Fifth Disease

Eric Lis

This week saw the release of the new Dungeons & Dragons Dungeon Master's Guide. I'd been eagerly awaiting this book, because in general I've liked the changes that WotC have made in the new edition and I was very keen to see how it would handle diseases of both the body and the mind. In short, I'm pleased. The new rules are simple but flexible and give the storyteller the ability to inflict all manner of dysfunctions upon a player. The book lacks a long list of pre-existing ailments to choose from, but arguably that's a good thing, since it doesn't step on the toes of my own marginal relevance.

That's the short version of my review. Here's the version with a bit more detail.

Here's my favourite thing that the writers of the DMG did: they explicitly state that diseases are, more than anything else, a plot device, and that "what matters is the story you want to tell." I'm biased; I approach all gaming as an exercise in storytelling. To me, whether I'm the DM or a player, I care about advancing the story in the coolest way possible, and Insults & Injuries often assumes that you play that way too. I realise that this isn't a universal point of view; many of the people I play with approach gaming as more as a strategic conflict game than a world-building game. For players who approach D&D much the same that they would World of Warcraft, defining diseases as plot devices rather than weapons has the potential to be much less interesting, but for a player like me, it's giving them exactly the emphasis that I'm looking for.

Sadly, after that, the DMG's coverage of diseases is a bit less useful. The section on physical diseases is, in a word, brief. The book presents three sample diseases in, to their credit, very rich detail, describing which populations are vulnerable and which are not, adding some amusing flavour text, and describing the pathophysiology from incubation to recovery. Good old cackle fever returns, making as little sense as ever, while the addition of "sewer plague" (more of a syndrome than a disease, but let's not split hairs) is a wonderful inclusion that, used carefully, could really make a group of PCs think twice about traipsing around in filth. The third disease, sight rot, is one I feel rather ambivalent about, but what makes it neat is that it's used as an example of a disease which can be treated by knowing the right curative herb. All three diseases taken together don't necessarily give a wide range of disorders to choose from, but they do elegantly sketch out the sorts of mechanics that can be combined and recombined to create a variety of fascinating and terrifying infections.

Physical disease is followed by a brief section on poisons, which presents nothing especially exciting or disappointing. There's an interesting set of rules for a truth serum, which from the sound of it really ought to be a magic item as opposed to a poison, because "truth serums" don't work quite like that in real life, and a range of other toxins with a range of DCs to resist and a variety of forms of harm that they can cause. The section includes some good stuffy, but no significant departures from older rules.

The section I found most interesting was the section on madness. Madness is divided into short term, long term, and indefinite forms, which gives the storyteller the maximum amount of flexibility to work with. Short-term madnesses, which last minutes, mostly simulate acute stress reactions: panic, dissociation, and fainting. I'm not thrilled with the list, as it's obviously much more inspired by H.P. Lovecraft's descriptions of madness than the American Psychiatric Association's, but for what it is, the list is varied, useful, and has obvious utility in game. The longer-term madnesses, which can last up to a few days, are fair descriptions of symptoms of real mental disorders, including obsessive-compulsive disorder, different forms of psychosis, dissociative amnesia, and even conversion disorder. The weakness in this section is that these "long-term" disorders aren't really things that people tend to suffer quite so transiently in real life, and as fun as it might be to briefly give a character OCD, it again clearly reflects a very fictionalized view of things. The indefinite madnesses are rather cleverly presented as roleplaying instructions as opposed to game mechanics, which once again maximizes flexibility for both the storyteller and the player who has to incorporate them into their character; they're totally unrelated to actual mental disorders, even more so than the previous two categories, but they have the potential to make the game cooler for everybody, and I suppose that's the most important thing. The one thing that I do want to praise in the section on madness is the choice not to use medical terminology. Speaking as someone who works primarily in the mental health field, I'm often disappointed by just how badly game writers seem to misunderstand what they're describing, but with this DMG, the only thing I objected to was the use of the word "madness." I've complained here before about, for example, the way that so many rulebooks equate schizophrenia with multiple personality disorder/dissociative identity disorder, and for all its other flaws, this book doesn't make errors like that. In fact, the authors chose to entirely leave out anything that sounds like dissociative identity disorder, for which I and most of the medical community salute them.

Overall, I'm pleased with how the DMG lays out sickness. The book provides a very basic framework that leaves almost everything up to the individual storyteller. The downside of this is that the storyteller doesn't have a lot in the way of diseases ready-made for their use, and this risks that the diseases that a storyteller comes up with might not be very sensible. On the other hand, this is a weakness which is at least partially covered by the disease mechanics given in the Contagion spell; by referring to that, a storyteller can work up a quick and dirty disease in seconds that probably won't break the game. The upside is that, since everything is up to the storyteller except for the broadest of strokes, disease becomes an infinitely flexible tool. This is appropriate because, of course, in the real world, sickness tends to be infinitely flexible.

Lastly, and perhaps the best news for me, the lack detail in the DMG means that you'll still get a lot of use out of your copy of Insults & Injuries when you want a list of diseases available for use. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on December 14, 2014. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system