Last week we asked, is it ethical to execute your enemies, and most specifically, is it ethical to execute the craziest ones. Today, I'd like to make the question even more complicated by asking a related question: is imprisoning even an alternative?

Last week, we asked a question that probably never crosses the minds of many adventurers: is it ethical to execute your enemies, and most specifically, is it ethical to execute the craziest ones. The answer to that question, like the answer to many of life's most important questions, was, "it's a definite maybe!" Today, I'd like to make the question even more complicated by asking a related question: is imprisoning even an alternative?

I'm actually being a bit unfair by formulating the question that way, because it's one that I don't think we can answer. We can form opinions on whether imprisoning or executing people has a more of an impact on crime rates, but to my knowledge, there's never been any good, rigorously collected data collected on which is really more effective, and there are logical arguments and moderately convincing statistics supporting both sides. My expertise isn't in law enforcement, however, but rather in science and medicine, and from that point of view, we do know a thing or two about the benefits and harms of locking people away, particularly those with mental disorders. Specifically, we know a little bit about what sorts of places it's better to lock them up.

First off, let's take a moment to recall that the vast majority of crimes, at least in the real world, are committed by those who do not have any symptoms of mental disorder, with the important exception of substance abuse disorders. Even in our game settings, where antagonists tend to have comic-book-style insanity with alarming frequency, a majority of the foes faced by our characters are entirely free of anything that the layperson might call "crazy." The major villains and other sorts of Big Bads do tend to be a little bit unbalanced, however, and pretty much every storyteller I've ever played with has thrown the occasional voice-hearing spellcaster against the players at some time or another. Let's presume, for the sake of argument, that the adventuring party read last week's column and, moved to mercy, have captured instead of killed a floridly psychotic enemy. The party now has to face the difficult question of what to do with their prisoner.

Broadly speaking, there are two different ways of locking someone away, "two" being a huge and shameless over-simplification or an astonishingly complicated issue, but adequate for our purposes today. Option one is to put someone in a jail, prison, detention centre, or other resource designed to keep them secure and unable to hurt anybody else except, perhaps, other detainees. Such a facility may or may not have the goal of rehabilitating an offender and reinserting them in society; in fantasy settings, such facilities tend to be rather horrific and inhumane places, which in my opinion makes them far too realistic (fun fact: in Canada's largest city, Toronto, there's a prison where living conditions are so horrific that as soon as you get sentenced there, they automatically knock time off of your sentence because it's deemed you'll have suffered sufficiently). The other form of locking someone away is in an institution, which is, in resource, a place which is geared towards treating mental disorder rather than sequestering and punishing. Psychiatric institutions have, throughout history, sometimes been just as bad as, if not worse than, prisons, but in the modern era there is usually (admittedly, not always) an appreciable major difference between them, and many institutions genuinely are places of healing and rehabilitation over a relatively short period of weeks to months as opposed to places of indeterminate confinement. The question, then, is whether it makes a difference which one you put somebody is.

In the 1930's, a man named Lionel Penrose formulated what has become known as Penrose's Law or Penrose's Rule, when he observed that "as institutionalization decreases, imprisonment rises." Penrose studied data from 18 European countries and noted that as governments and hospitals were closing psychiatric care beds, the number of individuals entering the criminal justice system and the prisons rose proportionately. Penrose suggested that the inverse could be true, and that opening more space in psychiatric hospitals would reduce the number of people going into prison. The implication, of course, is that people with mental disorders are being imprisoned, presumably unfairly, and if people were being adequately treated for illness, to whatever extent the illness is actually treatable by a society, they would not need to go to prison. His theory has been tested a few times in the decades since and apparently seems to hold true, although  the results are open to interpretation. What's particularly interesting is that the studies suggest that Penrose's Law is more true in low-income countries that may more closely approximate our medieval fantasy settings; rich countries may be better able to provide for the mental health care needs of the populace without putting them into either type of facility, but poorer countries are less equipped to humanely (and affordably) deal with the ill. It must also be noted that psychiatric care in Penrose's day was very different than today, since modern antipsychotic drugs and social support networks, though far from perfect, keep many people from needing to be locked up in the first place.

The problem, as this relates to our games, is that Penrose's rule may not apply. Penrose assumes that the country you're examining has the ability to provide health care of some sort, if only in terms of a locked institution. In contrast, medieval fantasy settings tend not to have good support systems for people who suffer from mental disorders, and fictional mental health facilities tend to be closer to Batman's Arkham Asylum or Ravenloft's Asylum for the Mentally Disturbed than to any of the hospitals that I've worked at. It's also extremely costly to put someone in an institution, and few societies want to pay for mental health care when a prison tends to seem easier to the people holding the purse strings. I've commented before how, to my knowledge, there aren't a lot of medieval fantasy game settings that practice socialized medicine, and this sorely limits the options of an adventuring party when they want to find a place where they can safely confine a dangerous enemy. 

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 March 2, 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.