We had to lose things like 'DRG gives a debuff to the enemy that makes Piercing damage 10% stronger', because any time you played BRD or MCH but didn't have a DRG in the party, it'd feel pretty bad knowing 'I could be doing 10% more, but I'm being artificially held back by the system'. Likewise, I expect this would end up in the same situation: DPS/Tank players feeling like their fun (doing big number) is being held hostage by whether the Healer wants to actually heal sooner rather than later. Additionally, there's occasionally times where in Savage, Tanks get domed for about 20% of their HP per autoattack, so would the Healer be forced to keep the Tank constantly topped up to keep them above 80%, lest their damage output start getting affected?
I think the suggestion shares some similarities in concept to the Aetherblight idea in the OP (which I added a lot later so it's understandable if you weren't aware of it), but this Trauma system would, if I understand it correctly, externalize the 'punishment' in such a way that it affects everyone. Whereas, I'd imagine the 'punishment' that you have to deal with for Aetherblight, is simply 'you, as the Healer, have to do more healing (compared to dealing with the Aetherblight quickly)', which internalizes both the resolution of the mechanic, and the punishment for not resolving it, to the Healer role.
If being below 50% meant having 20% reduced damage, heck, if it meant even 2% reduced damage, I expect GNBs would refuse to use Superbolide, as it'd require them to actively decide 'I will do less damage, so that I can be more surviveable' which was the exact issue and reason that the TankStance/DamageStance thing got removed (so that Tanks didn't have to 'feel' like they need to sacrifice Damage/Surviveability for the other). WAR and DRK would have it even worse too, as if they have a situation where they are constantly being brought back down to 1HP (eg Howling Eight), they're going to be told 'you need to deal 30% less damage, during this 2min window, as part of the strat' and it lasts a whole 10s, that's half the burst window!
As for reduced Max HP while suffering Trauma, I'm not a fan. I look back to how Weakness/Brink would reduce your Max HP, and lead to chain-death because after the first one, you simply don't have the Max HP to survive the subsequent raidwides. I also remember the whole 'Tanks using STR accessories and dying to Susano's TB' thing. I think it made sense to address those issues (whether the way they were addressed was 'the correct way' is a different topic). There's also a fair amount of times where we have multiple hits in a row, which drop us below 80% and would trigger the Max HP reduction mid-mechanic, which would have to be reworked/double checked to see that they still function. WHM would also be more punished than AST in this regard, as AST has CU and Neutral Sect shields over WHM's one-time Divine Caress shield, which means that in some cases, AST would be able to prevent multi-hit mechanics from taking the party into Trauma territory, while WHM would be forced to let them drop into the threshold to trigger the Max HP reduction (Tracking Tremors, some Brutal Impacts, etc.)
Let's imagine for example, a raidwide hit in a normal raid. It deals 50% of your Max HP in the Trauma version, and 25% of your Max HP, plus 25% of your Max HP as Aetherblight, in the other version. With the Trauma effect, if left alone (because the Healers want to just deal damage and not heal), the people who took the hit will deal less damage, through no fault of their own, due to Trauma. In the Aetherblight version, however, I would imagine that the more common punishments for leaving Aetherblight alone would be things like a Vuln Up (which does nothing on its own until the next hit hits), a DOT (which increases how much HP needs to be healed before the next mechanic, so, 'punishes the Healer' for leaving it alone), or a pseudo-DOT which converts more and more HP into Aetherblight over time (increasing how much HPS you have to push to get out of Aetherblight and stop the conversion, again punishing only the Healer for leaving it alone)



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