What does Duskwall do with the criminally insane?

Hi, first time posting, so sorry if this doesn’t belong here

I’m currently writing a novel set in Duskwall, and two of the protagonists are escaped mental patients, and I was wondering if anyone had any thoughts on how that would work. Currently I’ve been going with Ironhook having a mental ward for the criminally insane, which itself is little better than a prison with tranquilisers and straightjackets, and fairly little in the way of actual patient care

Does anyone know of anything in the lore to suggest that Ironhook couldn’t have such a ward, or if there’s somewhere better I could write it as? Has there ever been any kind of official statement on what Duskwall does with the criminally insane?


I’m not aware of anything official. Positioning it inside Ironhook makes sense to me.

In my Doskvol street maps I put “North Hook Asylum” in the Lost District. Presumably abandoned along with the rest of the Lost District, but who knows what haunts its halls…


Thank you for your reply

Ah yes, I see you did. That’s sure to come in handy, as this story does take the group into the Lost District

Also, these maps have been a great help as I’ve been writing the thing thus far, so thank you for that, they were definitely worth the purchase


I like where @timdenee was going with “haunts its halls”. I could see the asylum being a place with thin boundaries to the ghost field. Ghosts could be helping, preying on, or collaborating with the inmates.


I’m imagining Victorian treatments here plus a very large gray area as to what really are mental illnesses and what might instead be consequences of occult practices, spirits, demons, and Forgotten Gods. Not a nice place to be and certainly not much chance of a cure.

Ironhook looks ok to me when it comes to mentally ill criminals. I wonder though if there is also a “mentally ill, therefore not sane, therefore not a criminal” direction in Doskvol law. Mmm, probably not. Everyone’s a criminal, here, more or less.


I could see Ironhook having a section for “dangerous and mad” inmates, mostly classified because of how much of a danger they are to guards and other inmates. Less violent inmates, mentally ill or not, are officially just normal inmates (though individual guards and sergeants can group them together for ease of handling).

In this version, the very idea of mental illness as a medical field is very new, so treatment would largely be left to individual doctors (either wealthy nobles themselves or, more often, someone with a noble patron and funding) have various treatment facilities that can vary wildly in methodology and ethics. In one place, you have relatively well-meaning if still horrific and largely experimental treatment with stuff like isolation, cold baths and the like. In others, someone experiments with limited exposure to ghosts who are theorized to “feed on the damaged parts of the soul”.
At the very best, patients from the upper classes (or someone lucky enough to draw the attention from a wealthy and ethical patron) might just be placed in “resting facilities”, where they get to be shut off from polite society while having reasonably restful environs, possibly even with some miniature garden and exposure to art and music.

Edit: As usual, if you´re from the lower classes you´re in deep shit. Act “weird” and you get a beating. You could also quite probably be suspected of possession.


Any one think that people are forced placed there, so they are out of the way. Or a “Sixth Sense” situation where a person thinks they are insane, but really are a Medium of sorts.

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Such a good idea, an asylum is an ideal setting for hauntings and creepy atmosphere. See Thief Deadly Shadows and even Witcher 2.
Very inspiring!

There could well be sanitoria for wealthy families to send their troubled relatives for care - or to keep troublesome relatives out of the way. Treatment and care would probably vary significantly by the theories that the Doctors at each hospital held. Poorer families wouldn’t have that option, so it would either be kick them out, or try to hide/ confine them.

My question is: what sort of treatments would Duskwall offer? Electroplasmic shocks? Get ‘sane’ ghosts to possess ‘insane’ patients to control them? Would they be seen as being of benefit to cults, as prophets - or sacrifices? There are all sorts of horrible possibilities.

Incidentally, my office at work is in the basement, which I’ve been told was one of the wards, of a Victorian (well, Georgian) asylum built “to accommodate pauper lunatics”.


“The staff who dealt with the pauper lunatics was headed by the Medical Superintendent. He had his own house and servants, the principle aspects of his job being concerned with the administration and legal aspects of the running of the Asylum. There was very little medical treatment available for mental illness except for sedatives such as bromide & paraldehyde. The assistant medical officers were principally dealing with the general health of the patients. Due to this lack of medical treatment the attendants were appointed principally for their practical skills such as farm work, carpentry, laundry, cooking etc. The Asylum being as far as practicable a self sufficient organisation. Attendants were poorly paid and lived in with part of their pay consisting of free lodgings, food and laundry.”

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When thinking about psychological treatments (for the rich, of course – the poor are probably simply imprisoned), keep in mind that Duskwall’s mainstream culture has the opposite of the (real world) West’s reverence for the soul and disgust with the flesh.

In Akoros, the body is vibrant, wholesome, ecstatic, alive. The spirit is corrupt, wicked, a hungry ghost waiting to be unleashed by death.

The mind-body duality is demonstrably real, but the roles are inverted. Expect treatment to reflect this paradigm.


A good point I hadn’t thought of. I suppose, with this in mind, it might make sense to write any psychiatric theory as being that people see mental illness merely as an expression of the spirit within, which the body is failing to fully restrain. Rather than foregoing treatment attempts altogether and using psychiatric evaluations as just a way of establishing special containment procedures, as I had originally intended, I wonder if it might make more sense for their “treatment” to be attempts at strengthening the body as a prison for the disturbed spirit within


It wasn’t used for psychiatric purposes, but a game I ran featured a lobotomy needle capable of drawing the spirit out of a living person