Roll up, roll up and welcome to the greatest travelling RPG blog carnival in the world! This month the show has set up camp in my humble Illusory Sensorium, and as resident ring master, I could think of no more fitting topic for this month's entertainment than Illusions & Delusions.

Please take a seat, sit down, and enjoy. Unless you bought the cheap sets, then you will awkwardly be dragged into some audience participation - if you write something on this topic, please comment below, and I'll post a round-up on the eve of March.

Words Matter

Arguments about the definition of terms in the hobby are rarely fruitful, yet I must dwell on the meaning and use of the following terms. I posit that one of the primary challenges people face in bringing these ideas to the table is that common use of these terms is highly imprecise, with people conflating several distinct concepts. I am going to lay out my definitions for these terms as they relate to playing pretend: to round out our intuitive knowledge of folk psychology, nothing more. I am not trying to provide precise clinical or academic formulations, as that task certainly exceeds the remit of a blog post, and would ultimately be limited by our lack of scientific understanding of how consciousness arises and how to define it.

An important caveat is that I am writing from the perspective of clinical neurology (sadly burdened with a language of deficits), rather than psychiatry or psychology or philosophy, or better lived experience. The following experiences are deeply interwoven with what it means to be human, a sentient being. This gives them gravitas, but can be a source of consternation or even harm if played with too roughly. Hence we should approach these matters with the following principles front of mind: be gentle, be kind, and try to be a Good Human.

Insight

Having an understanding and belief of our internal and external experiences that would be similar to and shared with others: a consistent worldview. A person with retained insight demonstrates similar mental processes as our own, which is taken to be reflective of generally 'normal' thought patterns and beliefs. It should be evident there are multiple large and unfounded assumptions at play here, yet we must tacitly accept those to move forward.

I will highlight that insight is socioculturally context-dependent: if you believe with conviction that the world is flat, and that is the prevailing belief of your point in space and time, then that would be commensurate with retained insight. Hence despite various real-world religious beliefs being somewhat incompatible, each person holding those beliefs might be considered to have retained insight, if they are in line with those generally held by their peers.

This leads to an important principle: within a fantastical or imagined world, we must consider insight in relation to the presumed held beliefs of that other worlds inhabitants. It doesn't matter if (alien) gods actually walk the land, performing 'miracles' or warping human minds and flesh: it only matters if a character's worldview and beliefs regarding them is consistent with their peers.

Judgement

Acting in accordance with retained insight, a sound mind. Closely related to yet distinct from insight, the focus is now on how a sentient agent interacts with their external environment. Would or should I have acted that same way were I in their shoes, presuming shared rational thought processes and beliefs.

It is difficult to have retained judgement without retained insight, as our actions are unlikely to be perceived as rational to others if they arise from seemingly irrational beliefs or thought processes. Yet we can certainly see retained insight with impaired judgement: this would be a common use of the term 'irrational' when we complain that the way someone else has acted isn't in accord with what we think they should have done. If someone wins the lottery and spends it all frivolously on ugly art objects without anticipated resale value, we would reasonably consider those actions poorly judged, but could accept they have retained insight, and are merely acting on different motives or personal values.

Delusions

A fixed, false belief. The falsity is considered again in relation to one's peers, and the fixed nature means that it is upheld in the face of evidence that would compel others to change their belief. If I have never seen the sea and presume it is red, then witness it first hand and still maintain it is the same hue as fresh blood, that might be described as delusional. Whereas if I revised my belief with new evidence, that in fact the sea is blue and similar hue to a clear sky, that would have just been a misapprehension or non-fixed false belief.

Clinically, many delusions are described as paranoid: the implication of the fixed, false belief is that the person believing it feels distressed and less safe, as something in the external environment is taking an untoward interest in them, or intends them harm. Examples include believing your neighbour is listening in to your private conversations, or someone is surveilling your home with hidden cameras, or thoughts like a family member or partner has been replaced by a disguised imposter.

We can see there is a natural interplay between insight, judgement, and delusions: poor insight implies the presence of one or more delusional beliefs (a fixed belief that a jury of our own peers would consider false), and those delusions understandably lead to actions that seem irrational from the prevailing worldview, consistent with poor judgement.

Thought disorder

Arguably the conversational counterpart to judgement is thought disorder, where implicitly 'ordered thought' is the normal situation where someone's speech seems rational and follows from retained insight. Disordered thought is often described as circumstantial (ultimately making coherent statements, but with intervening irrelevant diversions or details) or tangential (no clear train of though is displayed, where the listener cannot predict where the conversation is going and the link between ideas seems irrational). In extreme cases thought might be so disordered so as to render someone unable to perform any effective communication at all, only producing meaningless sounds or becoming mute.

Related but often milder are the concepts of 'intrusive thoughts' (unwanted and distressing ideas, often associated with social stigma or taboo, and leading to anxiety about why they are occurring and whether they might lead to unintended action) and 'recurring themes' (repetitive rumination on a topic that is non-productive and distressing).

There are many other quite distinct language (dysphasia) and speech (dysarthria) disorders, but in practice the way we assess someone else's thought form must be through their words and actions, so thought disorder is inextricably linked with conversation.

Illusions and hallucinations

A false or misleading sensory perception. Can arise from any of the 'regular' senses: light touch, vibration or joint position, pinprick or temperature; or any of the 'special' senses: visual, auditory, olfactory (smell), gustatory (taste). No meaningful distinction exists from hallucination in my mind, though the latter term places the locus of responsibility on the person experiencing the misperception.

These sensory misperceptions can be mild and easy to ignore, through to intense and wholly consuming attention in severity. They might also occur singularly, briefly but recurrently, or persistently. They might engage multiple sensory modalities at once, and these might be perceived as originating from one consistent source (such as an audio-visual hallucinations or a person speaking to you) or disparately (hearing a childhood aria and seeing insects crawling over your bedsheets). The definition of the sensation may be abstract or indistinct, right through to indistinguishable from reality.

Critically, an illusion or hallucination may or may not be associated with impaired insight and judgement. One might see the visual hallucination of little people scurrying about their bedroom at night when the lights got out, but feels safe and knows and acts as though they are just a 'trick of the mind,' so this would be with retained insight and judgement. Conversely if the same perception caused distress and fear of personal safety, and resulted in attempts to chase them away or exterminate them like an infestation, that would manifest impaired insight and judgement.

Delirium

A state of impaired attention and alertness, often with visual hallucinations or paranoid delusions, provoked by a wide array of physical stressors on the brain. This is a common complication of serious physical illnesses and hospitalisation, that manifests with 'psychiatric' symptoms. A wounded soldier in a state of haemodynamic shock, losing consciousness and perceiving an errant loved one with whom they conduct a heart-felt conversation, would be a typical popular media depiction of being delirious.

Psychosis

We finally have the groundwork to discuss psychosis: a state of impaired reality-testing. Psychotic symptoms may include any of impaired insight and judgement, delusions, thought disorder, or hallucinations. A person experiencing delirium could reasonably be described as experiencing psychosis, though in practice the terms are usually applied exclusively, reserving psychosis for where no apparent physical trigger for the symptoms has been identified.

This is the 'umbrella' term for everything we have discussed above, and covers the breadth of symptoms experienced, and signs outwardly observable, of a person suffering from impaired reality testing. It can arise as a primary manifestation of a mental health condition (see next) or can occur secondary to several other mental health conditions including severe anxiety, depression, or mania (an excessive and inappropriate state of elevated energy and activity, largely the opposite of the more commonly understood depression).

Schizophrenia

A particular (family of) mental health conditions where psychosis is one of the primary symptoms. No relation to the far rarer and debated concept of 'Dissociative Identity Disorder' or 'multiple personalities.'

I will strongly recommend caution with the adjectives 'psychotic' or 'schizophrenic' in imagination gaming, as though they may be reasonably and carefully used in reference to the above definitions, they carry too much pejorative baggage and are far too commonly misunderstood to be salvageable amongst polite company. Similarly other terms like 'mad,' 'crazy,' 'insane' are often used synonymously and hold negative valency. These latter terms are commonly used in conversational English with a variety of meanings, and their use is often less problematic, but it would pay to still take note when you let them slip and ensure you are not contributing to a long and sullied history of stigmatising the symptoms of psychosis and the people who have suffered from it.

What Next?

With that important foundation laid, what fantasies can we now build in our mind palaces? I am going to write a follow up post at the end of the month to summarise the other submissions from the RPG Blog Carnival on my nominated topic of Illusions & Delusions, and also lay out my thoughts on how to get the most out of the following applications (and avoid the common pitfalls) of these ideas to our hobby:

• Illusion & enchantment magic: spells and monster powers in fantasy roleplaying (with good extensibility to similar effects from modern horror rituals, or psionic powers and sufficiently advanced technology in sci-fi settings)
• Mechanising & portraying mental health: sanity & stress mechanics in horror and investigation games, how we can be better
• Surreality & dreamscapes: how playing with perception and belief opens exploration of impossible landscapes of associative logic
• Lines of narrative authority and (un)reliable narrators: the social contract of who may say and establish what, and the tension of playing generously but misleadingly

If you would like to participate by writing a post, but aren't quite sure where to begin, please do take any or all of the above and just take a crack at it! Otherwise, illusion-themed home-brew content or adventure material for your favourite system would be great to see too. The only way to lose is to not play.

Safety & Sensitivity

These are clearly powerful ideas to enrich our imagination gaming with, as they cut down to the marrow of what is means to be a thinking and feeling human cell in the greater organism of society and culture, yet that carries immeasurable responsibility as well.

You, one of the other players, someone's friend or relative, or others you converse with online will have previously, at the present, or at some time in the future experience these symptoms. It bears repetition: these experiences can be extremely distressing and terrifying, threaten people's sense of identity and personhood, and in tragic cases lead to death, or at least permanent social and occupational disability.

Reflect on how you would approach discussing, imagining, and telling stories about people with terminal cancers, fatal heart attacks, or disabling strokes.

Carry that same candle of compassion with you, as you delve deeper into the unknowns of the human psyche, for how far that little candle throws its beams.