For a game whose main conceit is combat, the amount of visceral violence presented in most D&D campaigns is actually pretty limited. And that’s probably a good thing.
Even the rules themselves are abstracted a couple of levels away from the horrors of realistic combat, with almost everything being discussed in terms of hit points rather than shattered limbs and torn flesh. Unless you delve into homebrew or a couple of the optional rules squirrelled away in the DMG, there’s very little differentiating a punch to the face from a balliste bolt through the chest.
This isn’t the same in every RPG, of course. I remember flicking through the critical hit tables in the Warhammer 40k RPG Dark Heresy with an equal mix of awe and revulsion. If you get hit with the right weapon in the right way, your character can have their eyes boil out of their sockets, or their internal organs plop out onto the floor of the dirty hab-block where you’re making your stand.
Applying damage in this way is arguably much more realistic than the hand-waving alternative. Getting hit by a fireball should leave your ranger screaming in pain and clutching at blistered skin where their beautiful hair used to sit, rather than be something that can be shrugged off with a nibble on some trail rations and a bit of a breather.
But while it may feel appropriate for the grimdark future of 40k, it would be out of place at most of our D&D tables.
Sticks and Tones
To demonstrate why this might be, let us consider two of the biggest on-screen fantasy franchises out there: Lord of the Rings and Game of Thrones.
Despite sharing a handful of tropes and springing forth from the same vein of western fantasy, these two feel very, very different. One of the biggest reasons for that is the question of tone.
In LotR the heroes are noble and brave, and while evil presents temptations the characters we root for never truly fall into dark ways. There are forces of good in the world, and they battle the forces of evil.
While there are many deaths and a few smatterings of blood, the violence never becomes realistic enough to prompt a shudder or a wince. Even the game between Gimli and Legolas, where they count how many foes they’ve slain, comes across as light-hearted and a mark of skill rather than psychotic.
Compare this to the world of GoT and you get a rather different impression of things. There are heroes, for sure, but they have to make moral compromises at every turn and commit deeds that are violent, nasty and brutal. Good and evil are blurred in places, and in many cases are simply a matter of perspective.
Just as the morality of Westeros is stripped of pretence, so is the violence. People get hurt in horrible ways and all of it is laid out on the screen and on the page. Blood oozes across the battlefield and screams fill the air,
In both cases, the depth of violence on offer matches the tone of the world.
Blood on the Table
Reading the tone of a table is a vital skill for DMs and players alike.
I’m sure there are some groups out there that love it when the barbarian’s axe rips through someone’s ribs and leaves the orc with blood bubbling from their mouth, but there are also games where most of the players still aren’t allowed in the deep end of their local pool. Picking the wrong level of blood and gore for either will provoke boredom or frightened tears, depending on how badly you mess up.
Sometimes this is something a group will decide when they start out a game – I’m a big fan of ‘session 0’ for things like this – but usually it’s just something that people collectively settle on as time passes. When it comes to D&D, most people tend to leave things somewhere nearer Lord of the Rings rather than Game of Thrones.
Personally I prefer that level too, if only because it lets me crank it up when I want to suddenly shock players with a particularly violent death or a gruesome act of brutality from a villain. After all, if you throw flensing at your players every day, it’s hard to really ramp things up when you want to get serious.