living with D/deafness and Being Hard of Hearing

Deafness is another disability that lies within the world of liminal spaces. When you play a deaf character, you should recognize that there are varying degrees of deafness in the same way that there are varying degrees of blindness. People can be deaf in one ear or both, and deafness and hearing loss can be on a scale from mild to moderate to profound to severe. You can have varying levels of deafness within the context of one person, too. For example, a player could have a character who has only mild deafness in one ear, and profound deafness in the other.

What complicates this, ultimately, is that while a blind character might read braille instead of a text based medium, a Deaf character uses a variety of methods to communicate, and they might participate in a culture that is not hearing culture.

Does a Deaf character sign instead of speak? Do they have a Deaf speech pattern? Do they wear a hearing aid, or do they eschew them because they choose not to participate in hearing culture? (And you’re probably wondering, what _is_ hearing culture anyway? Check the sidebar on page XX.)

All these questions are important and valid, and they are where the D/deaf distinction comes in. People who identify as Deaf with a big D are members not just of the Deaf community by their disability, but by their cultural identity. Depicting this in an RPG setting might be a challenge, but it’s a storytelling challenge that can make your backgrounds richer.

Playing a deaf character doesn’t mean that you need to use a deaf speech pattern. In fact, you shouldn’t do that unless if you’re D/deaf and you have one already. Those speech patterns have been mocked and belittled by comedians and dramatists for over a century; there’s no need to repeat them in the present.

To play a deaf character you need to figure out some of the specifics around the disability. How deaf is your character? Has the character been deaf since birth, or is deafness a new part of their life?

Those choices affect how the character communicates and where they fit in the spectrum of D/deaf culture. Among the most important questions you’ll need to answer are:

  • Does your character reject D/deaf culture as a whole, or do they embrace it?
  • Are they happy with their identity as a Deaf person, or are they ambivalent about it because of how it has changed their life?

Deciding how your character communicates with the other characters in the game is the next most important decision you make. Whether you communicate through vocal language, a whiteboard, sign language, and/or lip reading, this decision always affects your gameplay.

Players shouldn’t try to create new ways for people with disabilities to live their lives, because there’s so much richness in the disabled community to look at and learn from. This especially applies to Deaf culture and language. If you’re in a game played by only able bodied people, your responsibility is to never mock or create your own “sign language.” Doing so is like mocking another language to entertain yourselves—you wouldn’t do it with Spanish, don’t do it here. American Sign Language, British Sign Language, and other forms of sign are not to be co-opted. If you want to learn how to sign, then do so and do it with respect, engaging with the culture and history of Deafness as you do so; learning to sign also makes you more able to work with a larger community of people in the world you live in.

There are games that have successfully developed hand signals for various kinds of communication. The third edition of Ars Magica is an excellent example of this. The creators of Ars Magica developed signs and hand gestures that correspond to spells you can cast at the table. This makes the game accessible to deaf players and able bodied players alike. This is an acceptable hack because it creates words for a system which doesn’t exist, rather than creating language where there is already a language in place to be used and learned. If you’re just making your own sign language words up because you don’t feel like looking up the word for dragon, it’s very different from creating a language of magic. Though of course, witches and wizards can be D/deaf too!

Hearing culture is what it says on the tin. It’s the expectation that the gold standard for living is to be able to hear. Deaf people have a completely different set of cultural norms and expectations, and hearing culture assumes that all norms for hearing people should be the preferred standard. Oral speech instead of sign is prized. It’s the false assumption that all things must be heard. Hearing culture is often enforced by not allowing Deaf people to sign, forcing people to accept hearing aids, and many other tactics to enforce the supremacy of hearing.

If you’re playing a character who’s part of the Deaf community, make sure you do your research, and make sure you respectfully portray that disability and the people who have it. As long as you’re doing that, consider that you might actually be able to get a stunt or a new way to invoke an aspect from being part of such a tight-knit community. Deaf culture comes in many forms, including attending schools for the Deaf or the use of sign language.

Historically, the development of sign language has differed significantly from country to country. Japanese Sign Language, for example, is still mostly a colloquial language, while American Sign Language is something you can learn from YouTube videos and community college courses. And knowing American Sign Language doesn’t mean you can communicate with a Deaf person from England unless you also know British Sign Language.

Deaf culture isn’t limited merely to linguistic preferences, however. There are also medical preferences around the choice of whether or not to treat deafness and hearing loss at all. For some parts of the community, there is a resistance to invasive medical technology, particularly cochlear implants, especially when it comes to children. Hearing parents of deaf children are often criticized for forcing their children to participate in hearing culture before they have the chance to learn about Deaf culture.

Deafness and Aspects

For able bodied and hearing players, it might seem very foreign and exclusionary to not want to hear, or to not want hearing people to participate in your culture, as some Deaf advocates feel. Being deaf often means that you are excluded from the hearing world. So Deaf culture being inaccessible to the hearing makes a certain amount of sense. That doesn’t mean that the world we’ve got already in place doesn’t use the lack of sound to various advantages. What you do with it in game matters a lot.

As an example for where silence (and lack of sound) can matter in a game, let’s talk about the action genre. Action adventures use the silent communication techniques we’ve seen in movies—they’re not sign language, but they’re still usable by characters of all abilities. A sniper who receives all their signals through hand gestures from a distance may be a Silent Killer, and so on.

Some examples:

  • Silent Killer: Invoke to get a bonus on stealth, take the perfect shot. Compel to miss the sound of an approaching enemy.
  • Perfect Lip Reading: Invoke to visually eavesdrop or communicate silently. Compel to miss part of a message when the speaker looks away.
  • One Side Hears, One Side Doesn’t: Invoke to ignore the effects of a flash-bang grenade. Compel to not know which side danger is approaching from.

There are plenty of ways to play a deaf character who interacts with their world with ease and engagement, without ever making them someone they’re not. You don’t ever have to make the character’s arc about them hearing or not hearing, but instead about how they navigate through the world. The purpose here isn’t to make deafness the plot point, but rather to make deafness part of the character as a fully realized piece to their identity.

Deafness and Skills

This mostly concerns talking and hearing skills. That doesn’t necessarily meant that your character can’t hear, but you might want to consider how it affects things. For example, Elsa’s deaf knight can’t hear the Master at Arms when he yells at her. Her deaf jewel thief can’t hear the clicks of a safe being opened.

But, she may have ways around it. Sign language, good social skills which get people to help her out on the sly, keenly trained touch sense for picking locks. Rather than think about what your character can’t do, consider how deafness affects what she can.

Deafness and Stunts

Think of particular circumstances in which being D/deaf is a benefit. For example:

  • Ignore the Noise: Because I am Deaf, I can ignore noise around me. Opponents cannot invoke aspects against me related to chaotic or distracting noise.
  • Pillar of the Deaf Community (Rapport): Because of my many friends and contacts in the Deaf community, once per game session I can find a helpful NPC who provides me a bit of useful information, lends me some gear, or lets me lay low in their apartment for a few hours. Work with the GM to decide on an appropriate person.

Deafness and Conditions

Consider taking the conditions Without My Device (page XX) and Low On Charge (page XX).

Player Advice

D/deafness invokes will have a lot to do with how your character deals with their D/deafness.

So, for example, Elsa has a hearing aid, and another character is really irritating. This NPC will Not Shut Up, and they’re just going on and on, mansplaining to her about how to break into a museum, when she’s worked plenty of heists… Cyberpunk Hearing Aid lets her tune out the frequency of the NPC and thus, she doesn’t have to fight him and waste time.

Another good example: If Joss Whedon had written a D/deaf character in Buffy, in the episode “Hush”, where everyone’s voices are taken away, the aspect Fluent in ASL would have been useful in communicating with the rest of the Scooby Squad.

GM Advice

Switching genres (because we can), let’s talk about how to compel D/deafness. Elsa’s playing a Knight of the Realm, which is great for her. But hearing aids don’t exist in this setting, so her character doesn’t hear very well at all out of one ear. So when the Master at Arms shouts at her to “Halt!” the GM can invoke Deaf Knight of the Realm and Elsa will be in a fair amount of trouble. After all, not following orders is not a good trait in someone meant to be a champion for the Queen.

Antagonists with Deafness

There have been some really fantastic antagonists in film and television who are Deaf. If you want to consider going that route, two examples to look at are from the first season of Fargo the TV show, and John Wick 2. Generally speaking, you don’t want to imply with the deafness aspect that the character cannot communicate or speak, so either they should have an interpreter for sign, or they can lipread or speak just fine.

Betrayed by the Meatcage: Mobility Issues

Elsa here. I don’t have a mobility issue, but I consulted several of my colleagues and friends who do.

Living with a Mobility Impairment

When you choose to play a character with mobility related disabilities, begin with asking how mobile—rather than immobile—your character is.

As with deafness and blindness there’s—you guessed it—a sliding scale of mobility. Players may create a character with a limp, a character with low balance who uses arm crutches, or a character who is either para or quadriplegic.

These choices determine how your character moves around the world, but also how your character interacts with the world. Counters are almost always too tall for a non-powered wheelchair user; a stairwell is almost always a challenge for a crutch user. When playing a character with a mobility disability, the thing to consider is what your environment bans you from doing. Whether it’s successfully navigating a staircase during a chase scene or finding your wallet on a tall counter, your environment is often your biggest enemy.

In the case of mobility impairment, we’re also not talking about a single diagnosis in quite the same way that we are with D/deafness or blindness; we’re talking about a whole host of diagnoses, some of which might come with other disabilities in tow.

For example, a character with muscular dystrophy has a whole body experience with their mobility issues, whereas someone who lost a limb due to an accident or an infection won’t have the same physical experience. Before you pick the mobility impairment your character lives with, you should definitely do research to understand where the mobility impairment comes from and how it will affect play.

Furthermore, not every disability uses the adaptive devices in the exact same way. In this case, I’m talking specifically about wheelchairs. You see “funny” memes on the internet a lot about miracles around wheelchairs, an image of someone standing up out of a wheelchair to reach a bottle of booze, for example.

Not only is that offensive, but it’s also downright incorrect. Wheelchair users aren’t just people who cannot walk or stand; many wheelchair users are given chairs because of fatigue or stress being put on their bodies. A wheelchair user might, for example, be able to stand up out of the chair and walk a few feet, or reach for a book on a tall shelf, but they may not be able to walk for more than a block, or run. It always comes down to what the wheelchair is meant for—and that’s why there’s so many kinds of wheelchairs to choose from. For more details on types of wheelchairs and how to add mechanics to your game, see page XX.

Mobility Disabilities and Aspects

Your aspects should reflect the kind of mobility impairment, as well as how it might interact with living in the wider world.

Aspects for mobility impaired characters might include things like:

  • Cane-Wielding Martial Artist: Invoke to gain a bonus to attacks and defense, or to not be parted from your weapon. Compel to give you trouble with that unexpected drop or to fail to notice the archer atop the roof across the street.
  • The Steve McQueen of Wheelchair Drivers: Invoke to speed away from the guards, to dodge through pedestrian traffic, or get a bonus to modifying your wheels for a soft surface. Compel to put a staircase in your way.
  • Weak Hands in the Cold: Compel to make it hard to hold onto the roof of the train going through the Canadian Rockies.

Mobility Disabilities and Skills

A mobility related disability doesn’t mean that characters can’t participate in combat, or escapes, or high-speed chases; it just means acknowledging during gameplay that your world is from the waist down, or requires an extra set of limbs to be ascended. See page XX for vehicle rules for wheelchairs.

Mobility issues primarily refer to issues with legs or with the ability to stand. However, characters might also have issues with their hands or arms. Generally in those cases the source of the issue is from pain, but muscles can atrophy or be injured and hands can develop tremors. If your character’s mobility impairment is at the spine, or involves arm issues, then obviously that will present differently.

Mobility Disabilities and Stunts

Many of the stunts relating to mobility disabilities may be tied to the use of assistive devices. In that case, GMs should be mindful that loss of the device in the fiction means taking away stunts from the player character. It may be okay in certain circumstances but should be a rare event. Other non-mobility-impaired player characters placed in similar circumstances (e.g., captured by a villain, lost in the desert, etc.) should suffer equivalent losses.

Examples of mobility-related stunts:

  • Blade Runner (Athletics): Because I have blade-style prostheses, I can run like the wind and jump like a hare; I get +2 to overcome actions made with Athletics when running speed or jumping height or distance are important.
  • Powered Wheelchair (Drive): Because I use a powered wheelchair, I get +2 to overcome or create advantage actions made with Drive against opponents on foot in appropriate terrain.

Mobility Disabilities and Conditions

Consider taking the conditions Without My Device (page XX), Exhausted (page XX), Making Payments (page XX), Hacked (page XX), Low On Charge (page XX), Limited Focus (page XX), and Medical Debt (page XX).

Player Advice

Look for ways that your disabilities may open up options, rather than limit them. Let’s take inspiration from a real world example: Senator Tammy Duckworth.

You’re running a House of Cards inspired Fate game, and there’s a sit-in on the Senate Floor. Sen. Duckworth has you covered. Her aspect Prosthetic Leg allows her to say that she hid her cell phone inside of the prosthetic; she’s smuggled it onto the floor of the Senate so she can record everything that happens during the closed session.

(This actually happened. Senator Duckworth is amazing.)

GM Advice

Compels might refer to not having the right adaptive device for a situation. It’s a lot harder to run in a regular prosthetic than with blades, for example. If you’re not in a cyberpunk setting, you probably don’t have a mechanized limb with fully articulated fingers. One kind of wheelchair might be better than another; for example a motorized scooter can only move so fast, whereas a manual wheelchair can be propelled by arms and possibly feet, or pushed by another person.

So Cara has multiple wheelchairs. She and her Leverage-style gang of heisters have managed to track their bad guy down to the seaside, and using an all-terrain air tire wheelchair, she can race along the sand dunes with the rest of her crew.

But when she’s trying to sneak into the bank owned by a notorious murderer, she uses a motorized chair, for quiet, less noticeable thieving. Both of these wheelchairs are effective modes of transit, both can be compelled, both can be invoked.

Both the GM and the player need to know the wheelchairs, and what they can do, though!

A prosthetic limb is not easy to use, and it takes time and practice to expertly handle one. Has your character had that limb for a long time, or is it new to them? What is the learning curve for them at this stage of their life? Also, is it a good prosthetic or is it a crappy one? There’s lots of kinds of prosthetics and they aren’t always good.

Missing limbs and paralyzed body parts aren’t the only kind of mobility impairment that your characters can experience, either. Disorders like cerebral palsy have different levels of effect on people’s lives. Some are crutch or cane users while others require a wheelchair or scooter to make their way through the world. Doing a little bit of research to get your character into the right place for the story you want to tell can go a long way.

Like with everything else in these sections, knowing what the disability is caused by is important, but knowing how it manifests and the sliding scale on which it functions is far more important. Your character doesn’t have to look like Stephen Hawking or like Artie from Glee in order to qualify as someone with a mobility impairment.

Antagonists with Mobility Disabilities

There’s a great character in Kingsman who has blade feet and she’s an assassin. That being said, wheelchairs, canes, and so forth are often used by evil characters to make them look vulnerable somehow. Let’s use Richard III as an example: within the Shakespeare play it’s assumed that Richard is ugly and deformed because he’s a bad person. We should strive not to make players with mobility related disabilities feel as though the alignment of the character is reliant upon their physical description.

Little People, Big Game: Dwarfism

Now I’d like you to meet Casey, who has a form of Dwarfism.

Living with Dwarfism

The concept of a dwarf in a fantasy setting was made popular by J.R.R. Tolkien, who was inspired by the dwarves from Norse and Germanic folklore. In most game settings, dwarves as a race are short with a solid, stocky build, many times shown with a beard (depending on the setting, dwarven women may also have beards as in Tolkien’s conception). They are known in many systems to be hardy, resistant to magic and poison, able to see in the dark, and attuned with various mining and smithing tasks. Some settings include subraces of dwarves with different abilities, aptitudes, appearances, and cultures. Settings with more of a modern, science fiction, or urban fantasy spin might have a similar version of dwarves, but as a player it’s important to think about the difference between the near-human dwarf based in fantasy and the actual impairment that people, like me, have lived with throughout history. No matter which type of dwarf you end up playing, there are some important things to think about when your character has unusually short stature.

Before describing types of dwarfism and things to think about when roleplaying someone with dwarfism, it’s important to note language use. “Midget” was once used to describe a person with proportional dwarfism, but is considered an offensive term because of its origins in the freakshows of the late 1800s and early 1900s. This connection is important because dwarves on the freak show circuit were on display solely as a curiosity based on their short stature. If you want to refer to a character with a form of dwarfism, good word choices include little person, dwarf, or person with short stature (or even better, their name!).

Dwarves are a great example of what disability scholars and activists refer to as the social model of disability. When a dwarf in a fantasy setting is in a dwarf-centric area, everything is sized for the average dwarf. Think of Gandalf visiting Bilbo Baggins in the Shire; everything in the Shire is sized for people with a stature shorter than the average human, making Gandalf the one disabled by the environment by being too tall!

When someone lives in an environment that’s built so they can function in the best way for their body, many pieces of that person’s environment may become unusable for other people with very different bodies. For example, I’m the only person with dwarfism in my family and everyone on my dad’s side of the family is over six feet tall (roughly 1.8m) with several people around six and a half feet tall (2m). My grandmother’s house was specifically built for taller than average people and made me feel like I was a gnome doing dishes in an orc’s house!

For players who want to play a character or have an NPC with dwarfism (versus a dwarf as per the fantasy race), it’s important to research what form of dwarfism the character has as each form comes with its own challenges in life.

I’ll give a really brief glimpse at the two main types, although there are more than 200 different types and all of them result in an adult height that is less than 4’10” (unless the person has had medical intervention to make them taller). The two types fall under proportionate dwarfism (with all parts of the body being similarly proportioned to a typically growing human. Ben Woolf, who played Meep on American Horror Story: Freakshow had this type) or disproportionate dwarfism (with limb-to-torso proportions different, either average torso and short limbs or short torso with long limbs. Peter Dinklage, the actor playing Tyrion Lannister in Game of Thrones, is a good example). Most forms are genetic, especially disproportionate types, but can be from birth defects or even acquired from something like brittle bones restricting someone’s growth. Each type brings its own challenges, some medical and some from social and structural barriers, all of which should be considered when trying to choose your high concept and trouble.

For example, with achondroplasia, the most common type of dwarfism where a person’s arms and legs are much shorter in relation to the trunk of their body, your character would likely stop growing between 3’8” and 4’9” (with a male averaging around 4’3” and a female around 4’1”). For most people with achondroplasia, their lifespans aren’t impacted at all so you won’t be tailoring a trouble based on that. That being said, the character might have problems with their joints due to the way their bodies move and are structured, so that might lead to a trouble based on needing a lot of medical care or physical therapy—Medical Bills Make Me Broke, In Debt to Corrupt Medical System, or Requires Long-Term & Frequent Medical Care.

Another example is the type of dwarfism I have, called pituitary dwarfism. It’s the most common type of proportionate dwarfism and can come about for a variety of reasons, like genetics, a brain tumor, or a pituitary gland injury (the pituitary is a gland in the brain that produces hormones that control growth and other important bodily functions). If the character is like me, they might have been born with it because of a broken blood vessel or they may have started out growing typically and had a brain tumor as a kid that impacted that area of the brain. Since I was born in the late 20th century in a developed country with modern medicine, I had growth hormone injections as a teenager to help me get taller. Nowadays, when kids are identified early as having pituitary dwarfism, they start the injections as early as possible, depending on their family’s health insurance and financial resources since the medication is expensive. An adult character may find that they need to continue these injections as well as deal with other health issues, making good troubles very similar to the character with achondroplasia—although there may be additional issues related to hard-to-get medications that are also hard-to-afford and can make Breaking Bad feel less fictional!

Something else to consider is that my type of dwarfism, when I’m not replacing growth hormone as well as the other hormones my body doesn’t make on its own, makes me have less physical endurance and get tired easily, which makes life difficult for adventuring or trying to survive in a post-apocalyptic setting.

Dwarfism and Aspects

There are other things that could make for good troubles or even just minor disadvantages or quirks for a variety of characters who are unusually short, whether they have a form of dwarfism or are a race that’s just smaller than a human. These might include: The World Is the Wrong Size, Picked on About Size by Peers/Family/Rivals, Hard to Find Clothes/Equipment/Weapons That Fit Body/Limbs, or the character might have a troubled or problematic relationship with a person, group, or institution (the only doctor that treats your character’s impairment, a fight the character started at the local Little People of America meeting, or inability to get healthcare from the government because of some snafu).

It can also be interesting to tie your trouble in with your high concept. For example, I’m a fitness geek who likes to try out all sorts of physical activities, so I might roll up a Dwarf Martial Artist as a high concept with a trouble relating to Having Trouble Finding Gear in My Size. A friend of mine rolled up a character with my type of dwarfism to play a Dwarf Spaceship Pirate who is Constantly Upset About Being Underestimated Because of her Size.

  • Dwarf Martial Artist: Invoke to: Low blow, hamstring, fight dirty. Compel to: Short reach, extra effort to hit above the belt.
  • The World Is the Wrong Size: Invoke to: Fit into places that typical people can’t fit, never hit your head, etc. Compel to: Require roll to reach items or handle items that aren’t sized appropriately.
  • Hard to Spot in a Crowd: Invoke to: Navigate unnoticed in a crowd, find cover, etc. Compel to: Get tripped over by others, require concentration to find certain people or places.

Dwarfism and Skills

Little people can do anything that regular sized people can do. The only advice I give? Don’t make blacksmithing their best skill in every game.

Dwarfism and Stunts

Stunts related to dwarfism might have to do with the ability to hide in small spaces, or taking advantage of being socially less noticed, For example:

  • Hard to Spot (Stealth): Because I am a Small Person, I get +2 to Stealth when hiding in restricted spaces.
  • Fly on the Wall (Empathy): Because I am often socially overlooked, I get +2 to overcome or create advantages with Empathy when observing people in a group as long as I do nothing to attract attention to myself.

Dwarfism and Conditions

Consider taking the conditions Exhausted (page XX), Low On Charge (page XX), and Medical Debt (page XX).

Player Advice

Invoking being a Little Person might be a challenge, but you’re sure to find options. For example, a rogue might use their size to sneak and hide underneath things that average sized people may not be able to use. Or, they might blend in with a crowd better because they can’t be spotted at the eye level of where everyone else is.

GM Advice

Compels may show up in social situations. Constantly Upset about Being Underestimated Because of Her Size may come into play, or you might have a character who is mistaken for a child all the time, and so they have a short fuse.

Compels may also occur in terms of negotiating a world not built for the character’s body. So, Casey may have to find unique solutions around opening some kinds of doors, accessing countertops, ovens, or even security systems.

Antagonists with Dwarfism

Tropes aren’t cool. So try to avoid having Little People represented only as uh, Little People. Like leprechauns. Or faeries. Or Hobbits. Make sure that you’re not tokenizing the disability using the traditional tropes assigned to it by fiction.

Check out Tyrion Lannister as a great example of a Little Person who isn’t necessarily evil—or good, either.

Chronic Illness as Disability

This is Elsa again. I have a heart condition, and I consulted a wide range of individuals dealing with chronic illnesses when writing this section.

Living with Chronic Illness

This is a sticky issue. We have to start there, because not everyone with a chronic illness, or illness at all, would consider themselves disabled. Some people would.

We’re also treading close to the curable realm, which is another sticky issue for disabled people. Some people with disabilities (like myself, Elsa) don’t feel they need a cure. They don’t want someone to come in and say, fix their eyesight permanently, for many reasons. But with chronic illness, sometimes there are cures available. Sometimes there are not.

Certainly, under the header of chronic illness, we also have to touch briefly on terminal illness, or severe illness which might leave the character with a disability that’s mentioned elsewhere in the book.

Advising caution here is paramount. Playing a character with multiple sclerosis (MS), cancer, or other life-threatening illnesses isn’t a good idea unless if everyone at the table is okay with it, and if you’ve done the research to make sure that you can do it responsibly.

With all of that said, let’s address some of the basics:

If your character has a chronic illness, it will pervade their entire life. They will not make a single decision without thinking about how their decision affects them with their chronic illness. A character with Crohn’s disease isn’t going to eat anything—certainly not the bread offered with bread and salt, nor a tasty snack offered by a fairy—without knowing whether or not the contents will harm them. If it’s a life or death decision, they will have to weigh that against their health. We’re counting asthma and allergies as part of chronic illness, because it’s a chronic interaction with the body, persistent, ever present, and something you have to be constantly aware of.

An excellent example of a character with a chronic debilitating illness is President Bartlet from The West Wing. President Bartlet’s relapsing and remitting multiple sclerosis challenges him to perform his duties as president as expected. We often see him doing things like dropping things or shaking hands until he absolutely cannot do it anymore; he even goes so far as to hide his condition because he feels he can’t be President and be a patient at the same time.

These are the expectations we need to weigh when living with chronic illness. It’s true with any disability really, but especially when it comes to something that is treatable, and that you have to live with the consequences of the minute you do just about anything.

A character with Osteogenesis Imperfecta might behave like Miles Vorkosigan does—recklessly. But they will pay for it every time, with casts, with new treatments, with painful medical care.

Ultimately, how your character handles their chronic illness will determine how the chronic illness affects them. A character with a pain disorder probably won’t display anything externally to suggest that they are disabled. Invisible disabilities might be the easiest to roleplay because they come out through roleplaying someone’s lived experience. A character who is in constant pain might have checks to make sure they can focus, or may have a short fuse when trying to be patient. A character with pain might also be able to take a lot of hits in combat, because they’re used to feeling pain—they may not recognize being smacked with a sword in the same way that someone else would. There’s an inversion here, both with pain and with fatigue. Whereas most of these disabilities affect your character in the moment, pain and fatigue might only show up during downtime scenes. Your character might thrive on the adrenaline, only to find when they come down, they’re not able to function as well.

Chronic Illness and Aspects

When selecting your aspects for a chronically ill character, consider the various symptoms that accompany the diagnosis when you build them. Research is key, as always.

For example, President Bartlet might have a trouble aspect like Suddenly Heavy Objects as a symptom of his MS—he might drop something suddenly, or collapse.

Fitting these aspects together is something like a puzzle. Whatever comes up most frequently for the illness might be what you pick, but knowing how it comes into play will be more important. For example:

  • Fibromyalgia Makes My Skin Hurt: Compel to make recovering from the Exhausted condition that much harder or to distract while you’re trying to concentrate.
  • Bones Like Glass, Pain Tolerance Like Steel: Invoke to ease recovery from conditions and consequences related to pain and fatigue. Compel to aggravate damage taken by a blunt force attack.

Sample aspects for characters with pain conditions might include a Part Time Wheelie researcher who can’t stand for long periods of time without ill effects, or a thief who has burned off their fingerprints so many times that they Don’t Have Feeling in Their Fingertips.

Chronic Illness and Skills

Skills will vary from illness to illness. One might have no issue with running, but another might not be able to use Athletics at all. Weighing these differences is important, but again this is about vigilance in the setting of your disability.

Chronic Illness and Stunts

You won’t find much here that’s advantageous, but with a bit of creativity you might find something, such as:

  • Lay Medic (Lore): I’ve spent so much time in hospitals that I have more medical information that a lot of medical residents. I gain +2 to overcome and create advantage actions using Lore when it comes to hospital procedure, medical knowledge, and health insurance bureaucracy.

Chronic Illness and Conditions

Consider taking the conditions Exhausted (page XX) and Medical Debt (page XX).

Player Advice

Invokes for a chronic illness will be challenging. There’s little that’s good about a chronic illness, few advantages that you can eke out of what’s generally a disruptive illness. But you might be able to use it to your advantage.

Someone who has a habit of fainting, for example, might be very good at faking it so that they can be hauled into the giant asylum for their undercover work.

GM Advice

Compelling an illness is easy. You could compel President Bartlet to drop a pitcher given to him by the Queen of England in her presence, and have that cause tension during a political negotiation.

You could have a character suffer fatigue during a chase, or have another develop blurry vision during a car driving scene. Negotiating these compels requires time with your player to figure out what their character’s disease would do to them.

Antagonists with Chronic Illness

One thing not to do is to make the weakness for your villain their illness. You shouldn’t get to the baddie just as they hack up their lungs from consumption, and find that they’re already dead. They shouldn’t be a supervillain with a cough, or a mastermind with cancer. These are tropes that have been trod a lot, and all they do is reinforce that being sick in the body means that you are sick morally.

Basically, disability and illness is not a barometer for morality. Watch for this in your NPC building; it’s a common trope that many people fall into without noticing.

This is an option for dramatic, climactic moments that directly involve a character’s chronic illness, not a recipe for every compel of the related aspect.

Simply speaking, this is a conflict. Give the asthma or allergy attack a skill and a rating, like Good (+3) Asthma Attack or Great (+4) Peanut Allergy. Give it stress boxes based on its rating: one box per point of rating (so a +4 Peanut Allergy would have 4 stress boxes). These stress boxes escalate in value just like a PC’s, but an asthma or allergy attack can check off as many stress boxes as it wants to absorb a hit, and has no consequences.

When you’re running the conflict, the asthma or allergy attack uses its skill to attack its victim each exchange, dealing physical stress. The victim might defend with Physique, Will, Athletics, or something similar. Using a skill that makes sense, the victim can attack the asthma or allergy attack on their turn, dealing stress to it. For example, an inhaler or epi pen might be a Resources or Lore roll, while using breathing techniques might be Will or Athletics. Other people can help by creating advantages, but can’t directly attack the asthma or allergy attack unless they have sufficient justification (such as a doctor administering treatment).

When the asthma or allergy attack gets taken out, it ends, leaving the victim with whatever stress and consequences it’s inflicted.

Not Your Puzzle: Autism

I’d like you to meet Zeph, Laurel, and Jess. They’re autistic and have written a fantastic section on how autism (a form of neurodiversity) works!

Living with Autism

Autism spectrum disorder (ASD) is characterized by difficulty with social interaction and communication as well as by restricted or repetitive behavior or interests. ASD casts a very broad net and includes many variations and more specific traits that aren’t at all uniform and may be difficult to recognize (Asperger’s syndrome has been removed from the most-recent psychiatric manual and is now classified as part of ASD). It can be especially difficult to recognize ASD because popular media featuring autistic characters tends to focus on a narrow set of traits that are easy to recognize and has led to a stereotyped ideal of what autism means and how it looks.

Think of autistic characters you have seen in television and movies and make a mental list of “autistic” traits you’d expect based on these depictions. I expect your list might include things like “difficulty understanding emotion,” “socially inept,” “logic-minded,” “obsessive,” or “inflexible.” I suppose all of those could be used to describe me, but they don’t really get at what it’s like for me, the underlying causes of behavior that makes people think of me that way. As a result, often when I see autistic characters in the media, I feel that they’re actually playing a neurotypical person with exaggerated quirks. I rarely feel that I’m seeing myself represented.

Despite what you see in many movies and TV shows, savant syndrome (genius in a particular area) is very rare; portrayals of it run the risk of implying autistic people are valuable only if they have superpowers despite their neurology, so I recommend not using this trope or being very careful with it. Exercise care when playing, and consider your character as happening to have both high intelligence and autism, not some magical combination.

When playing an autistic character, I recommend throwing out those ideas of how you think autism looks and focusing instead on how your character feels. Obviously autism is not the only thing that affects your character’s experience of the world, but it does mean that much of what they experience is processed differently.

For example, one of the more common autistic traits rarely seen in media depictions is sensory processing difficulties. Many autistic people are either hypersensitive or hyposensitive to sensory input—textures, sounds, images, light, etc. Your character might become overwhelmed by sensory input and shut down or appear to tune out, or they might engage with a point of focus, such as touching a wall as they walk along to keep them grounded in an overwhelming situation. Sensitivity isn’t always bad. I may enjoy the feel of my hand along the brick wall or have a whole-body experience of the sound of an orchestra. Your character may appear oblivious to others while experiencing hyper-awareness of some aspect of their surroundings.

Another common autistic trait is typically referred to as “special interests.” All this means is that we may be interested in things that seem unusual to others or may express those interests in ways that seem unusual. It might be that the interest is more typical for someone much older or younger than we are (maybe a cartoon or type of toy), that it’s focused on things that are mostly seen as practical or necessary rather than fun (such as collecting mundane objects and knowing tiny or obscure details about them), or that the topic of interest is typical but the level of interest seems intense and obsessive to others (such as listening to the same song over and over for weeks, which also happens to be a sensory experience). These may change over time, or an autistic person may rotate through a restricted list of special interests.

Similarly, autistic people often feel most comfortable when following structured routines and may have rituals which help them orientate in the world. I’ve prepared my breakfast in the same order, from the same ingredients, every day for over a decade years now. Having that disrupted no longer causes the meltdowns it did when I was younger and had fewer coping mechanisms, but it’s distressing enough that I bring the ingredients with me when I travel.

When considering the kind of autistic character you intend to play, consider the following questions:

  • Which sensory experiences does my character find most painful? Which do they find most pleasurable? Do they hardly experience some? You might have a love-hate relationship with your sense of touch. Or the two needn’t overlap: perhaps your light sensitivity means you’re most comfortable in dark rooms analyzing background noise on a headset. Although the lived sensory experience of an autistic person can be complex and overwhelming, focusing on a few sensory areas may help you and the GM remember when your character would respond to a stimulus.
  • What are my character’s most common methods for coping with sensory imbalance? Some possibilities for handling everyday sensory issues might include fidget toys, chewable jewelry, or earplugs. If the character is non-verbal, they might use a word/picture board or electronic device to communicate. See Adaptive Devices (page XX) for more suggestions and for advice on using game mechanics to reflect your character’s coping mechanisms.
  • What routines can’t my character miss and/or what rituals keep them grounded?
  • What have some of my character’s previous special interests been? You may want to declare these in the moment, but understanding whether your character is more likely to collect objects or happens to know every line and inflection of their favorite films will shape the type of special interests you may have in the future.

Autism and Aspects

Answering the questions above will help you shape what kinds of aspects your character might have. If you have auditory hyper-awareness, whether positive or negative, you might often hear things which others around you only perceive as background noise. This could be an aspect called Can’t You Hear That?. As a benefit to your character, it could be invoked to let them notice some tiny detail in the environment that alerts the group to danger or reveals something important. On the other side, it could be invoked against the character by distracting them from the task at hand, such as a car alarm going off three blocks away.

If the character is in a particularly chaotic environment or one with a very intense element such as bright lights or loud noises, the environment would have an aspect relating to the sensory effect. An environment with the aspect Noise From All Directions is likely to have a negative effect on the character. Or, your character might turn it around, creating a temporary aspect like In the Zone. They’ve filtered out extraneous stimuli completely and can focus exclusively on a single goal or sound as an anchor, giving them an advantage to accomplishing that specific thing.

An environmental aspect Stimtastic Wonderland would mean a room is full of fun textures that the autistic character finds calming or interesting. Stimming is a behavior used to provide sensory input. It may be used to filter out more distracting input, as a calming sensation in anxious situations, or just because it feels good. Some examples include spinning, fidgeting, tapping fingers, hair twirling, and whistling. A room with velvety curtains, textured walls, and toys that make odd noises could be a lot of fun to explore! (Velvet is my sensory nightmare! —Laurel) It could be invoked as a benefit to your character by helping them to calm down and focus, or invoked against them by making them not want to leave the room or focus on anything else until they’re satisfied. (Or cause them to freak out! This is a great example of how autistic people’s sensory experiences may dramatically vary. —Laurel)

Your current special interests may also be a source of aspects. For example, your character might have the World’s Best Key Collection. The character would find keys incredibly fascinating, have a collection of keys, and maybe own lock-picking equipment. It’s important to note that this isn’t a professional interest (although they may also pursue an occupation that utilizes or relates to it); the knowledge isn’t simply practical but rather borne out of the same sort of love that most people have for their favorite book or TV show. They would be able (and happy!) to talk to you for hours about different manufacturers and style characteristics, historical details, and how they work.

This could be invoked by letting them have the right type of key or equipment to get into a locked door, or knowing enough about the lock to realize that they’d noticed the key earlier and can find it. For a compel, while other characters are involved in something more immediately and obviously relevant like questioning an NPC or trying to solve a puzzle, the character may get caught up in the idea that if only they can discover the key, they can handle the situation. They become fixated on finding a key or interrupt a successful interrogation by demanding the key’s whereabouts.

Autism and Skills

Autistic characters aren’t necessarily more or less skilled in any particular areas than any other character. Consider how your answers to the questions in “Living With Autism” may affect your character’s skills, either inherently or through practice. For example, your character may not take any points in Notice because she often finds herself visually and auditorily overwhelmed in large spaces. Or she may have coped with that by developing excellent Notice to sort through too much information to focus on what’s necessary. Similarly, autistic people don’t necessarily have poor people skills. Your character may have put effort into easily building Rapport or learning how to Deceive by imagining their statement as true.

Autism and Stunts

This is a place where special interests shine. A character with an intense interest in mythology could have a stunt related to it, like:

Ask Me About Folktales! (Lore): Gain +2 to overcome and create advantage actions made with Lore regarding folktales, folklore, fairy tales, and related subjects.

Autism and Conditions

Consider taking the conditions Without My Device (page XX) and Meltdown (page XX).

Player Advice

The most important piece of advice for playing autistic characters is to play a character rather than a disability. Every autistic person is different, and all of us are much more than this particular diagnosis. It’s a large part of how I experience the world, but it isn’t my whole life. When designing an autistic character, don’t only consider how they’re different but how they have to adjust to function in a world built for people who think differently from them. Personally, I probably wouldn’t start with more than 2 aspects and 1 stunt that specifically relate to autism, preferring to focus on other parts of a character’s personality and making sure that they are well-rounded and interesting with the same range of motivations I would give any other character.

GM Advice

Let your player’s answers to the questions in “Living with Autism” shape how you use it in gameplay. Consider where they may encounter challenges and talk with them beforehand about specific consequences. For example, if things go poorly, they may be affected by a condition and experience a Meltdown (page XX). While some autistic people are completely non-verbal and must use other means of communication, others who can talk under normal circumstances might struggle to do so or lose the ability to speak under severe stress.

Antagonists with Autism

Because antagonists are often more one-note than a player character, exercise particular care in avoiding stereotypes. As previously mentioned, the savant trope has been done to death. Nor is lack of empathy an autistic characteristic. If an antagonist seeks or accepts humanity’s demise, this isn’t because they’re autistic.

Try not to make their disability into their undoing either. If Laurel’s your antagonist, you can’t just wrap her in a velvet blanket and call it a day—unless perhaps you’ve done intensive backstory research which has identified this critical vulnerability. Consider instead that reactions to stimuli and special interests may make your antagonist an interesting and well-rounded person, just as they do your character.

Depression & Generalized Anxiety

This section is a group effort—many people on this project wrestle with depression and/or anxiety, so we all contributed a bit.

Living with Depression or Anxiety Disorders

Both sadness and anxiety are feelings that are normal and even healthy. However, for many people at some point in their lives, these feelings become pervasive and excessive, interfering with daily life. Anxiety and depression are separate diagnoses, but they often overlap and coexist, so we’re covering them together.

Your character’s way of presenting as depressed or anxious may be completely counter to the way that they operate normally. A calm scientist or researcher may shoot off in rage when they’re anxious, for example, and many individuals wrestling with depression have an outwardly cheerful demeanor.


Characters with depression fall into two categories: People who have always had depression because of their brain chemistry and people whose depression is triggered by an event. The latter can come with relationships to other disorders like post-traumatic stress disorder, but for now we’re just talking about garden variety depression.

Depression isn’t a long period of sadness. Its symptoms reach much farther than that. The American Psychiatric Association’s criteria for diagnosis—sleeping too much or too little, lack of interest in activities, misplaced or excessive guilt or regret, overeating or losing appetite, fatigue, trouble concentrating and making decisions, slower than usual movement, thoughts of death and suicide—gives those who don’t live with depression a better idea of how it manifests, without using language that might stigmatize the person who has it. That being said, it’s not the be-all and end-all of depression diagnosis and shouldn’t be used as a checklist. Only five of the criteria must be present for a diagnosis of depression, and suicidal ideation is not a requirement. The way the symptoms manifest may vary wildly from person to person.

A character with depression loses interest in doing things they want to do—but it’s important not to play a depressed character like a mopey dog. Depressed characters may feel like they’re drowning in sadness, but that won’t necessarily change how they speak. It won’t make them sound like a sad puppy, which is one of the most common mistakes I see in playing depressed characters.

What’s more, depression is complicated—it doesn’t always manifest as sadness or despair. Often it’s a stubborn malaise, a general lack of motivation to do anything, that people frequently mistake for sheer laziness. Sometimes it’s hopelessness, sometimes angry self-loathing, sometimes all of the above. However it manifests, many depressed people have well-rehearsed social coping mechanisms—be careful of being too self-deprecating, say “I’m great! How are you?” a lot, practice that cheerfulness and enthusiasm. Fake it ‘til you make it.

Another thing to note about playing a character with depression is that depression can spiral. You start out feeling sort of not okay, and by the end of the depression spiral you’re at the bottom of your well. You have no idea how to get up or out, except to dig yourself further into the darkness.

Many people with depression also wrestle with anxiety, which compounds this problem—you obsessively worry about things, can’t find the motivation to actually do something, then feel guilt and self-loathing about the whole thing. It’s a feedback loop from hell.

Anxiety Disorders

Anxiety disorders cover a large range of issues centered on fear (fight or flight in the moment) and anxiety (worry about future incidents, often resulting in avoidance). These are natural and necessary feelings, so to be a disorder they must be out of proportion for the situation and/or hinder your ability to function in some way. Anxiety often interacts and coexists with other kinds of mental illnesses.

It’s worth doing a cursory search for anxiety disorders to look at the different types and get a sense of the many ways they can manifest. Phobias, panic disorders, agoraphobia, separation and social anxiety all fall under this umbrella. For the purpose of this book, we focus on generalized anxiety disorder, which is primarily persistent and excessive worry that disrupts your daily life. Symptoms include restlessness or nervousness, fatigue, insomnia, nightmares, muscle tension and pain, digestive issues, and trouble concentrating. Part of what makes generalized anxiety so difficult to diagnose is that the worries often focus on things that people normally worry about, like your job, money, the health of your family and you, the state of the world, or everyday things like chores and appointments. Everyone worries about those things, but it’s a disorder when that worry is excessive and interferes with your daily life.

The American Psychiatric Association only recognizes panic attacks, rather than the more general anxiety attacks. But in practice, most professionals and certainly most people who suffer from anxiety recognize that not all attacks result in panic. Personally, my anxiety attacks often happen in crowded grocery stores and similar situations. It takes a lot of effort to keep moving through the crowd, and I feel very nervous. However, the worst case scenario is that I might leave a loaded grocery cart behind and walk out of the store, and so far I haven’t had it get even that bad. I don’t feel like I’m panicking. But I still feel smacked upside the head by my anxiety.

An anxiety attack can present itself in a number of different ways. It can feel like energy you can’t push away, or push down; it can present like rage, hot and fast and uncontrolled; or it can present as completely shutting down and being unable to do anything. There are lots of different ways to have anxiety, just as there are lots of different ways to be deaf or blind.

Depression, Anxiety, and Aspects

A Miskatonic University librarian has situational depression about So Much Knowledge Forever Forgotten after their library is destroyed. They dwell on their grief over books and information lost to time—but also know a lot of obscure facts in an effort to save and reconstruct what they can.

The mobster with Seasonal Affective Disorder has the aspect Winter Is Coming and needs a certain amount of self care to manage their needs during wintertime game settings. But if you need to know when the sun will set or rise, or when the days start getting longer again, or you need access to a sun lamp, they’ve got you covered.

The action scientist’s anxiety may manifest as fear of failure with an aspect like I’m Probably a Fraud. It’s easy to see how to compel this, but it could also be invoked when the scientist has thoroughly researched a topic in an attempt to feel like they can look like an expert, or when they need to deceive someone—after all, they spend all of their time deceiving people about their qualifications, don’t they?

Social anxiety can manifest as thoughts like I’m Pretty Sure They Secretly Hate Me. It will make social situations daunting, but may also give your character an advantage in seeing through people who are trying to be nice to your face while stabbing you in the back.

Depression, Anxiety, and Skills

It’s unlikely that depression or anxiety would manifest in changing your skills. They may however, make it more difficult to do things. Characters may struggle with the actual action of getting up and doing research, or leaving for a heist. They may have to overcome debilitating anxiety, which raises the difficulty of using a skill, or fight off a panic attack after doing so (or as a consequence of failing a roll). It’s challenging to find skills that would be affected, however, because this is much more of a roleplaying disability than a skill based one.

Depression, Anxiety, and Stunts

You might think there’s not a lot of advantage you can draw from depression and anxiety, but… well, yeah, you’d be right. But if you think laterally, you can come up with a thing or two.

  • Self-Deprecating Joker (Rapport): Maybe it’s a shield—you make the joke before they do—but you’ve become skilled at the delicate art of the self-deprecating joke. Gain +2 to create advantage and overcome actions using Rapport when you crack wise at your own expense.
  • I’ve Heard It Before (Empathy): There’s nothing anyone else can say about you that your own internal monologue hasn’t said to you a thousand times already. Gain +2 to Empathy defense actions against mental attack or create advantage actions made to belittle, insult, or anger you.
  • Overstocked Emergency Kit (Lore, Crafts): Sometimes your planning for the worst case scenario pays off. You gain +2 to overcome actions made with Lore or Crafts when your emergency kit comes in handy—first aid supplies, signaling devices, battery chargers, protein bars, tools, etc.

Depression, Anxiety, and Conditions

Consider taking the conditions Exhausted (page XX) and Meltdown/Panic Attack/Anxiety Attack (page XX).

Player Advice

Just like other disabilities, it’s important to become familiar with the mental illness you’re portraying. Jot down a description and seriously consider each portion of the diagnostic material your character faces—it might be helpful to look at medlineplus.gov or another trusted online database. While the American Psychiatric Association’s DSM-V is helpful, it’s a tool primarily used by doctors; a layperson’s guide to mental illness will serve you just as well, if not better.

Commit to your choices, and follow through even when it’s difficult in gameplay.

GM Advice

Compels should never be about dictating to a player how their character should feel or react; this is even truer for aspects relating to mental illness. If you want to move a compel towards an emotional state, bring it about through negotiation with the player. For example:

GM to a player: “Chris just lost the file that would prove Dr. Akhan’s innocence. Given their Major Depressive Disorder, do you think this would cause them to experience feelings of worthlessness or guilt?” (Holds up a shiny fate point…) “If so, what happens next?

GMs can also rely on narrating physical symptoms that the character would experience. For example:

GM: “That night, Chris is unable to sleep. They toss and turn, but their mind won’t stop coming up with ways things could go wrong. By morning, Chris feels like there isn’t enough coffee in the world.” (Holds up a fate point.) “How does that affect them?”

Antagonists with Depression or Anxiety

So, when it comes to antagonists with depression or anxiety, you’ve got lots of examples to go with, but consider this when writing your antagonists or NPCs:

Is that character just like Sadness from Inside Out? Are they a mere representation of their diagnosis, or are they something more? Like with the rest of these disabilities and mental illnesses, a character who has a diagnosis isn’t only their diagnosis. They’re more than that. They’re a whole character, a whole person.

Am I Dreaming: Schizophrenia

Here’s Lillian, to talk about a perpetually misunderstood mental illness: schizophrenia.

Living with Schizophrenia

Schizophrenia is a disease that affects how you interpret reality. For someone without it, laughing off a sudden paranoid thought or an image out of the corner of your eye isn’t hard. When you’re schizophrenic, either of these situations can be fraught with fear.

It’s much more than hearing voices.

Schizophrenics have a brain disorder that can impact their ability to socialize and/or interpret reality, and are often “read” as having depression instead of schizophrenia. They are not inherently dangerous or psychopathic serial killers.

There are positive symptoms of schizophrenia, meaning new symptoms and behaviors that weren’t present in someone before the onset of their schizophrenia. There are also negative symptoms, meaning behaviors and abilities that have ceased or been greatly suppressed by schizophrenia.

The most famous of positive symptoms is hearing voices. It’s not a symptom every schizophrenic has, and the voice(s) can vary wildly in what they’re like. Some research suggests that the voices vary based on cultural differences, and American schizophrenics hear voice(s) that are critical, paranoid, and cruel. These voice(s) are famous in the news as directing schizophrenics to commit crimes. In reality, they most often chip away at the confidence and coping abilities of a schizophrenic.

Many schizophrenics tend to isolate themselves at home, cut off social contact, and avoid others whenever possible. This is often an outgrowth of their paranoia, another famous positive symptom. Severe anxiety and fears surrounding personal safety contribute greatly to this isolation. It also tends to prolong schizophrenic episodes. Delusions, strange behaviors, anxiety, hallucinations, nervousness, difficulty with coherent speech, and confusion are all common positive symptoms as well.

When it comes to the negative symptoms of schizophrenia, these losses are not only painful for a schizophrenic to cope with, but can be emotionally wrenching for those around them. Some schizophrenics exhibit a flat affect, meaning they no longer show signs of any personality; this often comes hand in hand with social withdrawal and severe fatigue.

These two sides of schizophrenic symptoms can make it hard to spot schizophrenia and complicates getting a correct diagnosis—the positive symptoms look like a manic episode, while the negative symptoms look like depression.

Children are rarely diagnosed with schizophrenia. It’s also rare for onset to occur after age 45. In teens, the onset may look like normal teen behavior—sleeping issues, drop in grades, withdrawal, irritability. It’s unusual for a teen to hear voices, but it’s common for teen schizophrenics to experience visual hallucinations. Most people experience the onset of their schizophrenia in their twenties.

The onset of schizophrenia occurs through stages. Promodromal is a common entry point, characterized by sleep disturbances, irritability, exhaustion, and emotional outbursts. This phase can last for as short a time as a week, to months or even years. After this, people move into an acute stage. Most frequently, this is only a month or two, characterized by hallucinations, paranoid delusions, and difficulty thinking and speaking coherently. Most schizophrenics are diagnosed in the acute stage. Acute stage schizophrenia can lead to a psychotic episode. No longer able to distinguish between reality and delusions, bizarre behaviors and extremes of emotion can emerge. There are a number of schizophrenics who only experience a single psychotic episode over the course of their lives. It’s important to stress that during the acute phase, a schizophrenic can still—though often with difficulty—distinguish between their symptoms and reality. Psychosis is when they lose that grasp on reality.

As a schizophrenic is treated for their acute symptoms, generally through a triangle of antipsychotic medication, therapy, and social support, they slide into remission. Typically, symptoms subside during this time.

Relapse is the final stage. The process repeats itself. But now there’s a frame already in place of care providers, people in a schizophrenic’s life who know about their condition, and a regimen of medication. This cycle may repeat several times before a longstanding remission occurs. A unique set of conditions may emerge over time, giving a schizophrenic an idea of what kinds of stresses and situations may cause a cycle of schizophrenic symptoms to return. As the years go by, positive symptoms may even decrease in severity, while negative symptoms increase and intensify.

A significant number of schizophrenics experience an incomplete recovery—they don’t respond to the most effective medications for schizophrenia, which acts as a substantial barrier to their long term recovery. These are patients who are willing and able to comply, but the medication simply fails to alleviate their symptoms. Often increasing social support and therapy has to take the place of medication. Most commonly, people experience negative symptoms in the case of incomplete recovery.

By now, you can see how perceptions of schizophrenia in media and entertainment don’t match the reality. It’s a complicated condition, one that leads people to an often solitary, stigmatized, and emotionally wrenching experience.

Schizophrenia and Aspects

Example aspects to convey your character’s schizophrenia could include:

Since you are a Creature of Habit to help order your thoughts, routine is very important to you. This aspect can be compelled to disrupt your routine and make the challenges you face more difficult. It can be invoked when you grab onto a routine and use it to pull some order out of the chaos in your mind.

Since your character Has Met the Bogeyman in the form of hallucinations, voices, or other manifestations of their fears, outside threats may not seem as immediate to you. This aspect can be compelled to make danger seem less menacing than than it is (”Just another hallucination, shut up, I know you’re not real!”) or on the contrary to make it reinforce one of your own familiar fears. It can be invoked when you use your experience with facing your demons to push past the fear of an immediate threat.

Since you’re Aloof for Your Own Damn Reasons, you don’t easily make casual connections with people you meet. This aspect can be compelled to make it difficult for you to befriend, convince, or sweet-talk NPCs. It can be invoked to resist peer pressure, seduction, attempts at getting information from you, and so forth.

Schizophrenia and Skills

Depending on the type and phase of schizophrenia your character has, anything that involves paying attention, short term memory, putting memories in order, and completing a task could be difficult to nearly impossible to accomplish. This is the burden of negative symptoms—behaviors and capabilities a schizophrenic can have impaired (or be unable to access/express). This could affect skills like Notice, Investigation, or Will when your character’s schizophrenia isn’t being managed well.

With positive symptoms (behaviors and capabilities schizophrenics experience that aren’t normal for them between schizophrenic episodes), they may believe they have supernatural abilities, they may suffer from feelings of paranoia and persecution, or they might exhibit risk taking behavior. Someone could experience elaborate delusions that they have skills they don’t have any real knowledge of. This could also affect Empathy and Rapport if people seem more dangerous than they are.

Schizophrenia and Stunts

Stunts are a place where the experiences and coping mechanisms of characters with schizophrenia can shine. For many with schizophrenia, cognitive tasks are difficult. But when those tasks are accomplished with the methods and aids that work for a given person with schizophrenia, they’re no longer as difficult. Stunts can be used to accomplish things with a skill that under normal circumstances can’t be done; for characters with schizophrenia, you could write stunts that help them do what they can’t under general conditions, something they’re capable of in specific circumstances.

Consider stunts that represent those coping mechanisms by allowing you to perform certain actions with alternate skills, such as:

  • I Run Therefore I Am (Athletics): You’re an avid runner, and lean on the endurance and strength that builds to bolster your sometimes shaky mental resilience. Use your Athletics skill rather than Will to size your mental stress track.
  • Talk Them Up (Rapport): You’re aware that unhealthy paranoia is a thing you tend toward, so you consciously rely on the vibe you get chatting with people to determine their trustworthiness. Use Rapport rather than Empathy to defend against lies and deception.

Schizophrenia and Conditions

There’s no condition for a psychotic episode. There’s no good way to capture the entirety of what a psychotic episode does to a person in game rules—it should only occur when you, the player, are OK with it occurring. Treat it as a self-compel of the aspect that establishes your schizophrenia, and play it out from there.

Player Advice

Think about the times you’ve misread social situations every time your character has to socialize. You can be “perfectly normal” and misconstrue a statement as hurtful or threatening; having this brain disorder makes this easier to do. All the time.

Consider when and why (and if) your character can fake being okay, and how much it takes out of them.

Before playing a schizophrenic character, ask yourself these questions and jot down some notes. Knowing these things about your character will help you roleplay more conscientiously.

  • When did your character experience the onset of their schizophrenia?
  • What kind of symptoms did they have then, and which ones do they exhibit now, if any?
  • Are they in remission? In another stage?
  • If they’re on medication, how well do they respond? Are they experiencing an incomplete recovery? Have they stopped taking their medication, now or in the past?
  • Have they ever experienced a psychotic episode?
  • What do they do to cope with their symptoms? How do they treat positive symptoms?
  • What kind of treatment have they/do they receive?
  • Who in their life knows about their diagnosis? If they keep it a secret, is it from everyone, or just specific people? What motivates their secrecy?
  • How do they feel about their schizophrenia? Did they decide not to abuse alcohol or drugs to improve their chances at recovery, or do they abuse substances to “manage” their symptoms?
  • Do they avoid personal relationships of any kind, or do they pursue friendships and romantic relationships like they would without their condition? Have they decided not to have children out of fear of possibly “passing it on”?
  • How do the people in their life treat them, if they know their diagnosis? Are there strained personal relationships, or ones that were terminated when their schizophrenia began? Is anyone overbearing about it, constantly checking up on them regardless of how they’re doing?

GM Advice

If your party contains a schizophrenic character, make sure you understand what schizophrenia is—and, just as importantly, what it is not. Avoid the tropes of violent psychopathy, multiple personalities, or whatever other nonsense popular culture has asserted it to be (including the word “schizo”—if that’s still in your vocabulary at all, consider excising it entirely, and not just at the game table). Give the player space to explore their character’s limitations. Don’t force a complete psychotic episode on them if they don’t want to play that.

That said, if they choose to play a schizophrenic character, give them the experience they want. Don’t be afraid to compel their disability-establishing aspect and make them feel the symptoms—voices, paranoia, etc. But make sure you do so from a place of knowledge, not pop culture. Yes, this means doing some homework as part of your own prep, but you signed up for that when you decided to sensitively run a game with disabled characters.

Antagonists with Schizophrenia

Age, treatment, social support, and country inform what these NPCs will be like. Schizophrenics in Western countries tend to report voices that are critical and cruel, while anthropological studies suggest auditory hallucinations experienced by schizophrenics in India and Ghana are far less geared towards devastation; these voices have been reported to be playful, even mild in their temperament. Most men become ill between 16-25, with 18 as an average age of onset. Women typically fall between 25-34, with 29 as an average age of onset. Where’s your NPC from? When did they experience their first episode? Have they ever been treated? Have any support, from anyone? When did they experience their first episode? Is it right now? Did they recover completely from their first episode? Or have they experienced incomplete recovery?

In general, you don’t look at someone and say “I bet they have schizophrenia.” Do they have visible symptoms, and if so, do they let other people call their own conclusions? When you have an NPC with schizophrenia, consider what (if anything) their schizophrenia looks like to the outside world, and how the outside world looks to them. If negative symptoms have impaired their ability to read social cues, they may be quiet, requiring coaxing. Or they may be a brash jerk. Schizophrenia impairs how the brain functions, so how they cope may be the most visible thing about their schizophrenia. If they experienced multiple episodes that created long term social and career issues for them, they may be willing to give a PC a break no one else would. Or they may hold them to a strict high standard, because they weren’t coping with what this NPC has had to live with.

So, your three beats to hit as you consider making a NPC with schizophrenia are how they look to others, how others look to them, and how they experience their schizophrenia.

Touched by Fire: Bipolarity

This is Phil; he’s been diagnosed with Type II Bipolar Disorder for a few years and is going to give you a sense of how that functions.

Living with Bipolar Disorder

Bipolar disorder is a neurological condition commonly found in writers, artists, and industry leaders. While there’s a clear genetic link to the condition, it usually manifests itself in early adulthood. In my case, I suffered several depressions after the age of 25 and was diagnosed at 35. The condition is characterized by cyclical mood swings ranging from high-energy manic phases to severe depressions, and it’s considered easily treatable with a combination of medications, healthy lifestyle choices, and psychotherapy.

In my day to day life, my condition manifests itself in larger-than-life emotions. I get really happy, excited, and loud in a second and then I can get super moody and non-responsive as I mull over that one thing someone said to me three hours ago. I can be a hard act to follow.

Fiction and real life are rife with examples of bipolar characters, many of which met tragic ends. Winston Churchill, Marilyn Monroe, Russell Brand, and Carrie Fisher are well known examples from real life. Norman Osborn (The Green Goblin from Spiderman), Carrie Mattison (Homeland TV series), and Locke Lamora (The Gentlemen Bastards book trilogy by Scott Lynch) are textbook examples of fictional bipolar characters. In fact, The Gentlemen Bastards trilogy would probably be among the best models for bipolar characters; it captures the essence of bipolarity without getting stuck in over-realistic details that could hinder play.

What truly defines bipolarity is the existence of recurring, intense phases of manic activity, usually triggered by a series of strong stimulations brought by exciting or overwhelming experiences. When that happens to me, I feel like a rock star, I need less sleep, I’m easily distracted, I express excessive happiness, I get super irritable, I may feel restless, I experience racing thoughts, and I have a tendency to make too many plans. Trust me, these are like freaking roller coaster rides!

The disorder is divided into two categories, Type I and Type II. They mostly differ with how individuals experience mania. Type I individuals suffer a more severe form of mania that disrupts the ability to work and socialize, and may require hospitalization to prevent harm to themselves or others. They can lose touch with reality to the point of being psychotic.

As someone with Type II, I go through milder phases of mania (called hypomania), which remain rooted in reality. In fact, given the modern world’s expectations for high performance, people with Type II bipolar disorder often go undiagnosed as they are considered “productive” individuals.

Being bipolar makes it easier for me to tap into my creative potential. My atypical brain chemistry helps me generate an impressive amount of ideas and scenarios in a short time. Highly intelligent and/or charismatic people with the condition often stand out in the crowd, which is why we seem to find so many among entertainment media and Fortune 500 companies.

The clichés of alcoholic grizzled writers and overdosing rockstars are widespread, yet are very much steeped in reality. The wild mood swings, frequent depression, anxiety, and general sense of sadness often leads those with bipolarity to self-medication through mind-altering substances. I’ve had my shares of binge drinking days. Such abuse, which often provides temporary relief from my occasional bipolar mal-de-vivre, almost invariably makes my depression symptoms worse; for some, this often leads to thoughts of death and suicide attempts.

All of the above can serve as inspiration when playing bipolar characters and can help flesh out their backgrounds. Giving your characters histories helps you define how they’re likely to react to stressful situations. If the character is young, she may be inexperienced with her condition and not quite understand that her actions and reactions come from her and not her environment; she might blame everyone else for them. An older version of that character might be more self-aware and may have developed balances and checks—or bad habits—to be more socially functional. Such elements could be part of your character’s high concept if they define who they are at their core. However, I’d advise you to put anything related to bipolarity other aspects. Bipolarity doesn’t usually define who we are, but it is very much a part of how we interact with the world.

Bipolarity and Aspects

Consider taking aspects that play on the mercurial nature of a bipolar’s mood swing like: Quick to Anger, Loud Talker, Sulks When Contradicted, Easily Excited, Unnerving Laugh, Twitchy, What Were You Sayin’?, etc.

You could also pick aspects that play to the deeper, manic/depressive facets of the character: Make It a Double, I’ll Try Anything Once, Well Hello There, I’ll Sleep When I’m Dead, What’s the Point?, I Have No [redacted] to Give, Try to Keep Up, Obsessive Overthinker, etc.

Triggering an Episode

Your aspects are the key to triggering a manic or depressive episode. A compel on the appropriate aspect is the trigger for either type of episode, but when you create your character and compose the aspect that establishes your bipolarity you should talk about what sorts of events tend to trigger you. They might include things like:

  • Drug use or overindulging in alcohol
  • Death of a friend or loved one
  • Major personal failure
  • Loss of a job
  • Failed relationship
  • Insomnia or loss of sleep over time
  • Change of seasons, especially winter’s darkness

The episode results from a compel, whether initiated by the GM or by you. Being off your meds (see the Off My Meds condition, page XX.) makes this much more likely. Once the compel occurs and is accepted, decide whether the episode will be depressive or manic (see Exhausted and Hypomania conditions, pages XX and XX), and go from there.

Bipolarity and Skills

Some skills might be easier or harder depending on where in your emotional cycle you land. If you’re feeling invincible, it might hurt you, or it might help you. Pay attention to where your character is, and how they’re feeling.

Your tendencies while in a manic phase might also affect your skills. If you tend to be loud and angry, it’s possible that you’re pretty good at Provoke and/or Fight. Perhaps that time you spent an entire weekend learning to weld gives you a higher Crafts skill.

Bipolarity and Stunts

There’s not a lot of advantage to be gained from bipolarity; the heightened productivity of mania is covered by the condition Hypomania (page XX). Otherwise, it’s all about harm mitigation:

  • I Know The Warning Signs: You’ve been around the bipolar block a few times, so you know the signs of an approaching episode and how to ward it off. When your bipolarity aspect is compelled against you to trigger an episode, if your character takes some sort of self-care action, you may buy off that compel with one fewer fate point than usual.
  • Risk Reduction: Your friends, colleagues, and business partners know to watch for manic behavior and mitigate some elements of risky behavior. Choose one area of trouble you could get into—financial, legal, social, or health—and you won’t hurt yourself or others in that realm during a manic or hypomanic episode.

Bipolarity and Conditions

Take the conditions Off My Meds (page XX), Exhausted (page XX), and Hypomania (page XX).

Player Advice

Bipolar characters make for unpredictable, reckless action heroes; razor-sharp thinkers plagued by countless inner demons; or hyper-perceptive investigators with a penchant for making terrible decisions. Bipolarity is a great vessel to create rich characters who can shine while still having a darker, dramatic streak. It’s fine to play up the ever changing behavior of the character—but make sure it’s never used as an excuse to act however the hell you want at the table. Play your character from the perspective of putting yourself in the shoes of someone whose brain is either on fire or stuck in gloom.

In play, feel your character’s emotions strongly and follow a cyclical pattern for those emotions.

GM Advice

If you’re going to GM a game with bipolar characters, you should think about ways to create dramatically significant points of stress for the characters. Thus, you can create situations for people to gleefully embark on playing their characters as they want or make for thrilling opportunities for compels for you. Have a few triggering situations ready and don’t hesitate to discuss with the players themselves so they can share what kind of scenes and what kind of character development moments they want to explore.

Antagonists with Bipolar Disorder

Bipolar antagonists will be larger than life, likely narcissistic and bombastic. The trick here is to make them human, not cartoon pastiches of the diagnosis we’re giving them.

PTSD: Living With the Past in the Present

This is Elsa again. I have post-traumatic stress disorder.

Living with Post-Traumatic Stress Disorder

Something horrible happened. Something you can’t process, but you can’t forget. Your brain reacts to that by protecting you—it’s the only thing it knows how to do. But by protecting you, by putting your memories into a box that you can only access when you’re terrified, the memories can be let out of their own Pandora’s box by a literal trigger from the past and that’s when things really get bad. PTSD is often discussed in relation to soldiers, and for good reason, but any traumatic event can cause PTSD.

Post-Traumatic Stress Disorder (PTSD) manifests for people differently, but the basic earmarks are the same. Night terrors. Anxiety attacks. Flashbacks. Hypervigilance. Sensory memories. People have different experiences of the disorder, but they all experience some of the above. Looking up the American Psychiatric Association’s guidelines for diagnosis might help you to figure out how your character’s PTSD manifests, but the basics are these: intrusive thoughts, flashbacks/nightmares, or triggers which set off anxiety. These aren’t the only factors in diagnosing PTSD, but they can get you started on understanding what you’re doing.

One of the reactions that you might consider is hypervigilance; it keeps you on edge but also helps make sure you’re ready for anything that might happen. PTSD sometimes manifests with a sharp memory for everything, allowing you to pull clear memories from your past.

That being said, PTSD is not a positive. Triggers, flashbacks, and night terrors are all cause for difficulty, especially if they happen in the wrong place at the wrong time. A trigger might be straightforward, like Sound of a Gunshot, but it’s also possible that a trigger won’t necessarily be obvious. It’s harder to outrun your fears when they present as a certain kind of smell, like ammonia for a character whose hospitalizations were particularly traumatic. PTSD will make you avoidant, hyperaware, and sometimes unable to cope in the face of the thing you fear most.

PTSD and Aspects

PTSD is a specific demon, one that preys on the specifics of your past; therefore you need to be specific about its execution. Naming an aspect for PTSD should be endemic to the kind of PTSD the character has. Night terrors isn’t really enough, but a specific night terror might be. A flashback isn’t enough, but an aspect naming the kind of flashback would be. You get the idea.

The CIA Agent with PTSD from a mission gone bad might have the aspect Hyperaware of Change which helps keep her safe from anything that might go wrong during a mission, but also makes it hard to let her guard down and relax, even among friends.

The thief who survived childhood abuse might have the aspect Memory for the Ages and can remember things that happened far in the past, thus being able to remember locations for heists with ease. Those memories may not be pleasant to call up, however.

PTSD and Skills

For the most part, PTSD doesn’t interact with skills. However, some skills may be affected during a flashback or a panic attack. Essentially, when your character is exposed to something triggering, they may not be able to perform, even with a high skill, at the same level as when they are fully functional. A character who was in a car accident may not be able to use their social skills to the highest level while they’re in a car, even if they have a skill which should normally transcend that.

See the condition Meltdown/Panic Attack/Anxiety Attack (page XX) for more ideas.

PTSD and Stunts

PTSD-related stunts will likely have to do with hypervigilance or memory, and their applicable circumstances will relate to an applicable trigger. For example:

  • The Smell of Napalm in the Morning: Because my PTSD is triggered by the scent of gasoline or similar fuels, I get +2 to overcome, create advantages, or defend when reacting to threats that produce such smells, like fires, nearby vehicles, accelerants, etc.
  • Hair-Trigger: Because my PTSD left me with a hair-trigger response to physical violence, I always go first in PC initiative order when I feel attacked by an opponent in my personal space.
  • Memory Like a Steel Trap: Because PTSD left me with inescapable memories, I never forget a smell; I get +2 to overcome or create advantages by recognizing specific smells I have encountered before.

PTSD and Conditions

Consider taking the conditions Exhausted (page XX), Meltdown/Panic Attack/Anxiety Attack (page XX), and Off My Meds (page XX).

Player Advice

Invoking PTSD might involve using hypervigilance or flashbacks. Invoking a flashback means deliberately exposing your character to a trigger in order to give the rest of the players information about the story you’re telling. The Exhausted condition (page XX) adds mechanical weight to the effects of encountering a trigger in play.

Characters living with PTSD not only need to have a well-articulated concept for how their triggers operate, they also need to have a well-articulated past and a reason for why they have the condition. Write up a timeline of events around your character’s PTSD—how and when it developed, how they’ve learned to cope, what things are triggers for them. Delving into your character’s psyche might seem silly at the beginning of a game, but making the choice to play a character like this demands it for good roleplay, and it will make your story richer for having it.

GM Advice

Post-Traumatic Stress Disorder is a mental illness brought on by circumstances outside of the individual’s control. PTSD isn’t something you’re born with, but something you gain as a result of lived experience—which means that PTSD is a mental illness your character can get during a game.

PTSD is like a permanent consequence in Fate Core, if you’re playing to make these kinds of choices. PTSD isn’t something that a player can have their character resolve between sessions—a GM would have to agree to at least a year long interlude in order to resolve that consequence as a result of gameplay.

Antagonists with PTSD

Try not to create antagonists whose PTSD is the reason for their evilness. For example, a soldier who wants revenge against the people who he was at war with isn’t a cool storyline for a number of reasons.

A woman who wants revenge against her rapist? It’s been done many times, and unless if a player has specifically asked to play through that scenario as a catharsis of some variety, it’s not something you should spring on someone.

Stipulating that a villain has PTSD is often used as a get out of jail free card, something to complicate whether or not they should be allowed to continue doing evil things. That’s not just infuriating for people with PTSD who don’t want to do those things, but it reinforces the assumption that people with PTSD are always angry.