Taking Damage: Tabletop and Chronic Pain

I wake up in the morning, and my fingers creak like old doors. Particularly painful old doors that resent you for trying to move them. There'll be rain today. I run my hands under the hottest water my bathroom sink can produce until my joints move like midcentury doors, maybe even ones from the ’70s, and start my day. 

That night, rain patters against the window as I sit down for a session of Dungeons & Dragons. The party throws themselves into a fight. My character drops, stands up again with a few magic words or a potion. We win the day, go home, rest. When my character gets up the next day, their sword is as light in their hand as it was the day before. At the table with my friends, I stretch my stiffening fingers.

When I first started playing D&D back in 2015, I didn’t think twice about hit points. They’re such a tidy abstraction. D&D’s health system—and that of its many play-alikes—has been criticized for its unrealism. People point out the whack-a-mole of characters falling and getting up with one hit’s worth of health left, the bloodlessness of the endless math, the way it fails to create the sweeping, narrative combats we see in fantasy novels. I understand all those complaints, but I’ve accepted them as necessary simplifications, artifacts of D&D’s wargaming past players have to live with. It’s only now, as pain becomes a part of my daily routine like it is for the heroes I play, that hit points have started to feel strange. Incomprehensible. Inhuman. 

I know too well what getting up feels like when everything hurts, and it’s nothing like that. 

In Christine Miserandino’s landmark article, “The Spoon Theory,” she explains something that looks like a more human way of understanding hit points. Miserandino, who lives with lupus, showed an abled friend what life with chronic pain is like through a simple object lesson with spoons from the diner they sat in. She gave her friend a handful of them, then walked through the tasks of the friend’s normal day. For every single task—even the ones her friend didn’t think to mention because they took so little effort—Miserandino took away those spoons, a tracker of how much of herself the friend had left to finish her day. And, importantly, Miserandino said the friend could never put the spoons down because she “can never forget” about her illness.

Spoon Theory shares a lot of traits with D&D’s hit points, and any attempt to define them would feel empty without the terminology that now proliferates in disability circles. The ticking time bomb, counting down to zero. The slow chipping away at a resource. The seeming inescapability. But that seeming starts to get at where the two systems diverge. Sure, your hit points always sit at the top of your character sheet, staring at you. But if you’re not in combat, they matter extremely rarely. Players can, to use Miserandino’s words, forget about them. There is no feeling of constant awareness, no need to maintain that could perhaps be more accurately called stamina. In Fifth Edition, there’s no concept of “stamina,” except in a few variant rules—and tweets from the authors—whereas Spoon Theory explicitly measures your ability to keep going while pain and exhaustion threaten to suck you dry. D&D offers very few choices to either lose hit points or expend some other resource, but that’s a core factor of living with chronic pain. Clearly, Miserandino’s spoons and D&D’s hit points, while superficially similar, cannot be understood the same way. Frustrated, tired, and already sore; I decided to look elsewhere on my game shelf for the chance to play heroes who hurt.