Chapter 3: Some Scars Are Invisible

Fate Core provides a system for mental conflicts and the potentially lasting consequences that can result from them. The tools we provide here are designed to supplement the standard mental conflict rules in handling the long-term mental toll of horror on the characters.

Media Inspiration

The following books, movies, and TV shows are useful sources of inspiration when considering the mental toll of horror:

• The Orphanage is an excellent movie that speaks to the extremes to which grief can drive people.
• The Tell-Tale Heart by Edgar Allan Poe, along with several of his other works, focuses on the repercussions of guilt and shame.
• Jessabelle is a Southern Gothic movie about recovering from extreme injury while in your childhood home.
• 10 Cloverfield Lane depicts the consequences of isolation and uncertainty on the human psyche.
• The Road by Cormac McCarthy is a novel exploring the twin roles of hope and fear in driving the characters to survive in a bleak, post-apocalyptic world.
• I Am Legend by Richard Matheson is a classic about a man surviving alone and surrounded by vampires who comes to realize that he has become a monster to the monsters.
• The Shining by Stephen King excruciatingly depicts the descent of one man into madness.
• Stakeland is a tale of humans surviving a vampire apocalypse, being herded for food and facing unimaginable terrors in the night.
• Alien gets under your skin... Literally.
• Quarantine is a zombie film in a filthy, claustrophobic setting that practically assaults all five senses.
• Knights of Sidonia is action sci-fi with a heaping helping of visceral horror and some good ideas about how to integrate it into other stories.
• Child of Fire features creatures that provoke a visceral reaction largely outside of normal horror tropes.
• Scream, A Nightmare on Elm Street, and The Texas Chain Saw Massacre are the classics of ’80s slasher flicks, and capture the essence of splatter horror.

Tools of the Trade

Representing mental health issues at the table is something you must handle sensitively and respectfully. The possibility of causing distress to a player by mistreating the subject is very real, and so is the risk of reinforcing prejudice against—and misunderstanding of—people with mental health issues.

The issues of player consent and safety we discussed earlier are of paramount importance when you’re going to explore the subject of mental health. So, before discussing specific rules, let’s briefly review the general tools that you have at your disposal as a GM to make psychological trauma a viable—and non-harmful—character arc at the game table.

Metagaming is the practice of considering the game as a whole—including rule books, character sheets, and other materials—rather than relying entirely on in-character experiences. While often derided for “ruining” a game, metagaming is an excellent tool for discussing choices prior to their occurrence.

Steering is the use of the metagame materials and out-of-character discussion to make in-character choices. Your group needs to be on the same page when it comes to the use of psychological trauma in plot and story, and the best way to do this is with all eyes open following a discussion of the subject.

In addition to using discussion to make plot points about mental illness acceptable, use of X-Cards, Script Change, and Open Door Policies (players can leave the table at any time for no reason, to protect their boundaries) can help keep the room feeling safe. Just because you’ve discussed something prior to it happening, doesn’t mean that everyone will be okay in the moment that it happens. A player who was just fine with the idea of roleplaying a mental breakdown might not be when it comes time to do so, or someone else at the game table may find to their surprise that it’s too much for them to watch.

All these tools make it possible to tell stories involving mental illness and psychological trauma safely and respectfully.

Wounds Lead to Scars

Horror fiction is powered by the things we fear. Commonly, we fear the things that can happen—or be done—to us, or to our friends and families. We can experience a trauma, and thus acquire mental health issues that we didn’t have before. As explored in “Body Horror”, we can lose a limb, sight, or hearing in a horrifying way, and mental consequences can result. There may also be mental consequences for seeing something awful, as described in “Visceral Horror”.

Whatever happens to a character, there can be psychological repercussions if what happened was traumatic.

Such repercussions are real. Unlike a system with a well of sanity points which can run out and make a character unplayable, we encourage you and your players to recognize and engage with psychological trauma, and to see through the consequences of a character’s actions or experiences. Having mental consequences doesn’t mean you’re out of the game.

The trick is, when we play out the kinds of horror which require us to pursue very real fears, we must treat the people in real life who experience these things with civility and kindness. This section addresses some ways you can do that without harming players—or even observers—of your game.

Before we get started, we want to state up front two hard rules for portraying characters with psychological problems in any Fate horror game:

• Mental illness does not make people act like cartoonish caricatures. Players must keep their characters consistent with their aspects and pre-existing beliefs rather than using their psychological issues as an excuse to act without a moral compass or to do “crazy” things.
• People with psychological problems are not punchlines. Characters may well find humor in their situation, but it’s important that your group only ever laughs with characters rather than at them in respect to their mental health.

What About Existing Mental Illnesses?

The Fate Accessibility Toolkit is a handbook for playing disabled characters and running games with disabled characters in them. It covers a variety of disabilities, including actual psychological disorders and mental illnesses, and how they might be portrayed within a game.

Dealing with Grief

Bereavement is a particularly potent source of mental harm. Loss is something we must all deal with in our real lives, and in a horror game PCs and NPCs are likely to die on a regular basis. How characters respond to the loss of a close friend, mentor, or collaborator is a worthwhile place to explore psychological trauma. If you’ve ever experienced the death of a family member or friend, you probably remember what it felt like, but there are many ways to grieve.

Characters who live with addictions might indulge in those habits more than they regularly do as a reaction to a death. Others may go totally numb, protecting themselves from their actual feelings by pretending that nothing is wrong—right up until it goes very wrong. Still others react with anger.

Grief is an emotional and physical response to death. Some people feel physically ill upon hearing that they’ve lost someone—and it’s not a psychosomatic response. Others can’t stop crying, no matter how hard they try.

Grief can be about more than death, as well. Loss of a friendship, a lost pet, or any other kind of traumatic or sudden loss, whether it’s a death or the end of a career, can trigger grief responses from characters.

Trauma Aspects

For the purposes of this section, a trauma is a single, definable event or series of closely related events that creates overwhelming distress and exceeds a character’s ability to cope normally.

A trauma aspect is any aspect that’s intended to represent a significant, long-lasting effect of trauma on a character’s mental wellbeing. This will usually be a moderate, severe, or extreme consequence or an aspect gained while a coping condition is checked. A player can choose to treat a situation aspect as a trauma aspect if they understand this will make it last indefinitely; characters never really heal from traumas so much as they find ways to cope with them.

Whenever a character takes a trauma aspect, identify potential triggers and responses associated with the aspect. Together, these form a guide as to how the character expresses their reaction to the trauma in everyday life.

If a character was in a horrific car accident, they may have an anxiety attack every time they try to drive a car on the highway, or in the rain. If they were trapped inside a house with a serial killer trying to break in, they may be afraid of being alone, or they might still get a pang of fear in their gut when they walk past a window with the curtains closed. Or maybe they’re afraid of the sound of knocking on the door.

Players, take the time to research genuine mental illnesses when coming up with trauma aspects, as this will help you to pick triggers and responses that really go together instead of building a genre cliché. It’s possible that you’ll discover what you were looking for wasn’t what you expected.

Rather than using a clinical name like Acute Stress Disorder, use an evocative name that guides how the aspect affects the character—mental illness doesn’t look the same for any one person all the time.

Richard’s character, Tanvir, was in a car crash that killed his husband. His husband’s ghost has been haunting Tanvir in mirrors and windows ever since. Richard researches post-traumatic stress disorder and decides it would be the appropriate basis of a trauma aspect, so he chooses Legacy of Shattered Glass.

Using Trauma Aspects in Play

You can invoke or compel trauma aspects when appropriate—usually when one of the triggering conditions you identified when creating the aspect occurs—to complicate a character’s life in a way consistent with their psychological state.

One technique is to compel a trauma aspect to incite a flashback, in which the player re-enacts the traumatizing scene from their character’s past. Used sparingly—once a session at most—this is an excellent way to instill a scene with drama and character development.

When the ghost punches a mirror to get Tanvir’s attention, the GM asks Richard to play out a fraction of that car crash in a flashback spotlight scene.

A character can be compelled in other ways as they fail to cope with their trauma, meaning they experience nightmares, experience a panic attack, or freeze in place. They might instead use a maladaptive coping mechanism like ritualized behavior, avoidance, or hypervigilance. See “Coping Conditions” for a system that builds on the idea of maladaptive coping.

When a character marks a box of mental or physical stress, that’s a good time to offer a compel on one of their trauma aspects as the strain of the situation causes the symptom to take effect. Most importantly, the player and GM should agree on what triggers the symptom or condition.

Tanvir has a Gun-Shy condition that he marked off during a desperate gunfight. Later, when he’s in a standoff with a gun-toting cultist and has to mark his second physical stress box, Elsa uses that as justification for a compel on Gun-Shy to make him freeze for a moment and let the cultist move unopposed to a tactically advantageous position.

Trauma aspects last until the character takes the time to treat them through professional therapy or heart-to-heart conversation with another character. Each game will function differently in how difficult it is to treat trauma aspects, but the idea is to highlight the process of healing and treating mental illnesses. Players heal their characters’ physical wounds by seeing a medic; why wouldn’t characters also see therapists or psychiatrists?

Once a trauma aspect has completely healed, this means that the character has learned to use healthy coping mechanisms to deal with their psychological discomfort, which never entirely goes away. Healthy coping mechanisms aren’t an aspect to be invoked or compelled, but part of how the character acts and behaves.

Tanvir eventually lays the ghost of his husband to rest; the literal haunting ends, though he continues to be haunted by the accident. Eventually, after regular visits to a therapist, he learns to cope with his remaining symptoms of PTSD using mindfulness, exercising regularly, and investing more deeply in his other relationships.

Coping Conditions

This system uses conditions from Dresden Files Accelerated, page 116, to represent coping conditions—maladaptive coping mechanisms that enable characters to keep functioning in the face of a horrible, hostile world, but which ultimately make life more difficult for the character.

• When a character takes physical or mental stress, their player can check a coping condition to absorb stress in addition to a single stress box and any number of consequences.
• A fleeting coping condition can absorb two shifts of stress, a sticky one can absorb four shifts of stress, and a lasting one can absorb six shifts of stress.
• You can also cause PCs to check a coping condition due to the consequences of a compel or an in-game experience that doesn’t inflict stress, such as encountering an eldritch tome.
• A coping condition is defined the first time it’s checked, not written on the character sheet in advance.
• While a coping condition is checked, the character has a trauma aspect of the same name. If an opponent caused the condition to be checked, they get a free invoke on the related trauma aspect as normal.
• Checking a coping condition means that the character begins engaging in the maladaptive coping behavior described by the condition, and will do so until they take whatever steps are necessary to clear out the condition. As the character has an aspect of the same name, they can be the subject of appropriate invokes and compels.
• Each character can have only one of each kind of coping condition—fleeting, sticky, and lasting—on their character sheet.
• Coping conditions aren’t fixed to a limited list; any character can take one of the example conditions given here or a new one created by your group.
• If a character has an unchecked coping condition at a minor milestone, their player can delete the condition from their character sheet instead of changing one of their aspects.
• If a character already has a coping condition defined and needs to check a more severe one, they can “upgrade” their current coping condition, moving it to the higher condition slot and freeing its existing slot for immediate use. They can only do this if they don’t currently have a condition defined in the higher slot.

Elsa is playing a Mythos Scholar and marks a sticky Flashbacks coping condition on encountering an evil book. She experiences flashbacks to the horrors within the text, hideous images flashing across her mind every time she tries to recall the book’s content. Later, when exposure makes Elsa’s flashbacks worsen, she upgrades it to a lasting condition as she suffers repeated nightmares featuring the content she’s read. This frees up her sticky coping condition slot for later use.

• Fleeting coping conditions remain checked for a scene but are cleared out immediately when the scene ends or the character escapes from it.
• Sticky coping conditions remain checked until the character recuperates naturally. The maladaptive coping behavior recurs when triggered by stressful situations or affects the character continually until they have a chance to find some peace with a good night’s sleep, a stiff drink, a convivial meal, meditation, or some other calming and centering activity.
• Lasting coping conditions remain checked until the character seeks help. The maladaptive coping behavior recurs regularly and the character must receive counseling and/or medication to clear the condition, needing someone to overcome at least Great (+4) opposition.

Example Coping Conditions

• Hypervigilance: Characters with this condition might be highly sensitive to touch, or have an overactive startle reflex, increased scanning for threats, and heightened awareness of surroundings. A fleeting version of this condition fades when the immediate danger is past, while a sticky hypervigilance condition can be resolved with rest and the establishment of trust. A lasting hypervigilance condition may never be resolved without significant story developments.
• Obsessive Ritual (sticky or lasting only): The character copes with their psychological distress and lack of control through specific rituals. Some rituals are checking mechanisms (checking locks, turning faucets on and off) while others relate to distress about contamination (fear of germs, excessive washing of hands), hoarding, rumination, or intrusive thoughts. Sticky conditions are treated by the resolution of the concern (for example, some kind of workaround for the stemming issue like carrying hand sanitizer or having a security system) while lasting ones can be permanent without significant psychological assistance.
• Avoidance: The character cannot engage with the object of their trauma. For example, Elsa’s character steps on a rattlesnake. The snake doesn’t bite her, but the experience of finding her foot right next to a rattling snake, ready to strike and able to poison her, sticks. Whenever she sees a picture of a snake, her heart speeds up and she looks away. When she finds out there are plastic snakes at the toy store, she reroutes herself to avoid it. Avoidance can look like sticking fingers in ears to not hear a topic of discussion, closing eyes, taking alternate routes, or shouting over someone so you cannot hear them.
• Inappropriate Emotion: The character’s emotional responses to sources of stress are mixed up. For example, instead of becoming scared in a nerve-wracking situation your character becomes angry and prone to lashing out at her allies because anger is more controllable than fear. A fleeting version of this condition fades when the stimulus is past, while a sticky version needs to be resolved after resting and having a chance to process complex emotional responses. A lasting version requires conversation, soul-searching, and therapeutic assistance to overcome.

On Othering Mental Illness

The Collins English Dictionary defines othering as “feeling or making others feel disowned and alienated.”

When creating stories involving mental illness, it’s important to make sure not to other those mental illnesses. Othering in fiction is the act of creating characters whom readers and consumers of media cannot identify with because they are different, and using that difference to make the audience fear them. An example of this is Renfield from Dracula. Renfield does the bidding of a vicious creature, he wears the trappings of insanity (a straitjacket), and he eats flies and other insects. All these things are the imagery used to paint Renfield as “crazy”—and thus supposedly incomprehensible to us. Mental illness is being used in this context to make Renfield scary or creepy, rather than him being perfectly sane and still working for Dracula (which to me, reader, is even scarier).

The practice of othering creates a space between a person who is different and “normal” people, and capitalizes on that space to make the other look more terrifying. When you create characters with mental illnesses, please don’t cast them only as a villain or tragic figure. Plenty of people with mental illnesses come out of normal and stable settings, and while we don’t want to make it look like mental illness isn’t a problem, we need to acknowledge that a mental illness, by itself, is not a reason to simply decide someone is evil or in some other way unfit for social interaction.

Especially in America, where the distinction between a perpetrator of gun violence and a “crazy person” must be re-examined every time there is a tragedy, we must not conflate mental illness with violent acts. We must remember that people with logic and purpose might still have a mental illness, and that people who commit violent acts may not have one at all. Oversimplifying these matters hurts everyone, not just those with the illnesses in question.

Horror fiction has a particularly bad track record for othering people for their nature, mental or physical issues, or behavior as a lazy way of indicating that they’re the villain or to make it acceptable that they become victims.

It’s possible to use themes of The Other in your horror games without punching down at people who are different from the mainstream, where The Other represents the forces of totalitarianism, alien threats, or a liberating or a transformative force which is ultimately embraced by the characters.

The Horror of Viscera and Gore

A common source of emotional and mental distress for characters in horror fiction is exposure to bodily harm or its gory aftermath. You can use these as a seasoning in your game to induce instinctual reactions of repulsion and revulsion in both a player and their character. This shared reaction can help the player identify with their character’s situation and heighten other aspects of horror—for example, a sense of helplessness.

In this section, we provide tools and advice for using visceral and splatter horror in your games as a source of psychological trauma for the characters. Like any seasoning, use visceral horror sparingly—repeated use quickly numbs its impact.

Lovecraftian Horror

While this section is aimed squarely at emulating gore and splatter horror, its systems also work well for representing the disturbing and unsettling nature of encounters with the eldritch and uncanny which are the hallmarks of Lovecraftian horror. Rather than gore, encounters are with mind-boggling architecture and Things That Should Not Be.

The Narrative Uses of Viscera

When describing viscera, open and close your description with senses other than sight to heighten the sense of wrongness and discomfort. Open with the taste of rot in the air, or the smell of a pustulous blight. End with the squishing sound of something moving or settling, or the feel of something unexpectedly wet—or dry—under a character’s foot or hand.

Viscera serves a practical purpose as well, by providing evidence of something off-screen. This allows you to retain mystery by keeping a threat out of view while influencing the current action with its aftermath. Gory remnants of an attack provide clues about how a monster works, such as how it kills its victims or whether it behaves in certain ways during or after an attack. Such remnants can also build tension by intimating a future threat, demonstrating the power of something that must be confronted—or escaped—soon, or revealing some of its capabilities.

Splatter horror overturns the normal limitations of viscera by turning the gore up to eleven. Depictions of violence are frequent, extreme, and fast-paced, resulting in exaggerated injury and suffering. When you’re running a splatter horror game, use the same advice and mechanics, but delay any viscera-related compels until after the dust settles and events have had a chance to sink in.

Visceral Aspect Compels

Viscera is normally the basis for compels as soon as the characters encounter it. As their instincts override their higher reasoning and they make bad decisions as a result, their players temporarily lose their narrative control as well. Usually you’ll compel a situation or monster aspect representing the gore itself, but in some subgenres tying the compel back to a character aspect may be more impactful.

In Richard’s survival horror game, the PCs stumble into the aftermath of a zombie attack. Richard passes out a fate point to each player, with the compel “The Brutal and Bloody Corpse Carnage turns your stomachs. You spend several minutes throwing up and regaining your composure, which was very much a bad idea. By the time you’ve recovered yourselves, you realize that several of the corpses have risen to their feet and are almost on top of you...”

In Elsa’s nihilistic horror game, the investigators have discovered the imprisoned results of the cult’s experiments. She compels one of the investigators: “Because you’re a Secluded Scholar, you’re overcome with shock and disgust and scream in fright when one of the prisoners rolls over and stares at you. This goes wrong when you hear heavy feet treading on the stairs down to your level...”

Decision-based compels driven by viscera are a great way to set up classic horror situations, like a character...

• ...fleeing the scene and ending up alone with something dangerous nearby
• ...fleeing the scene and leaving behind something (or someone) important
• ...screaming and attracting unwanted attention
• ...ruining their tough facade in front of someone they want to impress
• ...abandoning a carefully-prepared ambush and frantically attacking

Viscera can also be used for event-based compels. These draw on the exact circumstances more than decision-based compels, but some examples include characters...

• ...being so distracted that they miss an ambush
• ...being mistaken as the cause of the gore by another party
• ...slipping in the gore and getting thoroughly covered in it
• ...incorrectly identifying the victim because they can’t bring themselves to look carefully

The Mental Toll of Gore

Characters often want to come away from a viscera-splattered scene with something they can use as an advantage later. In horror genres with powerful monsters, these scenes offer a great opportunity to build up advantages and free invokes that can be used in a later confrontation...but not without a cost to their mental wellbeing. Rather than using compels to reflect the traumatizing experience of scenes like this, make the gore a character in the scene and have it act directly on the characters as they investigate in a contest or conflict.

Give the visceral mess a Gore rating, and roll attacks with it every exchange, defended by Will or Careful. A Gore rating at or slightly below the group’s average Will rating means that characters must be cautious, since the GM has a stock of fate points per scene they can use to boost their attacks. Depending on the circumstances, the gore can roll against a single character, divide its shifts among everyone, or, for an especially challenging scene, attack everyone with its full roll.

Make the scene brisk, with characters creating some advantages against the threat, taking some stress and maybe a consequence, and then getting out. To change things up a bit, you could transition to a fight or a chase after an exchange or two.

Bruce’s players have found some bodies half-dissolved in some malignant but dormant fungus. He’s about to compel them to flee the scene when Marissa suggests that this is a great opportunity to learn more about the source of the fungus. After rolling to create several advantages to analyze samples of the fungus, Bruce rolls the scene’s Gore of Good (+3) defended by Marissa’s character’s Fair (+2) Will and Nick’s character’s Average (+1) Will. Marissa’s is fine, but Nick’s character takes a 3-shift hit. He marks a stress box and takes a mild consequence of Unmoored from Reality.

Next exchange, Nick looks at his treacherous dice and declares that he’s conceding before Bruce rolls. Marissa’s PC shrugs off the hit again, and Bruce and Nick decide that the fungus has begun to wake up and he’s passed out from inhaling the spores.

Splatter Attacks

Monster stunts are another effective way to bring viscera into play, especially in a splatter horror game. When triggered, these stunts let the monster create an advantage representing disgust or revulsion, or make a Provoke attack against all witnesses.

Triggers might include:

• When the monster’s target takes a consequence
• When the monster succeeds with style
• When a disgusting monster first comes into clear view
• When you first smell the monster’s stench
• When a monster is discovered in an unexpected place, like hanging from a ceiling or moving through a pipe that should be too small for it

These stunts are powerful, and should be limited—usable once per scene, requiring a fate point, or requiring an invoke of a suitable situation aspect.

Chainsaw Flourish: When the Appalachian Stalker succeeds with style on an attack with his chainsaw, the GM can spend a fate point to roll a Provoke attack against everyone else in the original target’s zone.

Hardened Hearts

Sometimes it doesn’t make sense for a character to be bothered by viscera. In some subgenres of horror, especially survival or splatter horror, this works without further complication. Give your character an aspect like Expert Surgeon or Combat Veteran justifying why they can shrug off a bloody mess or a room strewn with internal organs. Since aspects are always true, you can use such an aspect to argue that a viscera-based compel is inappropriate, and you’ll always have something to invoke when defending against viscera-based attacks.

In other genres, especially those focusing on psychological horror, this kind of hardening comes at a cost. One way to handle this is with a stunt that exchanges your internal cost for an external cost; instead of you getting grossed out, everyone nearby is disturbed by your indifference.

Inured: You’ve got a strategy for coping with viscera and gore, but it’s not comfortable for others. You have a sticky condition (Dresden Files Accelerated, page 116)—Disturbingly Callous []—that you can check at any time. While it’s checked you’re immune to gore-based mental attacks and can’t have visceral aspects compelled against you—but you also can’t use or defend against the Empathy skill. To clear Disturbingly Callous, you must demonstrate that you are vulnerable and human after all, for example by making an emotional appeal in a safe place, or putting yourself in danger for your allies. Anyone without Disturbingly Callous checked adds one to the shift value of every gore attack they receive if they’re in the same zone as someone with the condition checked.