No Dumb Questions

Yesterday, a friend asked about designing a "testicular torsion" spell, and despite not being framed as a particularly serious question, I've been thinking about it way more than I should. After all, it's a pretty good example of game design in microcosm.

What do you hope to accomplish? What are you trying to model? What genre are you emulating?

Let's start with what it is, in case you don't want to click the above Wikipedia article: as the name suggests, testicular torsion describes a twist in the spermatic cord, cutting off blood flow to a testicle. This usually causes extreme pain, and if not treated quickly, can result in necrosis of the testicle within hours.

As for a magic spell, that's going to depend a little on how the game designer views magic. Does it actually cause the medical affliction? Does it just cause the associated pain? Is it temporary or permanent? Can it affect only people with testicles, or does it cause an equivalent sensation in everyone?

Genre will also have an impact. In heroic fantasy, like Pathfinder or post-WotC Dungeons & Dragons, it seems right that the spell might just cause the sensation and it will probably only last a short while. In sword-and-sorcery or horror or other "low" magic settings, it might cause the actual affliction and require medical attention to fix.

Frequently, systems with supernatural powers already have an appropriate pain spell, so that's a great starting place. 

In no particular order, here are some thoughts across a couple of game systems: 

• A friend in the same conversation is much more conversant in Pathfinder 2e than I am, and so went with that system. He made it an Incapacitation spell with a Fort save that probably progresses in stages like a disease. Critically succeeding on the Fort save negates it, while any lower degree of success inflicts worsening penalties of Clumsy and/or Enfeebled.
• For D&D 5e-ish games, I'd probably take inspiration from symbol; it lasts a minute requiring a Con save to avoid the incapacitated condition. Save again at the end of each round to negate it.
• If it's a really low level spell, maybe it only lasts a short time or grants disadvantage, similar to (but not the same as) the frightened condition.
• Different editions handle pain differently. AD&D 2e has symbol grant a -2 Dexterity penalty and a -4 attack penalty for 2d10 rounds. D&D 3e has a low-level power word, pain spell that just does damage over time for a handful of rounds.
• It's more fiddly than I tend to like my rules, but I'd probably allow an appropriate medical roll or healing spell to alleviate the pain. We're talking something like a Healing check in AD&D 2e or a Wisdom (Medicine) check in D&D 5e. In games lacking defined proficiencies, it might involve your character's background, or it might be outside the realm of things that player characters can accomplish. Better get to the local hospitalier as soon as possible!
• Outside of the D&D paradigm, I'd be more likely to just drop penalties on someone until the situation is resolved. For example:
• In Unknown Armies, third edition, a testicular torsion spell is probably a minor spell causing immense pain (I might assess a -20% or -30% penalty), minor injury (maybe 1d10 wounds), and perhaps even a stress check (rank-3 or rank-4 in Violence or Helplessness). It might last a few minutes, although I tend more toward the "you need to go to the hospital" end of the paradigm. Maybe it depends on the number of charges?
• My memory of World of Darkness and Chronicles of Darkness is a little fuzzy around the edges, but a substantial wound penalty (say -3 to -5) feels right. As above, the specifics of the power used determines if there's a duration or if you need medical attention. The victim might take a little bashing damage.
• The spell Wrack in Call of Cthulhu is pretty similar to what one would want from a testicular torsion spell; it might be less intense, and won't have the physical side effects. On the other hand, the duration is probably longer than Wrack, lasting until treated. 
• The further you get outside of traditional systems, the more abstract the effects are going to be.
• I tend to shy away from using hit points/wounds/etc. to model pain, but in a paradigm like Powered by the Apocalypse or Forged in the Dark, a point of Harm might actually get the point across: it makes you less effective when acting and brings you closer to something really bad happening. Get out of the action and to a healer as soon as possible.
• A storygame that's even less focused on physical reality and more focused on emotional reality might wholly eschew physical consequences for such a spell. Instead, it focuses more on the experience of your friends getting you to the doctor and helping support your recovery. In fact, in contrast to many games that remove the afflicted character from the action, this spell in a storygame might actually thrust the afflicted player into the spotlight.
• For any of the grittier systems, I'd probably also put something in place to model the severity inherent in leaving the situation untreated. Maybe something like, get medical attention within six hours or you might need surgical removal.

In addition to considerations of genre, you probably also have to think about your table. Tables more used to heroic systems probably find "save or suck" spells to be anathema to their play style, while tables more on the survival horror end of things probably consider such things a consequence of combat anyway. In a Pathfinder game, a spell that takes you out of the action for a prolonged period is an impediment to the combat sport. In a Call of Cthulhu game, a spell that takes you out of the action might be the lynchpin of another wild story revolving around horrible things that happen in a cosmic horror game. (I personally like to imagine that one character gets hit with the spell so another character helps them to the hospital; predictably, these two investigators are the only survivors of the scenario, as everyone else tries to carry on and so mysteriously disappears.)

This rumination doesn't solve anything, but in terms of game design, it's an intriguing question. What are you trying to model with a piece of design? What do you hope to accomplish? How do your goals change with the game you're currently playing?