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Introduction

He-Man wakes up on a beach, and his head and body ache. The last thing he remembers is that his ship had sunk the night before in a storm while he was escaping from his kingdom and the dragons. When he opens his eyes, the first thing he sees is the face of a child with leaves in his hair who, in an unknown language, utters a spell that heals his wounds from the shipwreck.¹

This opening scene of a six-month-long fictional narrative features He-Man, an orphaned prince, Sombra, a wizard boy with a pet wolf, and other fantastic characters who travel across continents, fight archdruids, and find love. Part of a fantasy narrative roleplaying game inspired by Dungeons & Dragons, these memorable characters were created and performed during the pandemic (2020-2021) by teenage boys hospitalized in the Dr. C. Tobar García Children’s Hospital for Mental Health in Buenos Aires, Argentina. Most of the children who participated in this narrative game did not know how to read or write, due to the situations of social vulnerability (poverty, violence, abuse) they face. Still, they were able to generate these stories, making use of oral, visual, and non-verbal languages and behaviors.

Children and adolescents who temporarily reside in the Tobar García Hospital or other mental health facilities in Argentina often have their lives on hold. They are waiting to resume school activities, rebuild family and community ties, and enjoy cultural possibilities and natural spaces in the city. Their life stories are mobilized only by what the hospital can offer within the limits of the scarce resources.

Through narrative roleplaying games, the recreation team (part of the in-patient care facilities at the Tobar García Hospital) seeks to foster spaces for the co-creation of memorable narratives during hospitalization. These narrative games are part of a diverse set of playful practices proposed by the recreation team, as a result of exploring and putting into practice the individual and collective interests of the children who go through hospitalization. By doing so, the team aims to foster ways to relate with each other by sharing the pleasure of playing.

An Interactive Workshop Experience

In this Perspective, we focus on an interactive workshop in which we sought to inform and inspire students and care practitioners on the use of narrative roleplaying games in diverse contexts of care and rehabilitation.

First, we briefly explain the workings of narrative roleplaying games, including Dungeons & Dragons (D&D). Then, we present a short literature review on how and why these types of games have been used in care settings, focusing particularly on D&D experiences. Then, we explain our workshop design, which is based on these research findings. In the next section, we discuss the workshop outcomes, including a selection of creations by the participants as a result of the narrative roleplaying game we performed during the workshop.

Finally, we reflect on our learning experiences together with the students and care practitioners who were part of the workshop. These reflections will hopefully invite caregivers, patients, experienced experts, teachers, students, and researchers to think through the possibilities for playful practices of collaborative storytelling in the different contexts of care with which they are engaged.

Dungeons & Dragons and Narrative Roleplaying Games

Dungeons & Dragons is a fantasy roleplaying game involving several players. One person performs the role of the ‘master’ or coordinator, the main narrator who coordinates the collective story. The other players create and enact their own characters and their storylines. These characters can freely choose their desired actions: for example, to attack a creature, to win a discussion, to play a prank. They roll the dice with the aim to get a score that is in line with the difficulty of their desired actions. Depending on the score they get with the dice (success or failure), the ‘master’ or coordinator describes the effects of their actions. For example, if after deciding to attack a creature, the player rolls a 1 (the lowest score), the described outcome might be that they fail to attack the opponent due to an unfortunate fall. However, if they roll a 20 (the maximum score), the described outcome might be that they successfully defeat the opponent. These are the basic rules and coordinates of the game, which are explained in detail in the D&D manuals.

Beyond these rules and coordinates, what counts when playing Dungeons & Dragons or any other narrative roleplaying game is the creative process of collaborative storytelling, the creation of characters, and a certain amount of luck with the dice. Taking into account these basic ingredients, the development of a narrative roleplaying game is accessible and possible in diverse settings.

Literature Review

Highlighting the increasing demand for Dungeons & Dragons in the context of the pandemic, Ian S. Baker and colleagues provide an informative, up-to-date overview of studies on the mental health benefits of roleplaying games in clinical and non-clinical settings.² One finding from this overview was based on a study with adult participants performing D&D in a therapeutic setting, in which Matthew S. Abbott and co-authors observe that the “participants described increased confidence in social situations, particularly with boundaries or making mistakes.” Moreover, the skills they learned and practiced during the game “helped them with interpersonal issues and conflicts they had in their lives.”³

The positive impacts of playing roleplaying games for the development of personal and social skills is also stressed by Rosselet and Stauffer in their study on the use of these games with gifted children. Roleplaying games, they argue, are “an effective way of intervening with gifted children and adolescents to improve their intra- and interpersonal skills,” including creativity, self-awareness, decision-making, collaboration, and communication skills. These authors also highlight the importance of training care practitioners to develop and deliver support through intra- and interpersonal skills within the setting of the roleplaying game, as well as facilitate the children’s ability to translate these skills outside of the game setting.⁴

Workshop Design

The rationale of our workshop design is based on the aforementioned research findings on the use of narrative roleplaying games in care settings. The workshop was co-designed by the two authors of this paper. Santiago Barugel is part of the recreation team at the Tobar García Hospital, where he coordinates narrative roleplaying games and other playful practices, including the story featuring He-Man and Sombra quoted at the beginning of this article. Marileen La Haije analyzed a selection of episodes from the narrative roleplaying games performed at the Tobar García Hospital for her research on Latin American arts-based practices that promote the human rights of people who experience mental suffering.

We were invited to provide a guest workshop as part of the Master Course ‘Literature and Care’ coordinated by Zoë Ghyselinck and Jürgen Pieters (Ghent University, 2023). This course targets literary students who seek to put into practice their literature expertise in specific care settings (eg, palliative care centers, psychiatric institutions), as well as care practitioners (eg, therapists, social workers) who want to gain new knowledge and skills from the field of literary studies with the aim to enhance their care practices.

The key objective of our workshop was to foster exchanges of ideas, experiences, and practical tools with students and care practitioners on how to integrate the use of narrative roleplaying games in diverse care settings. The workshop was based on the idea that the best way to learn how to develop playful practices in care settings is through practice-based learning: by playing. That is, we proposed a series of game-based exercises with the workshop participants, including a narrative roleplaying game. In this way, we aimed to encourage participants to engage in the creative processes they could carry out in their own care environments.

Workshop Outcomes

With the aim to foster creative production as a starting point for playful practices of collaborative storytelling, we proposed a narrative roleplaying game called ‘Birds-eye View.’ We asked the participants to close their eyes, listen and imagine:

We would like to know what kind of bird you would be if you could be a bird. How big would you be? Would you be colorful? How high would you fly? What do you see around you? How do you imagine your voice? How would you pursue love? Are there any risks or dangers in your environment? If you could think of some of those things, try to imagine something that happens to you being a bird.

We gave them some time to write a short story about an episode from their imagined life as a bird, after which we collectively read and discussed a selection of these pieces. The interrelations and tensions between nature and human presence was one of the recurrent topics we addressed. Some significant examples:

Penguin Story
I, a penguin, competed in the national ice sliding contests at the South Pole. I slid so hard that I went out of the curve and landed in the sea. There was a sea lion trying to eat me, so I swam away. I thought I saw land so I jumped out of the water right into a boat belonging to a National Geographic team. Six months later, David Attenborough told about my adventures on television.

Crow Story
The crow flies through the city. It watches people through the windows of their homes. She longingly stares at all the shimmering jewels around their necks and croaks in frustration. Her stomach rumbles, she flies away in a fit of anger, mad that she cannot find a scrap of bread and suddenly she finds herself lost in a sea of grass fields. Some are fresh and green while others are desolate and dying. Never before had she left the city and seen a place where the air is clean, the skies are blue and there are songs of other birds she never heard before. She finds herself looking at the city with its black smoke, familiar windows and thinks by herself: I want to go back.

Magpie Story
I am a magpie, colored black and white. My mother thinks her parents, who are dead, have become magpies. My mother is not crazy, but I grant her this little craziness (being ‘loco’). As a bird, a magpie, I do not want to fly that high, or that far away from human society, from the town I grew up. I would like to see what people are doing in this town, on the land I know, in the fields that surround them, and at the port. I think I could feel what they are up to, what they think and know, desire and feel. I would like to be their black ink on white paper-magpie, to spread their stories around, and to mingle them with my own.

As we discovered during the workshop, this collection of individual stories could be an excellent starting point for a creative process of collaborative storytelling in a group setting: all about birds from around the world (from crows connected to urban spaces to penguins in the Arctic) dealing, in diverse ways, with human presence.

Reflections

In what follows, we reflect on two key learning experiences we shared with the students and care practitioners who were part of the workshop:

1. While collectively reading the narrative pieces by the workshop participants, we explored possible interactions between the stories, laying the foundation for a bird-based roleplaying game. This is an important lesson we learned: When introducing playful practices of collaborative storytelling in contexts of care, try to look for common grounds, topics, and interests, without losing sight of the individual features, perspectives, and poetics of each personal story.
2. We confirmed that starting from a position of enjoyment is how we can achieve true involvement in storytelling and the co-production of shared stories. Narrative games involve us (caregivers, patients, experienced experts, teachers, students, researchers…) as subjects: subjects who (wish to) play, imagine, create stories, listen to, and interact with the stories of others. In fact, the group discussions after the ‘Birds-eye View’ exercise featured important reflections by the participants on their own engagement with practices of shared reading and storytelling in diverse care settings, as well as the joy, fear, and other strengths and challenges they experienced as caring readers and storytellers.

Conclusion

We hope that the experiences shared in this Perspective help caregivers, patients, experienced experts, teachers, students, researchers, and others to reflect on learning experiences through creative processes, inspiring and fueling the co-creation of memorable stories in care contexts.

We propose that playful practices of collaborative storytelling represent a culmination of the creative process that can initiate dialogues and encounters among individuals, starting from something unique and growing in a supportive, collective manner. The future of this creative process will draw on new experiences in other care contexts and contribute to the co-production of knowledge on the use of narrative roleplaying games in clinical and non-clinical settings.

1. Barugel S. Juegos de rol, espacios creativos para nuevas narrativas. PSP Tobar Sobre Infancias y Adolescencias. 2022;5. Available at: https://issuu.com/juanmabf/docs/revista_5. Accessed 12-8-2024.
2. Baker IS, Turner IJ, Kotera Y. Role-play games (RPGs) for mental health (why not?): roll for initiative. Int J Mental Health Addict. 2023;21:3901–3909. https://doi.org/10.1007/s11469-022-00832-y
3. Abbott MS, Stauss KA, Burnett AF. Table-top role-playing games as a therapeutic intervention with adults to increase social connectedness. Soc Work Groups. 2022;45(1):16–31. https://doi.org/10.1080/01609513.2021.1932014
4. Rosselet JG, Stauffer SD. Using group role-playing games with gifted children and adolescents: a psychosocial intervention model. Internat J Play Ther. 2013;22(4):173-192. https://doi.org/10.1037/a0034557