I’ve been on a bit of a realism kick lately. Not an “elves couldn’t exist” type of realism, but a realism based on the logic of the story that is being told. One thing my musings and discussions with other gaming friends has brought up is how essential the idea of healing is to a game.

Have you ever seen an action movie where the hero gets hit, but of course it is in the shoulder and they just kind of continue on. Or wrestling. Oh god, wrestling. As entertaining as wrestling is, any person who took that much punishment in one night would be hospital bound for weeks before walking again, let alone wrestling the next week. Watching these sorts of miraculous feats of endurance and thinking about how Hit Point systems, wound penalties, and damage tracks function in games, I’ve come to realize how necessary it is to have healing of some phenomenal sort in our game worlds. Games, both video and tabletop, have healing in the forms of magic, nanobots, meds, stims, herbs, food, etc. that help us believe that not all injuries are the realistic, bone crunching, put Harry Dresden in the hospital for a few weeks types of game elements that they would actually be.



Healing Allows Us To Buck Reality

Having access to some sort of phenomenal healing ability in games lets us thematically ignore the fact that an adventurers life would leave them crippled with arthritis, torn muscles, and bad backs, if not with actual limb breakage. If we assume that our healing element fixes most minor things easily, then those torn muscles or sprained ankles we would acquire from marching through a dungeon with even a 1 HP injury suddenly have a reason to never come up in our stories. Sure the healing potion didn’t heal us up to full, but its mere presence lets us assume that we probably don’t suffer the minor annoyances that would hinder us in the real world. This extends to major injuries as well. Sure, that would have taken your arm off, but getting those healing nanobots in turns a hospital stay injury into a minor annoyance.

Healing Does Away With A Lot Of Needless Down Time

Following along the bucking reality arc, down time is required to heal from most wounds. Even when we get sick, we need to rest our bodies or the malady just continues on and on. If our games didn’t have an element of healing to them, we would have to rest our characters whenever they got injured in any believably major way.

Healing Removes Annoying, Fun Breaking Consequences

Sure, your leg was nearly cleaved in twain, sure it should probably be in a splint and not moved, but heck, that healing spell mended it right up. You can keep walking on it, you can still make disguise checks because that brace isn’t in the way, you can still sneak about. Maybe you’ll take some penalties to the rolls, but you can hand-wave away some of the truly annoying factors, unless of course they are relevant to the game. Having the hand-wave of healing lets us pick and choose when the consequences are fun to play out and when they are a bore.

Healing Means That Lasting Injuries are Story Elements

When you live in a world where healing is accessible to the player characters in some better than reality way, it means that lasting injuries are actually important. If a player needs to be out of a game, their leg is broken and the healing doesn’t work right now. They’ve been written out, but there is a reason for it. That creaky shoulder that is tied to the epic battle in your back-story, it actually has importance in the game and is significantly different from a creaky shoulder someone got from overextending while taking out a 1st level goblin.

Healing Props Up The Sanitized Fantasy World

In most of our fantasy settings, the world setting has all sorts of fantastic elements, but it is rarely depicted as the peasant filled, work and grime, everyone is dirty except the king realities that were the norm in many periods of time that we gain inspiration from. In some societies and cultures, bathing and cleanliness were valued, but in many being clean and preventing disease wasn’t an easily available option or not a concern. Still, many of the settings we create rarely reflect those ideas and times. Some do, but we default to a moderately clean backdrop because that is what most of the world is like today. Healing in a sanitized fantasy world may not be readily available to all, but it helps prop up the possibility of a cleaner civilization in that time period. Disease may not spread as much if a cleric heals a sick girl or alchemists can brew up some super healing herbs for the commoners and nobleman alike.


Healing, aside from any mechanical effects on the game, is an important background story element that enables a lot of invisible story structures that we take for granted about our play. It’s important to respect and look at those kinds of elements, to understand what functions they serve and how they can craft our play experience.

What is your best story about healing letting a character keep chugging on? What other elements provide story reasons for some of the game elements we take for granted? Do you prefer the gritty realism and the extra struggles it brings or do you enjoy these type of game/story enhancing elements?

15 replies
  1. Troy E. Taylor
    Troy E. Taylor says:

    In DnD, healing really ought to work in a fashion like poisons, in that after taking damage, even when restored, the PCs are afflicted with a debilitation to an ability score. This would not render a PC down and out for a session, but would emphasize the ladting effects of wounds. But ask any player. They hate the effects of poisons worse than loss of hit points.

    • John Arcadian
      John Arcadian says:

      Yeah. Anything that feels like it takes away possibility really gets to players. Hit points are a renewable resource, but a limit on an attribute feels like taking something away from the core of the character, even if it is realistic.

      I like the idea of X # of hit point loss limiting an attribute for a session. It’s a good way to model that the damage is more than surface wounds without making it a permanent loss. That would be a nifty mechanic to play around with in a game.

  2. randite
    randite says:

    I actually ran a short campaign without any magical healing and relatively verisimilar healing times. (A homebrew system of my devising.) The PCs barely survived all sorts of things and were limping and scar-riddled by the time the campaign came to an end (just 5 months of in-game time [like two months of that was recovering from injuries]). I think it made the game all that more heroic. The players really seemed to feel the tension when they entered the fray.

    One character actually got her left hip fractured and then later pulled out of socket. The closing narration for her went something like “You walk up the long path to your father’s hall, grimacing at the painful limp that will haunt you for the rest of your life…” The archer was pretty grateful to be out of the fray for most of it. He just had to deal with horrible scars from the exploding acid monster…

    In the end they really saved the day, and got wealthy, but at heavy cost to their health.

  3. Scott Martin
    Scott Martin says:

    I usually enjoy steaming past injuries, but Randite’s is a great example of using them to build a mood. We had a similar experience; we were playing a non-magical old west game, and a solid gunshot would take you out for at least a session. It’s a hard mindset to switch to after you’ve been relying on magical healing for 30 years…

  4. brcarl
    brcarl says:

    I mostly play D&D. For me, it helps to think that all but those last handful of hitpoints are actually just fatigue and effort, not actual physical damage. Fact is, a single arrow to the chest is going to kill anyone, I don’t care what level you are. So those first 3 arrow “hits”? Actually, they just forced the hero to dodge away and strain a muscle, then a second dodge caused him to stumble and twist his ankle, and the third grazed him leaving a bleeding but superficial wound.

    Ultimately, it’s all about abstraction. We need some way to keep the tension high without worrying that a single hit from a stupid kobold is going to kill the hero.

  5. Nojo
    Nojo says:

    I’m with Randite. I enjoy the grime.

    This reminds me of why I really like Warhammer Fantasy Roleplay. All the grime, dirt, and grit, all the time. There is *some* magical healing, but not much, and using it can take a terrible toll on the caster.

    But I don’t remember things slowing down due to wounds in table time. We might have to wave a few weeks or more while the Rat Catcher healed up as much as he ever would, but we’re good at hand waving.

    A Song of Ice and Fire RPG is also full of grim choices. I know my character lost an arm. That character was the most memorable character I’ve ever played, and I started with White Box D&D.

    With gritty systems the difficulty comes when a PC or two is out for a while but the story has a ticking clock and the game must go on. We tended to limp on, always ready to create a new character. Sometimes we played an NPC while our main character writhed in a filthy hospital bed.

    Nothing wrong with enjoying a good old insta-heal D&D style game. Grim-dark just happens to be my favorite flavor of fantasy, so I gravitate to those games.

  6. 77IM
    77IM says:

    As part of my Quest to Understand Pacing, I’ve been thinking a lot about how hit points aren’t really a health mechanic, they’re a pacing mechanic. They represent how many times in a battle you can screw up and get hit, and how many times you need to attack a foe in order to take them out for good. Too few and all combatants get taken out in one hit; too many and the fight becomes a slog. The game works best when you have just enough hit points to notice trends happening and adjust to them (e.g. “He’s vulnerable to fire!” or “Don’t stand next to it!” or “Run!”).

    Actual wounds, injuries, and health are sort of orthogonal to this. Story-wise these are great consequences to a battle, but they can totally wreck pacing and participation. I think that’s why most games have totally unrealistic damage and death rules: most people usually prefer the unrealistic option to play the game over the realistic option to suffer, bleed, and die.

  7. Razjah
    Razjah says:

    I like less healing, but some is good. FATE works well in this aspect. Stress is recovered very quickly, but consequences take progressively longer to heal. Minor takes an extra scene, moderate a session, severe takes a whole story arc.

    While extreme (if used) requires earning a significant milestone (or major, can’t remember the name) just to open that slot again. There is no real recovery from extreme consequences, they fundamentally change the character. Over time that new consequence can be changed, but it takes a long time to bring the character back.

    I also like that this option provides the fatigue side of the HP mechanic and the enduring wound side.

    Savage Worlds does a good job too. Wounds are annoying but can be overcome with magic or with other forms of healing.

  8. Blackjack
    Blackjack says:

    I’ve done a few short games in systems where healing magic was available but the party had very little of their own. E.g., no clerics in the group. It was interesting how quickly most of the players adapted to playing cautiously in character. They realized that for low level PCs, taking two whacks two in combat could mean falling unconscious and bleeding out. While the party had enough healing resources to revive one such casualty, a combat that caused multiple serious injuries would send the group evacuating for help. As a result they focused on gathering intelligence, snooping around, and thinking carefully about how to gain the upper hand in combat before busting through the door. Even the heavy fighter types could find ways to be useful in gathering intelligence.

    Note that I did say most players adapted. There were a few, often one per group, who simply couldn’t accept the change in play style. “What, one arrow shot and I’m half dead??!” exclaimed one guy. “All this lurking around sucks,” complained another. “We should just go in there and kill them!” The smaller number of folks unprepared to adapt to the game are not going to be happy with it. So, as a GM, you should ensure your players are aware of how accessible healing will be in the game and what the in-character consequences of it are likely to be.

    • Razjah
      Razjah says:

      I would love to see this with my group, last time we played Pathfinder the GM added an NPC cleric because the group was so bad about playing cautiously or just buffing in general. I kept trying to tell them that mass defensive buffs are like preventative healing. It didn’t work.

  9. NinjaWolfHybrid
    NinjaWolfHybrid says:

    inspired by TV shows like Miami Vice and the a-team my friend and I created a homebrew rule system for modern d20 role playing based on 3.5 Dungeons and Dragons. This included automatic weapons that can dish out some serious damage,so that when an NPC pulled a mac-10 at point blank range a whole party of characters would put their hands in the air. This created the necessity for a system to deal with huge amounts of damage thus the optional injuries system was born. I came up with a list of specific injuries each with a corresponding penalty and an amount of time required to heal it. the worse the injury the more hit points of damage a character could soak by taking it. this gave the game some gritty injuries but only when the players chose to take one. so they didn’t have to deal with their characters characters being crippled against their will.

  10. Matthew J. Neagley
    Matthew J. Neagley says:

    There were several systems back in the day (I think Pendragon may have been one of them?) that had realistic healing times with months to years of downtime for relatively small injuries. To deal with the pacing issues that caused they took a longer view than a single character and you played your descendants after your original character got too old to get in bar brawls anymore.

  11. Norcross
    Norcross says:

    I’ve been off the net for a few weeks, but when I read this article the first thing that came to mind was all those cliche plots that start with “someone murdered the king…”. So any adventurer with enough gold can go to a temple in the same city and get raised from the dead, but they won’t heal the frickin’ king???

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