Mental Health and Lovecraft

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By Josh Fox and Rebecca Annison

With invaluable input from Shoshana Kessock, Brie Beau Sheldon and Tobias Strauss

First published in Lovecraftesque.

Content Warning: this essay includes mention of mental health stigma, stereotyping, and ableist language.


“If I am mad, it is mercy! May the gods pity the man who in his callousness can remain sane to the hideous end!”

H.P. Lovecraft, ‘The Temple’ [1]

Ideas and tropes about madness are inextricably linked with Lovecraft’s work and the roleplaying culture around it. “Mad”, “crazy”, “insane” and similar are used to dismiss people, turning them into stereotypes rather than individuals. This contributes to the social stigma associated with mental health, which can lead to real-world hurt and harm such as reduced self-esteem, self-value, and confidence; and decreased propensity to seek help for mental health problems[2]. Playing Lovecraftian games without extending and continuing this harm is important – but is it even possible? This essay will look at the ways in which Lovecraft used madness, how role-playing has contributed to it and what practical things we can do to step back from that without losing the essence of Lovecraft.

Although modern society understands mental illness better than in Lovecraft’s time, media representation of mental illness remains two-dimensional and inaccurate. One in four people suffers from mental illness[3]: yet it is misunderstood, sensationalised, and stigmatised[4]. And on a personal level, stereotyping of mental illness can insult, offend, and harm those around your gaming table.

So how do we tell Lovecraftian stories without repeating the hurt and harm?

How does Lovecraft use mental health and madness in his work?

There is a perception that madness dominates Lovecraft’s work. He depicts a world where understanding the true horrors of the cosmos could rip back the veil from someone’s eyes and send them spiraling into “madness”. But this is only a potential threat – not an inevitable journey, as often portrayed in Lovecraftian roleplaying. Near-ubiquitous “sanity” mechanics ensure that mental illness comes up again and again, becoming a focus for play to an extent not present in Lovecraft’s work.

Lovecraft did use reductive and hackneyed portrayals of mental illness: but descent into “cackling madness” is neither certain nor universal in his stories – many of his protagonists survive the horror shaken but unharmed.

Lovecraft uses “madness” in five ways in his stories:

1. As shorthand for unstable, unreliable, hostile, or evil. Lovecraft routinely uses “mad” and its synonyms to describe objects and the environment. For example, in ‘The Music of Erich Zann’, houses lean “crazily”, music is “frenzied”, and the viol is “insane”, heightening the tension by making everything hostile. He describes people similarly – “the mad Arab Alhazred” and old Zadok who is “touched in the head”. Often these descriptions are meant literally by the narrator, but this also serves as a cheap way to cast individuals as unreliable. This can be harmful during gameplay precisely because it is so thoughtless and casual. It is also the easiest of Lovecraft’s usages to ditch, since it doesn’t affect the story.

Quite often the perspective character will say that they have themselves “gone mad”: again, this seems intended literally. But the perspective character is almost never portrayed as a stereotypical “madman”: they are always lucid, able to describe their experiences dispassionately and in great detail.

“I must be careful how I record my awaking today, for I am unstrung, and much hallucination is necessarily mixed with fact.”

H.P. Lovecraft, ‘The Temple’[5]

2. Bait and switch. Lovecraft frequently uses narrative distance as a way of creating a “willing suspension of belief” – we go along with the idea that there’s nothing sinister going on because the horror is plausibly deniable. “Madness” is one way that Lovecraft achieves this. Sometimes he implies characters are “mad” based on bizarre-sounding claims they make – claims which are invariably revealed as true. Other times the implication is based on strange behaviour which later turns out to be entirely reasonable given the horror. Lovecraft plays on our own prejudices about mental illness to put off his final reveal, but the reader knows all along where the story is going.

For example, Charles Dexter Ward entreats Dr Willett to “shoot Dr Allen on sight and dissolve his body in acid. Don’t burn it.” Dr Lyman from the “hospital for the insane” takes this as proof of Charles’s “well developed case of dementia praecox” (The Case of Charles Dexter Ward).

In The Shadow Out of Time the “unconscious stupor” of Nathaniel Peaslee, and later the “trend of his expression and language” and other signs, are intended to give the impression of “madness”; when in fact his mind has been taken over by an alien consciousness.

Of course, by doing this Lovecraft is relying on stereotypes about mental illness and thereby reinforcing them. But the behaviour we see is ultimately revealed to be unrelated to mental illness.

3. Supernatural effects on the human mind. There are examples in Lovecraft’s work of supernatural effects creating a temporary “madness-like” effect. These are not portrayals of mental illness per se, but psychic or magical influence. There is no attempt to link these to real-world mental illness (even seen through the lens of a 1920s belief system). Although some of these effects (hallucinations, for example) would certainly be classified as mental illness by modern medicine, they clearly aren’t the same as real-world mental illness.

Examples include:

  • the compulsion of the main character to seek out the undersea temple in ‘The Temple’, linked to the influence of the ivory statue;
  • the “madness” of Mrs Gardner, caused by the Colour, in ‘The Colour Out of Space’;

4. Short-term loss of control. Confronted with terrifying and overwhelming horrors, Lovecraft’s characters sometimes lose control temporarily, in a hyperbolic version of the fight, flight, or freeze response. The protagonist in ‘Dagon’ screams and flees, while in The Case of Charles Dexter Ward Dr Willett “screamed and screamed and screamed in a voice whose falsetto panic no acquaintance of his would ever have recognised.”

5. Long-term psychological problems resulting from exposure to the horror. Lovecraft describes characters whose worldview has been shattered, so the universe no longer makes sense to them. This is a fundamental theory of Lovecraft’s:

“The most merciful thing in the world, I think, is the inability of the human mind to correlate all its contents. We live on a placid island of ignorance in the midst of black seas of infinity, and it was not meant that we should voyage far. The sciences, each straining in its own direction, have hitherto harmed us little; but some day the piecing together of dissociated knowledge will open up such terrifying vistas of reality, and of our frightful position therein, that we shall either go mad from the revelation or flee from the deadly light into the peace and safety of a new dark age.”

H.P. Lovecraft, ‘The Call of Cthulhu’[6]

Protagonists seem morbidly obsessed with what they have seen, emotionally flat and in some cases suicidal – such as the protagonist in ‘Dagon’, who opens the story with his intention to “cast myself from this garret window into the squalid street below”. Importantly, we do not see stereotyped incoherence or drooling “madmen”, but a lucid yet fatalistic condition. This resembles the symptoms of Posttraumatic Stress Disorder, and indeed PTSD is a reasonable real-world model for how a person might respond when exposed to supernatural horror. Equally, though, this could be seen as a rational reaction to discovering your worldview is fundamentally wrong.

PTSD symptoms

– Flashbacks, bad dreams and frightening thoughts

– Guilt, depression, self-loathing, worry or emotional numbness

– Tense, on edge, easily startled

– Difficulty sleeping

– Angry outbursts

– Incomplete or lost memory of the horror

– Avoiding things that are reminders of the horror

– Associated problems like substance abuse

Summarised from the NHS website[7] and adapted for eldritch horror

These different approaches are sometimes combined: in ‘The Call of Cthulhu’ we have cultists who are characterised as “mad” (i.e. a literal statement on their mental health), at the same time that their dancing and vocalisations are described as “mad” (i.e. unpleasant and wrong), causing policemen to faint.

But there are plenty of examples where Lovecraft’s protagonists, having uncovered the true nature of the universe, do not “go mad,”.

In ‘The Dunwich Horror’, Professor Armitage and his team defeat the horror and uncover the final chilling twist without “losing their minds”. In At The Mountains of Madness, Professor Dyer returns to continue his successful academic career, later joining a similarly horrific expedition in The Shadow Out of Time. In The Case of Charles Dexter Ward, while Dr Willett “has not been the same since”, there is no indication that this is anything other than a minor effect; and he goes on to defeat Joseph Curwen.

So, to put that in Lovecraftesque terms; you can choose to have the Witness survive unscathed, as Lovecraft himself often did.

Handling “madness ” in Lovecraftian gaming

Anyone sitting down to play your game might be dealing with their own mental illness issues, whether they are open about them or not. And they will almost certainly have family or friends who are living with mental illness. Being careful and respectful about representing “madness” in your game ensures that your players have an enjoyable experience while having the stuffing scared out of them. After all, the idea is to traumatize the characters not the players.

Creating a culture of consent at the table is a great way to getstarted with this. Horror should make us uncomfortable, but that discomfort should be consensual. You should look to do this before, during and after the game. Discuss beforehand whether and how mental illness might come up in your game, and what everyone is comfortable with. If, during play, things drift into poor or offensive representation, or start to breach boundaries set by the group, speak up. And after the session, discuss how things went and any issues that came up – leaving room for earnest feedback, without blame, but with suggestions for improvement and assistance.

Many Lovecraftian roleplaying games include mechanics to “strike characters with madness” at the sight of something unknowable. This is where the greatest risk of stereotyped play arises: if the player is taken by surprise, and forced to ad lib a mental illness. If this happens, don’t just rush into it. Take a moment to review what you’ve agreed about mental health, and to allow the player to think about how best to play through this.

Lovecraft’s use of themes of “madness” breaks down into two approaches which you might use in your game: use of language, and use of actual malign influences on the human mind.

Lovecraftian language in your game

Lovecraft’s baroque language is a part of what makes his fiction what it is. In practice, narration in roleplaying games tends to take this down a notch anyway, because it’s pretty cumbersome when spoken out loud. Even so, elaborate narration adds atmosphere to your game. There’s a great collection of Lovecraftian language at the back of the Lovecraftesque rulebook which you can use in place of mental-illness-based slurs. Words like “blasphemous”, “abomination”, “blasted”, and “unnatural” are just as evocative – and just as Lovecraftian.


  • “[V]ast angles and stone surfaces—surfaces too great to belong to anything right or proper for this earth, and impious with horrible images and hieroglyphs” (‘The Call of Cthulhu’).
  • “[T]he nightmare plastic column of foetid black iridescence oozed tightly onward through its fifteen-foot sinus; gathering unholy speed and driving before it a spiral, re-thickening cloud of the pallid abyss-vapour” (At the Mountains of Madness).

As mentioned earlier, Lovecraft used “mad” as shorthand for “unreliable” or “evil”. Instead, try these options:

  • Use other words. Rumours of strange things in Innsmouth can be far-fetched, elaborate, or unbelieveable, rather than “crazy”.
  • Directly describe a person’s behaviour or symptoms. Have someone report hearing Charles Dexter Ward talking to himself in his room. They may appear uneasy and confused about it – but they needn’t also call it “mad”.
  • Use other shortcuts to “unreliable” that don’t denigrate a whole group of people. Use drunkenness, sleep deprivation, dark nights, ill-defined shapes, and poor eyesight. The tricks of narrative distance set out in Lovecraftesque work here.

“In a rational age like the eighteenth century it was unwise for a man of learning to talk about wild sights and strange scenes under a Congo moon; of the gigantic walls and pillars of a forgotten city, crumbling and vine-grown, and of damp, silent, stone steps leading interminably down into the darkness of abysmal treasure-vaults and inconceivable catacombs.”

H.P. Lovecraft, ‘Facts Concerning the Late Arthur Jermyn and his Family’[7]

Tools for a culture of consent

Lovecraftesque uses explicit bans on specific e lements to avoid, which could include portrayal of stereotyped “madness” or specific language. A similar commonly-used approach is to agree at the start “lines” (material to be excluded from the game), and “veils” (material that can be included, but never described in detail). Optionally, such pre-game agreements can be done anonymously, by privately contributing to a list of banned elements which is then anonymised by the facilitator or GM[9].

Other tools are used to handle problematic material in real time. You can use the X-Card for this purpose. Other commonly used tools are keywords like “cut/brake[11]”, and Brie Sheldon’s “script change”[12].

Mental illness in your game

We’ve discussed already how Lovecraft’s characters may have their minds blasted by eldritch effects, temporarily lose control of themselves when confronted by evil, or be traumatised by the revelation of an inhuman universe. You needn’t remove these elements from your game; but you should avoid reducing victims to “crazy”.

To answer some common misconceptions about mental illness:

  • A person is not their mental illness. To define a person by their mental illness is very damaging. By identifying a character only by their illness, you rob them of the ability to be fleshed out and interacted with as a fully-realised human being. Mental illness is just that: an illness.
  • People with mental illnesses are not “mad”. Contrary to popular stereotype, just because someone has a mental illness doesn’t necessarily mean they act “crazy”, or can’t think straight. Most mental illness is invisible, even on a prolonged interaction: and while it may have far-reaching effects on a person’s life, people who have a mental illness are in general as able to hold a conversation, hold down a job, or think through a problem as anyone else.
  • Mental illness does not automatically make you more untrustworthy, weak, or violent. Many people believe there is a causal link between mental illness and violence, or even evil, just as Lovecraft describes the “potentially dangerous madman” in ‘The Temple’. But people with mental health problems are far more likely to be the victims of violence than its perpetrators[12]. Games with “crazy mental patients” or “crazy cultists” as antagonists perpetuate this abhorrent stereotype.
  • Mental illness is not sexy or cool or funny. Portraying someone as being sexy or cool because of the symptoms of their mental illness ignores the real trouble those illnesses cause. Suppose a character is affected by bipolar disorder during your game. You might portray them becoming manic; staying up every night, being quirky, off the wall, and risky. But what about taking medication, having trouble holding down a job, and the bipolar lows? To represent the “cool” parts of mental illness while ignoring the minuses is not respectful. This goes double for creating a character whose mental illness is played for laughs: a particular issue with bit-part characters who come on stage, do something “crazy”, and then disappear. Our advice is simply to avoid this.
  • Mental illness can be life-threatening[13] to a person suffering, depending on their illness. For some people, self-harm is a reality: this subject, and those related, are very dark topics to bring to your game table. Approach them with caution and compassion, and never use them lightly. Always consider who is around your table and how this topic may affect them.

Fortunately, Lovecraft’s stories did not focus on mental illness of a sort that reduces characters permanently to a set of symptoms. We’ve outlined above how Lovecraft’s “crazy people” were typically (a) not really “mad” at all, (b) only affected in the short-term, or (c) suffering from symptoms not dissimilar to PTSD. None of these require you to portray a stereotype.

Lovecraft’s characters who become “mad” have usually encountered something that was too hard for them to comprehend, or else suffered an external supernatural influence. Even so, they are nearly always lucid – clinical, even, in their ability to analyse what has happened and their own mental state – and far from the stereotype of a “madman”.

“Assuming that I was sane and awake, my experience on that night was such as has befallen no man before. It was, moreover, a frightful confirmation of all I had sought to dismiss as myth and dream.”

H.P. Lovecraft, The Shadow out of Time[14]

So by all means, have your characters break down in the face of the horror, but try also to show each person’s unique reaction to the horror; what they find terrifying; what they cling to in the face of it; and how their personality continues to show itself. You can display a character’s individuality, even when they’re affected by trauma or other influence, in a number of ways:

  • Through their possessions, their clothes, their home. This is a particularly convenient shortcut to personality, because you can display it even when someone is unable to respond rationally: they may clutch their crucifix for comfort, or a photograph of family.
  • Through others. Real people have employers, loved ones and friends. These characters can tell you what a victim is like when they’re not terrified by horrors.
  • Through the things they say. You can drop in references to friends, or beliefs. You can pepper their language with scientific or religious words as appropriate. Such nuances can even come through in the speech of someone affected by the Colour out of Space.
  • Through their behaviour. An ex-soldier might express horror and panic through firing their gun, rather than fleeing. A committed believer in science might, upon having their worldview shattered, become obsessed with the holes in scientific theory. Giving glimpses of these things, even for walk-on characters, enriches your game far more than using “madness” as shorthand – and makes the impact of the horror more horrifying. For important characters, take the time to weave in details and nuances – and then, if and when they lose control or become jaded by the horror, you can reincorporate and twist those details, to show the influence the horror has had on them.


The above advice applies to all Lovecraftian games; but Lovecraftesque provides two further tools.

Lovecraft commonly uses inner monologues, revealing how the protagonist is at first dismissive of the bizarre clues, how this gradually segues into fatalistic doubt, culminating in open expressions of fear. Correspondingly, Lovecraftesque encourages you to speak out loud the Witness’s fears and rationalisations. Use this technique liberally, to show how the Witness experiencing an increasing sense of distress – but especially in the Journey into Darkness, to accelerate the sense of fear and discomfort.

When introducing strange behaviour, remember that, regardless of what you have in mind as the explanation, other players will be leaping to their own Conclusions. By leaving the explanation ambiguous, you enable other players to be creative. You could easily have one player who thinks a character’s strange behaviour is explained by trauma and mental illness; a second who thinks they are acting in rational response to the supernatural; and a third who thinks they are acting under a supernatural effect. So try to leave it ambiguous for as long as you can.


These suggestions are not the only way to present a character with mental illness “correctly” or perfectly. That would be impossible, because mental illness is so complex – after all, professional actors struggle to achieve an authentic portrayal. Your play group may not get everything right, and may run into trouble during play. That’s alright, provided you are always working to improve. Nevertheless, if you follow the advice in this essay, you can eliminate offensive stereotypes, and keep your portrayal respectful. And you can do all this while staying true to Lovecraft’s dark vision of the world.

1 Lovecraft, H.P. 1925. ‘The Temple’, in Weird Tales September 1925. Chicago.

2 YoungMinds. 2010. Stigma – a review of the evidence.

3 The Health and Social Care Information Centre. 2009. Adult psychiatric morbidity in England, 2007. Results of a household survey. [accessed 22 July 2016].

4 UW School of Social Work, Mental Health Reporting. 2016. ‘Facts About Mental Illness and Violence’. [accessed 22 July 2016].

5 See above, note 1.

6 Lovecraft, H.P. 1928. ‘The Call of Cthulhu’, in Weird Tales February 1928. Chicago.

7 [accessed 15 August 2016].

8 Lovecraft, H.P. 1921. ‘Facts Concerning the Late Arthur Jermyn and his Family’, in The Wolverine March–June 1921.

9 This approach is used in When the Dark is Gone. See: y-2/ [accessed 22 July 2016].

10 Stark, L. 2014. ‘A Primer on Safety in Roleplaying Games’. [accessed 22 July 2016].

11 Sheldon, B. 2013. ‘Script Change in Action’. [accessed 22 July 2016].

12 Phend, C. 2012. ‘Mentally Ill Often Targets of Violence’. [accessed 22 July 2016].

13 [accessed 15 August 2016].

14 Lovecraft, H.P. 1936. The Shadow out of Time, in Astounding Stories June 1936. New York.