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  DESIGN 
  Joshua Raynack 
   
  EDITOR 
  Doug Meershaert 
   
  COVER ILLUSTRATION 
  William-Adolphe Bouguereau 
   
  GRAPHIC DESIGN 
  Joshua Raynack 
  Ryan Rawls 
  Johannes Wiebel 
   
  WEB PRODUCTION  
  AND DEVELOPMENT 
  Ryan Rawls 
   
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  This product is 3.5 
  System and PRGC 
  Compatible 
   
  
  his system allows you to intro-
  duce an element of dark hor-
  ror into your game. In cam-
  paigns using these rules, char-
  acters gain a new attribute called Sanity. 
  This statistic functions like an ability 
  score in some ways, but it has its own 
  unique mechanics that represent the 
  character’s descent from a stable and 
  healthy mental state into confusion, de-
  mentia, and mental instability.  As a 
  character encounters monsters, witnesses 
  horrible acts, master forbidden knowl-
  edge, or cast spells, his Sanity score, and 
  his corresponding ability to function as a 
  normal member of his race, deteriorates. 
  This gradual descent is balanced in part 
  by the powers that characters gain each 
  time they overcome a horrific foe or grow 
  in skill and expertise, but even as those 
  characters grow in power, they know or 
  fear that an even greater peril lays ahead: 
  the threat of becoming permanently in-
  sane. 
   
  WHAT IS SANITY? 
  Sanity is the natural state of ordinary life. 
  Normal mental balance is endangered 
  when characters confront horrors, enti-
  ties, or activities that are shocking, un-
  natural, and bewildering. Such encoun-
  ters cause a character to lose points from 
  his Sanity score, which in turn risks tem-
  porary, indefinite, or permanent insanity. 
  Mental stability and lost Sanity points 
  can be restored, up to a point, but psy-
  chological scars remain. 
   
  Insanity occurs if too many Sanity 
  points are lost in too short a time. Insan-
  ity does not necessarily occur if Sanity 
  points are low, but a lower Sanity score 
  makes some forms of insanity more 
  likely to occur after a character experi-
  ences an emotional shock. The charac-
  ter’s Sanity may be regained after a few 
  minutes, recovered after a few months, 
  or lost forever. 
  3 
  GAME ENHANCEMENT | Insanity 
  WHAT IS SANITY 
  
   
  A character may regain Sanity points, and even 
  increase her Sanity point maximum. However, in-
  creasing a character’s ranks in the Knowledge 
  (forbidden lore) skill (see below) always lowers her 
  maximum Sanity by an equal amount. 
   
  SANITY POINTS 
  Sanity points measure the stability of a character’s 
  mind.  This attribute provides a way to define the 
  sanity inherent in a character, the most stability a 
  character can ever have, and the current level of sane 
  rationality that a character preserves, even after nu-
  merous shocks and horrid revelations. 
   
  Sanity is measured in three ways: starting San-
  ity, current Sanity, and 
  maximum Sanity. Start-
  ing and current Sanity 
  cannot exceed maximum 
  Sanity. 
   
  STARTING SANITY 
  A character’s starting San-
  ity equals his Wisdom 
  score multiplied by 5. 
  This score represents a 
  starting character’s cur-
  rent Sanity, as well as the 
  upper limit of Sanity that 
  can be restored by the 
  Heal skill (see the Heal 
  Skill and Mental Treat-
  ment, later in this sec-
  tion). After creation, a 
  character’s current Sanity 
  often fluctuates consid-
  erably and might never 
  again match starting Sanity. 
  A change in a character’s 
  Wisdom score changes her 
  starting Sanity in terms of what treatment the Heal 
  skill can restore. Current Sanity, however, does not 
  change if Wisdom rises or falls. 
   
  CURRENT SANITY 
  A character’s current Sanity score fluctuates almost 
  as often as her hit points. 
   
   
  Making a Sanity Check: When a character en-
  counters a gruesome, unnatural, or supernatural 
  situation, the GM may require the player to make a 
  Sanity check using percentile dice (d%). The check 
  succeeds if the result is equal to or less than the 
  character’s current Sanity. 
   
  On a successful check, the character either 
  loses no Sanity points or loses only a minimal 
  amount. Potential Sanity loss is usually shown as two 
  numbers or die rolls separated by a slash, such as 
  0/1d4. The number before the slash indicates the 
  number of Sanity points lost if the Sanity check suc-
  ceeds (in this case, no Sanity is lost); the number 
  after the slash indicates the number of Sanity points 
  lost if the Sanity check fails (in this case, between 1 
  and 4 points). 
   
  A character’s current Sanity is also at risk when 
  the character reads certain books, learns certain 
  types of spells, and attempts to cast them. These 
  Sanity losses are usually auto-
  matic (no Sanity check is al-
  lowed); the character who 
  chooses to undertake the 
  activity forfeits the indi-
  cated number of Sanity 
  points. 
   
  In most cases, a new 
  sanity-shaking 
  confronta-
  tion requires a new Sanity 
  check. However, the GM 
  always gets to decide 
  when 
  characters 
  make 
  Sanity checks. Confront-
  ing several horribly man-
  gled corpses at one time 
  or in rapid succession 
  may call for just one San-
  ity check, while the 
  same corpses encoun-
  tered singly over the course 
  of several game hours may 
  require separate checks. 
   
  Going Insane (this is where 
  it gets fun): Losing more 
  than a few Sanity points may cause a character to go 
  insane, as described below. If a character’s Sanity 
  score drops to 0 or lower, she begins the quick slide 
  into permanent insanity. Each round, the character 
  loses another point of Sanity. Once a character’s San-
  ity score reaches -10, she is hopelessly, incurably 
  insane. The Heal skill can be used to stabilize a 
  character on the threshold of permanent insanity; see 
  the Heal Skill and Mental Treatment below for de-
  tails. A GM’s description of a Sanity-shaking situa-
  tion should always justify the threat to a character’s 
  well-being. Thus, a horde of frothing rats is horrify-
  ing, while a single ordinary rat usually is not (unless 
  Seeing certain atrocities can cause severe shock. 
  4 
  GAME ENHANCEMENT | Insanity 
  Gustave Dore 
  
  the character has an appropriate phobia, of course). 
   
  MAXIMUN SANITY 
  Ranks in the Knowledge (forbidden lore) skill simu-
  late a character’s comprehension of aspects of the 
  dark creatures at the edge of reality. Once gained, 
  this horrible knowledge is never forgotten, and the 
  character consequently surrenders mental equilib-
  rium. A character’s Sanity weakens as his compre-
  hension of these hidden truths increases. 
   
  A character’s current Sanity can never be higher 
  than 99 minus the character’s ranks in the Knowl-
  edge (forbidden lore) skill. This number (99 minus 
  Know edge [forbidden lore] ranks) is the character’s 
  maximum Sanity. 
   
  LOSS OF SANITY 
  Characters ordinarily lose Sanity in a few types of 
  circumstances: when encountering something uni-
  maginable, when suffering a severe shock, after cast-
  ing a spell or when learning a new spell, when being 
  affected by a certain type of magic or particular spell, 
  or when reading a forbidden tome. 
   
  SEVERE SHOCKS 
  A shocking sight of a more mundane nature can cost 
  Sanity points. Severe shocks include witnessing an 
  untimely or violent death, experiencing personal 
  mutilation, losing social position, being the victim of 
  treachery, or whatever else the GM decides is suffi-
  ciently extreme. The following list gives some exam-
  ples of severe shocks, and the Sanity loss each one 
  provokes. 
   
  TYPES OF INSANITY 
  There are three types of insanity: temporary, indefi-
  nite, and permanent. It is possible to cure the first 
  two types of insanity, however the third type of in-
  sanity, permanent insanity, cannot be cured. Perma-
  nent insanity occurs when characters’ Sanity points 
  are reduced to –10 or lower. 
   
  TEMPORARY INSANITY  
  Whenever a character loses Sanity points equal to 
  one half his Wisdom score from a single occurrence 
  of Sanity loss, the character has suffered a significant 
  shock that the GM must ask for an additional Sanity 
  check. If the check fails, the experience proves too 
  much for the character to comprehend and goes tem-
  porarily insane. If the check is successful, the charac-
  ter does not go insane, but he may not remember 
  exactly what happened. 
   
  This type of insanity may last for a few minutes 
  or perhaps even a few days. The character may ac-
  quire a phobia relevant to the situation, faint, or even 
  suffer a  minor nervous breakdown. Regardless what 
  happens, he is able to run and hide from the imme-
  diate threat. 
   
  A character suffering from temporary insanity 
  remains in this state for either a number of rounds or 
  a number of hours; roll d% and consult Table 1-2: 
  Duration of Temporary Insanity to determine 
  whether the insanity is short-term or long-term. Af-
  ter concluding the duration of the insanity, roll d% 
  and consult either Table 1-3 or 1-4 to identify the 
  specific effect of the insanity. 
   
  In order for the player to role-play the situation 
  accordingly, the GM is encouraged to describe the 
  effect to the inflicted character.  The Heal skill may 
  alleviate or erase temporary insanity (see below) 
  Temporary insanity ends when the duration has 
  elapsed or earlier should the GM decide it appropri-
  ate to do so. 
   
  INDEFINITE INSANITY  
  Should a character suffer a loss of 20% (one-fifth) of 
  their Sanity score or more in the space of 1 hour, he 
  goes indefinitely insane. An episode of indefinite 
  Sanity Lost¹ Shocking Situation 
  0/1d2 
  Surprised to find a mangled animal car-
  cass. 
  0/1d3 
  Surprised to find a human corpse. 
  0/1d3 
  Surprised to find a human body part. 
  0/1d4 
  Finding a stream flowing with blood. 
  1/1d4+1 
  Finding a mangled human corpse. 
  0/1d6 
  Awakening trapped in a coffin. 
  0/1d6 
  Witnessing a friend’s violent death. 
  1/1d6 
  Seeing a ghoul. 
  1/1d6+1 
  Meeting someone you know to be dead. 
  0/1d10 
  Undergoing severe torture. 
  1/1d10 
  Seeing a corpse rise from its grave. 
  2/2d10+1 
  Seeing a gigantic severed head fall from 
  the sky. 
  1d10/d% 
  Seeing an evil deity.  
  Table 1-1: Sanity Examples 
  ¹ Loss on a successful check/loss on a failed check. 
  d% 
  Temporary Insanity 
  Type 
  Duration 
  01-80 
  Short-term 
  1d10+4 rounds 
  81-100 Long-term 
  1d10x10 hours 
  Table 1-2: Duration of Temporary Insanity 
  5 
  GAME ENHANCEMENT | Insanity 
  TYPES OF INSANITY 
  
  insanity lasts for 1d6 game months (or as the GM 
  dictates) and the symptoms may not be immediately 
  apparent. 
   
  This allows the GM to determine exactly the 
  nature of the Indefinite Insanity. Table 1-5: Random 
  Indefinite Insanity offers the GM an aid in choosing 
  what particular form a character’s indefinite insanity 
  takes.   
   
  Though many of the indefinite insanity results 
  seem deliberating, it is still possible for players to 
  continue playing these characters. The character 
  may stumble madly through the rest of the adven-
  ture, but with a weakened grasp of reality, such a 
  character can pose a danger to himself and others. 
   
  The Heal skill can be used to restore Sanity 
  points during this period, however the underlying 
  insanity remains. Even if the character is cured of 
  effects of the indefinite insanity, the experience has 
  changed the character forever. 
   
  PERMANENT INSANITY  
  A character whose Sanity score falls to –10 goes per-
  manently insane. The character becomes an NPC 
  under the control of the GM.  A character who has 
  gone permanently insane can never be normal again. 
  He is forever lost in his own world and from the real-
  ity of the environment that surrounds him. The 
  character may be a ravening lunatic or outwardly 
  indistinguishable from a normal person; however, 
  the character has fallen into a deep, internal corrup-
  tion by searching forbidden knowledge. 
   
  A GM may use Table 1-5: Random Indefinite 
  Insanity to outline the disorder a permanently insane 
  character suffers. 
  d% 
  Effect 
  01-20 Character faints (can be awakened by vigorous 
  action taking 1 round; thereafter, character is 
  shaken until the duration expires). 
  21-30 Character is frightened. 
  31-40 Character is panicked. 
  41-50 Character shows physical hysterics or emotional 
  outburst (i.e. laughing, crying, and so forth). 
  51-55 Character babbles in incoherent speech or in a 
  torrent of coherent speech. 
  56-60 Character gripped by intense phobia, and suffers 
  from the cowering condition. 
  61-65 Character becomes homicidal, attacking nearest 
  creature (a familiar counts as part of subject’s 
  self). 
  66-70 Character has hallucinations or delusions. 
  71-75 Characters say or do whatever those nearby say 
  or do. 
  76-80 Character is gripped with a strange or deviant 
  eating desire (dirt, slime, human flesh, and so on). 
  81-90 Character falls into a stupor (assumes fetal posi-
  tion or oblivious to surrounding events). 
  91-99 Character become catatonic or nauseated (can 
  stand but no willpower or interest; may be led or 
  forced to perform simple actions). 
  100 
  Roll on Table A3-4: Long-Term Temporary In-
  sanity Effects. 
  Table 1-3: Short-Term Temporary Insanity Effects 
  d% 
  Effect 
  01-10 Character performs compulsive rituals 
  (constantly washing hands, praying, never step-
  ping on cracks, and so on). 
  11-20 Character has hallucinations and delusions (at 
  the discretion of the GM). 
  21-30 Character becomes paranoid. 
  31-40 Character gripped with severe phobia (refuses 
  to approach object of phobia except on a suc-
  cessful Will save [DC 20]). 
  41-45 Character has aberrant sexual desires 
  (necrophilia, nymphomania, and so on). 
  46-55 Character develops an attachment to a ―lucky 
  charm‖ and cannot function without it. 
  56-65 Character develops psychosomatic blindness, 
  deafness, or the loss of the use of a limb or 
  limbs. 
  66-75 Character has uncontrollable tics or tremors (-
  4 penalty on all attack rolls, checks, and saves, 
  except those purely mental in nature). 
  76-85 Characters have amnesia (All of the character’s 
  Knowledge skills are useless). 
  86-90 Character has bouts of reactive psychosis 
  (delusions, hallucinations , and so on). 
  91-95 Character looses the ability to communicate via 
  speech or writing. 
  96-100 Character becomes catatonic (can stand but no 
  willpower or interest; may be led or forced to 
  perform simple actions). 
  Table 1-4: Long-Term Temporary Insanity Effects 
  6 
  GAME ENHANCEMENT | Insanity 
  
   
  GENERAL    
  MENTAL DISORDERS 
  The following disorders exemplify those depicted on 
  Table 1-5: Random Indefinite Insanity. 
   
  ANXIETY DISORDERS  
  Anxiety disorders generally develop from a variety of 
  risk factors including personality, genetics, and life 
  events that burden the character. When this anxiety 
  builds over a prolonged period of time (especially 
  when combating frightful creatures), the character 
  may begin to develop an anxiety disorder. 
   
  Generalized Anxiety Disorders: The character 
  suffers from a variety of physical and emotional 
  symptoms that can be grouped into certain catego-
  ries. 
   
  Motor Tension: The character suffers from jit-
  teriness, aches, twitches, and so on. All attack rolls, 
  Fortitude and Reflex saves, and all checks involving 
  Strength, Dexterity, or Constitution take a –2 pen-
  alty. 
   
  Automatic Hyperactivity: The character suffers 
  from immense sweating, a racing heart, dizziness, 
  clammy hands, and so on. All attack rolls, saves, and 
  checks take a –2 penalty. 
   
  Expectations of Doom: Anxieties culminate 
  into a fear and an anticipation of misfortune. All at-
  tack rolls, saves, and checks take a –2 morale pen-
  alty. 
   
  Vigilance: The character suffers from distrac-
  tions, inability to focus, insomnia, and so on. All Will 
  saves and checks involving Intelligence, Wisdom, or 
  Charisma take a –4 morale penalty. 
   
  Agoraphobia: The character has a fear of open 
  places. The character becomes very nervous outside 
  familiar surroundings and must make a Will save 
  (DC 15) in order to leave home or engage socially. 
  The character may also develop a related phobia, 
  such as uranophobia (fear of the sky), baraphobia 
  (fear of the loss of gravity), or xenophobia (fear of 
  strangers). 
   
  Obsessive-Compulsive Disorder: This malady 
  develops into two forms: obsessive thoughts or com-
  pulsive actions. Some characters may exhibit both. 
   
  Obsessions: The character cannot help thinking 
  about an idea, image, or impulse incessantly, often 
  involving violence and self-doubt. Obsessive im-
  pulses pose dangerous situations when coupled with 
  auditory hallucinations. There might be “voices” 
  urging the character to take a dangerous or aggres-
  sive course of action. 
   
  Compulsions: The character insist on perform-
  ing ritual actions, such as locking and unlocking 
  doors, before entering or leaving their apartment. 
  The need to perform these actions are so great, a 
  character may ignore their survival in order to per-
  form these actions.  Performing a ritualistic compul-
  sion lasts 1d10 rounds. 
   
  Phobia or Mania: A character afflicted by a pho-
  bia or a mania persistently fears a particular object or 
  situation. 
   
  Phobia: A Will save (DC 15) is required for a 
  character to be able to force themselves into (or re-
  main within) the presence of the object of their pho-
  bia, and even then the character takes a –2 morale 
  penalty as long as the object of the fear remains. 
   
  Mania: Manias are rarer than phobias. A charac-
  ter affected by a mania is inordinately fond of a par-
  ticular stimulus and takes great pains to be with or 
  near it. This behavior might turn into a fetish. For 
  example, a character with Hematophobia has a fear 
  of blood while a character with Hematophilia has an 
  unhealthy (possibly sexual) attraction to the act of 
  bleeding. 
   
  DISSOCIATIVE DISORDERS  
  A character who becomes dissociative suffers from a 
  lack of connection to thoughts, memories, feelings, 
  actions, or sense of identity. Certain ordeals are so 
  d% 
  Mental Disorder Type 
  01-15 Anxiety (includes sever phobias). 
  16-20 Dissociative (multiple personalities, amnesia). 
  21-25 Eating (anorexia/bulimia). 
  26-30 Impulse control (compulsions). 
  31-35 Mood (maniac/depressive). 
  36-45 Personality (various neuroses). 
  46-50 Psychosexual (nymphomania, sadism).  
  51-55 Psychospecies . 
  56-70 Schizophrenia/psychotic (delusions, hallucinations, 
  paranoia, catatonia). 
  71-80 Sleep (night terrors, sleepwalking). 
  81-85 Somatoform (psychosomatic conditions). 
  86-95 Substance abuses (alcoholic, drug addict). 
  96-100 Other (megalomania or GM’s discretion). 
  Table 1-5: Random Indefinite Insanity 
  7 
  GAME ENHANCEMENT | Insanity 
  GENERAL MENTAL DISORDERS 
  
  horrifying for the character that it becomes too terri-
  ble to remember. 
   
  Dissociative Amnesia: This is the inability to 
  recall important personal information by trying to 
  avoid unpleasant memories or events. The character 
  must make a Will save (DC 20) to recall such details 
  or the cause of amnesia. 
   
  Dissociative Fugue: The character flees from 
  home or work and cannot recall their past. Characters 
  may assume a new identity. 
   
  Dissociative Identity Disorder: This is the infa-
  mous multiple personality disorder that has pro-
  voked the production of many films and books. Each 
  personality a character harbors has a distinct name, 
  behavior, and possibly, even gender. The player 
  needs to keep track of each of the character’s differ-
  ent personalities (each character has the same ability 
  scores and games statistics, but different goals, out-
  looks, attitudes and so on). 
   
  EATING DISORDERS  
  These disorders are dangerous as they might lead a 
  character to starvation. The two most common are 
  Anorexia Nervosa and Bulimia Nervosa. 
   
  Anorexia Nervosa: The character has an over-
  whelming fear of becoming fat and constantly loses 
  weight, as well as taking Constitution damage at the 
  rate of 1d8 points per week. 
   
  IMPULSE CONTROL DISORDERS  
  These disorders include compulsive gambling, 
  pathological lying, kleptomania, and pyromania. 
   
  MOOD DISORDERS  
  These affect the character’s outlook and attitude to 
  the point where it impinges on their abilities. 
   
  Depression: This disorder may include symp-
  toms of weight gain or loss, too much or too little 
  sleep, persistent feelings of guilt or worthlessness 
  and can lead to hallucinations, delusions, stupor, or 
  thought of suicide. 
   
  All attack rolls, saves, and checks take a –4 mo-
  rale penalty. 
   
  Mania: The character possesses a constant 
  euphoric or irritable mood. This includes talkative-
  ness, great delusional self-esteem, no need for sleep, 
  easily distracted, and so on. All attack rolls, saves, 
  and checks take a –4 morale penalty. 
   
  Bipolar Mood Disorder: The character changes 
  between the two mood states staying in one mood 
  for weeks at a time or rapidly switching from one to 
  another without notice. 
  PERSONALITY DISORDERS  
  These disorders cause an unpleasant behavior, mak-
  ing it difficult for characters to interact with others. 
  The character takes a –4 penalty on all Charisma-
  based checks.  
   
  In addition, the attitudes of NPCs the character 
  encounters are shifted in the negative position. On a 
  successful Diplomacy check, the attitude of the 
  NPC in question shifts one step toward hostile; on a 
  failed check, the attitude of the NPC in question 
  shifts two steps toward hostile. 
   
  See Table 1-6: Personality Disorders for more 
  types of this disorder. 
   
  PSYCHOSEXUAL DISORDERS  
  Types of this disorder include transsexualism, nym-
  phomania, paraphilia, necrophilia, and so on. 
   
  PSYCHOSPECIES DISORDERS  
  Characters with this disorder might believe they are 
  a 
  different type of creature: animal, undead, aquatic, 
  and so on. 
   
  SCHIZOPHRENIA DISORDERS  
  Characters suffering from this disorder suffers a 
  break from reality. Symptoms include hallucinations, 
  delusions, and cognitive impairment. 
   
   
  Type 
  Effect 
  Antisocial 
  Reckless behavior, habitual liar, and so on. 
  Avoidant 
  Low self-esteem or socially withdrawn. 
  Borderline 
  Impulsive or unable to control. 
  Compulsive 
  Perfectionist, authoritarian, or indecisive. 
  Dependant 
  Lacks self-confidence or subordinate. 
  Histrionic 
  Craves attention and excitement; may 
  threaten suicide. 
  Narcissistic 
  Craves attention and admiration. 
  Passive-
  Aggressive 
  Stubborn and deliberately inefficient. 
  Paranoid 
  Jealous, humorless, or secretive.  
  Schizoid 
  Aloof, has few friends; indifferent to praise 
  or criticism. 
  Table 1-6: Personality Disorders 
  8 
  GAME ENHANCEMENT | Insanity 
  
  SLEEP DISORDERS  
  Insomnia and narcolepsy are two of many types of 
  sleeping disorders. These disorders cause distur-
  bance in the character’s daily activities. Characters 
  performing demanding tasks such as engaging in 
  combat or casting a spell may, when stressed, need 
  to make a Perception check (DC 15) to stay awake 
  and not put themselves in a dangerous situation. 
   
  SOMATOFORM DISORDERS  
  These disorders are diagnosed when a character suf-
  fers from physical symptoms without actual physical 
  injury or disease. 
   
  Somatization Disorder: The character suffers 
  from a physical ailment or disease-like effect. Symp-
  toms can include dizziness or impotence to blind-
  ness and intense pain. The character does not be-
  lieve that their symptoms represent a specific dis-
  ease. All attacks rolls, saves, and checks take a –2 
  penalty. 
   
  Conversion Disorder: The character has dys-
  functions that suggest a physical disorder, though 
  involuntary, the symptoms actually provide a way for 
  the character to avoid some undesirable experience. 
  All attacks rolls, saves, and checks take a –2 penalty. 
   
  SUBSTANCE ABUSE DISORDERS  
  Characters with a substance abuse disorder finds 
  comfort in using a particular drug. This includes al-
  cohol, amphetamines, cocaine, hallucinogens, mari-
  juana, and so on. 
   
  Characters should feel a daily personal struggle 
  and Will saving throws might be used to resist or 
  succumb to such cravings. All attack rolls, saves, and 
  checks, take a –2 penalty because of withdrawal 
  symptoms. 
   
  GAINING OR  
  RECOVERING SANITY 
  During the events of a campaign, a character’s Sanity 
  score can increase. Although it can never exceed 99 
  minus his Knowledge (forbidden lore) ranks, his 
  maximum Sanity and current Sanity can exceed his 
  starting Sanity. 
   
  Level Advancement: A character’s current San-
  ity can become higher that their starting Sanity as a 
  result of gaining levels. Whenever a character gains a 
  new level, they roll 1d6 and add the result to their 
  current Sanity. 
   
  Story Rewards: The GM may reward increases 
  in a character’s current Sanity should they foil a great 
  horror or other evil enterprise. 
   
  MENTAL THEREPY  
  To give useful therapy, a healer must have the Heal 
  skill. Intensive treatment can return Sanity points to 
  a troubled character. However, Sanity points re-
  stored in this manner can never cause the character’s 
  Sanity score to exceed their starting Sanity or maxi-
  mum Sanity, whichever is lower. A character can 
  have only one healer at a time. 
   
  Such treatment may help a character instantly 
  snap out of an episode of temporary insanity, how-
  ever recovery from indefinite insanity only comes 
  with time (typically 1d6 months). 
   
  TREATMENT OF SANITY     
  While treatment of temporary insanity can end with 
  a moment of consultation and a quick Heal check, 
  9 
  GAME ENHANCEMENT | Insanity 
  GAINING OR RECOVERING SANITY 
  THE HEAL SKILL AND  
  MENTAL TREATMENT 
   
  Sanity rules provide a new use for the Heal skill. 
  Allowing trained healers to help recover Sanity 
  points. 
   
  Immediate Care: When someone suffers an 
  episode of temporary insanity, a therapist can 
  bring them out of it by making a Heal check (DC 
  15) as a full-round action. 
   
  A therapist can also use immediate care to 
  stabilize the Sanity score of a character whose 
  current Sanity is between –1 and –9. On a suc-
  cessful check (DC 15; requiring a full-round ac-
  tion), the character’s Sanity score improves to 0. 
   
  Long-Term Care: Providing long-term care 
  means treating a mentally disturbed person for a 
  day or more in a place away from stress and 
  distractions. A healer must spend 1d4 hours per 
  day doing nothing but talking to the patient. If 
  the healer makes a Heal check (DC 20) at the 
  end of this time, the patient recovers 1 Sanity 
  point. A healer can tend up to six patients at a 
  time; each patient beyond the first adds 1 hour 
  to the total time per day that must be devoted 
  to therapy. The check must be made each day 
  for each patient. A roll of 1 on any of these Heal 
  checks indicates that the patient loses 1 point of 
  Sanity that day, as they regress mentally due to 
  horrors suddenly remembered. 
   
   
  
  treatment of permanent insanity is pointless since a 
  character can never recover regardless of the thera-
  pist or facility. 
   
  Thus, indefinite insanity is the only form of 
  mental illness that might be addressed by interven-
  tion and treatment. 
   
  After 1d6 months, if undisturbed by further 
  trauma and with an agreement with the Game Mas-
  ter, an indefinitely insane character finds enough 
  mental balance to reenter the world. There are three 
  kinds of care that may help the character regain San-
  ity points during this recovery period. The type of 
  care a character receives are based on the resources 
  the character has, either personal or through family 
  and friends. 
   
  PRIVATE CARE  
  This involves the character finding care at home or 
  in some friendly environment (i.e. a church or the 
  home of a wealthy relative or friend) where constant 
  vigilance and nursing are available. It is a place 
  where personal care is undistracted by the needs of 
  competing patients.  
   
  If mental healing or alchemical medications are 
  available, roll d% for each game month that one or 
  the other is used. A result of 01-95 is a success: add 
  1d3 Sanity points for either therapeutic or alchemical 
  medications, whichever is used (but not both). On 
  the result of 96-100, the healer fumbles the diagnosis 
  or the character rejects the alchemical treatments. 
  He or she loses 1d6 Sanity points, and no progress is 
  made that month. 
   
  INSTITUTIONALIZATION  
  Commitment in a good insane asylum is the next 
  best 
  alternative. Therapy using the Heal skill is usually 
  the only treatment available, however primitive in-
  stitutions might undermine treatment. 
   
  Roll d% for each game month a character is in 
  the care of an institution. A result of 01-95 is a suc-
  cess: add 1d3 Sanity points if therapy with the Heal 
  skill was available, or 1 Sanity point if no treatment 
  was present. 
   
  On the result of 96-100, the character rebels 
  against the environment. He or she loses 1d6 Sanity 
  points, and no progress can be made that month. 
   
  WANDERING AND HOMELESS 
  If the two previous cares are not available, an insane 
  character may end up homeless, babbling incoher-
  ently as he or she struggles for survival. Such a char-
  acter gains no Sanity points unless he or she is able 
  to join a group of the homeless and find at least one 
  friend among them. To find a friend after joining 
  such a group the character can make a DC 15 Cha-
  risma check once per month. If a friend appears, the 
  character recovers 1 Sanity point per game month 
  thereafter.  
   
  For each game month during which an insane 
  character lives as a derelict, roll d%. On a result of 01
  -95, the character survives. On a result of 96-100, the 
  character dies as the result of disease, exposure, or 
  violence. 
   
  TREATMENT IN A FANTASY  
  OR HISTORIC CAMPAIGN 
  The treatments listed above are methods intended 
  for a high-fantasy campaign setting.  But what if you 
  are not playing a high-fantasy campaign or what 
  10 
  GAME ENHANCEMENT | Insanity 
  REAL WORLD HISTORY 
   
  As the number of people living in cities in-
  creased, there became an increasingly large 
  population of urban mentally ill. Generally speak-
  ing, in rural areas the mentally ill had been able 
  to rely on local charity and support, or managed 
  to simply "blend in" with the rest of the popula-
  tion. However, under the demands of larger cit-
  ies they faced a higher degree of difficulty and 
  had a much greater chance of causing disruption 
  or simply being noticed. This led to the building 
  of the early asylums which were little more than 
  repositories for the mentally ill -- removing them 
  from mainstream society in the same manner as 
  a jail would for criminals. Conditions were often 
  extremely poor and serious treatment was not 
  yet an option. The first known psychiatric hospi-
  tal, Bethlem Royal Hospital (Bedlam) was 
  founded in London in 1247 and by 1403 had be-
  gun accepting "lunatics." It soon became (in)
  famous for its harsh treatment of the insane, and 
  in the 18th century would allow visitors to pay a 
  penny to observe their patients as a form of 
  "freak show". In 1700 it is recorded that the 
  "lunatics" were called "patients" for the first time, 
  and within twenty years separate wards for the 
  "curable" and "incurable" patients had been es-
  tablished, representing the beginning of a clear 
  shift in the attitude towards mental illness to-
  wards a disease of some form. 
   
  
  something a bit more gritty?  Well, it is your cam-
  paign and the rules listed above are fine to use in 
  any campaign setting, however the rules presented 
  below offers methods based on historical accounts.  
  This allows to bring in an entirely different atmos-
  phere to your game. 
   
  MID 0r LOW-FANTASY 
  In a traditional fantasy campaign based on a medie-
  val setting—or prior—adequate treatment for those 
  suffering from mental illness looks bleak.  They are 
  essentially two venues a character has available in 
  getting treatment: go to a monastery or wander. 
   
  A monastery is a refuge away from the 
  world and is a place where a character can 
  peacefully 
  collect 
  their 
  thoughts.  
  Some monasteries dedicated 
  themselves wholly to this 
  cause.  In order to enter into a 
  monastery, 
  one 
  must give the 
  Abbot all of his 
  or her posses-
  sions.  This is 
  used to support 
  the monastery and 
  the new addition.   
   
  Roll d% for 
  each game month 
  a character is in 
  the care of a mon-
  astery.  A result of 
  0 1 -
  05 is a success: add 1d3 Sanity points if therapy with 
  the Heal skill was available, or 1 Sanity point if no 
  treatment was present. 
   
  On the result of 06-95, no Sanity is gained.  On 
  the result of 96-100, the character rebels against the 
  environment. He or she loses 1d6 Sanity points, and 
  no progress can be made that month.   
   
  Another method is to continue wandering about 
  the countryside and hope that the companionship 
  with friends pulls the character through.  As long as 
  the group the character continues to travel with at 
  least one companion of a good alignment, the charac-
  ter recovers 1 Sanity point per game month thereaf-
  ter.  Otherwise, a character may make a DC 15 Cha-
  risma check once each game month to recover 1 San-
  ity point.  Also, while traveling with a group that 
  does not have at least someone with a good align-
  ment, the character is considered to be derelict. 
   
  If the character is without a traveling group, 
  then use the “Wandering and Homeless” treatment 
  outlined above. 
   
  Alchemical Treatments in a Fantasy Setting  
  In a fantasy game, the Game Master should decide 
  whether rare herbs and alchemical substances can 
  provide the same benefits that modern psychiatric 
  drugs can deliver.  Therefore, a Game Master need 
  only decide how easily he wants characters to over-
  come Sanity loss and insanity effects.  Once the de-
  sired tone of the campaign is known, the Game Mas-
  ter can determine whether alchemical treatment is 
  available.  You may decide that the Sanity variant 
  assumes that skilled alchemists can create sub-
  stances that offer the same bene-
  fits that psychiatric drugs can 
  provide.  However, you may feel 
  that, like real world history, very 
  few alchemists bothered brew-
  ing poultices for curing the 
  mentally ill, but instead 
  tried to create a formula 
  of turning lead into 
  gold for their rich pa-
  trons. 
   
  As long as a char-
  acter can afford the cor-
  rect herbs and alchemi-
  cal substances and is 
  able to ingest them, 
  the symptoms of indefinite 
  insanity can be ignored.  In-
  gesting these alchemical substances and drugs does 
  not make a character immune or even particularly 
  resistant to further Sanity losses.  A DC 25 Craft 
  (alchemy) check is needed to accurately prepare the 
  correct herbs and substances and administer the cor-
  rect dosage. 
   
  Long-term alchemical treatment can restores 
  lost Sanity points, just as use of the Heal skill can.  
  For each month the character takes an accurately 
  prescribed psychiatric medication, the character re-
  gains 1d3 Sanity points.  As with treatment through 
  the Heal skill, long-term drug therapy can never 
  raise a character’s current Sanity score above her 
  starting Sanity. 
   
  A character cannot regain Sanity from both 
  treatment with the Heal skill and alchemical treat-
  ment in the same month. 
   
  Restoring Sanity with Magic 
  The way Sanity loss and magic healing interact can 
  greatly affect the feel of your game.  At one extreme, 
  11 
  GAME ENHANCEMENT | Insanity 
  TREATMENT OF INSANITY 
  Gustave Dore 
  
  the Game master can rule that magic can easily cure 
  Sanity loss, in which case Sanity becomes little more 
  than a specialized version of “mental hit points” that 
  include some neat side effects (insanity).  In such a 
  case, characters can usually restore themselves to full 
  Sanity with a day or two of rest and spellcasting. 
   
  At the other extreme, the campaign might be 
  structured so that magical healing can do little or 
  nothing to restore Sanity, and even powerful divine 
  spellcasters capable of curing the most deadly physi-
  cal malady shy away from those encounters that 
  might drain away Sanity points.  The spells that can 
  potentially restore Sanity points are discussed below.  
  The Game Master should feel free to choose which 
  of these spell effects are present in the game, but 
  once established, these effects should not be 
  changed in mid-campaign. 
   
  Atonement: Although this spell does not usu-
  ally restore Sanity, it can be used in those rare cases 
  when a character’s own actions inadvertently lead to 
  an evil act that causes the character to lose Sanity 
  points.  If a geas/quest spell is combined with the 
  atonement spell, Sanity points are not restored until 
  the task is completed.  A successful use of the atone-
  ment spell can restore all Sanity loss through the 
  direct result of the evil acts for which the character 
  atones. 
   
  Calm Emotions: This spell cannot restore San-
  ity directly, but it can temporarily mitigate the ef-
  fects of temporary or permanent insanity.  While the 
  spell is in effect, the targets act calmly and ignore 
  behavior changes caused by Sanity loss. 
   
  Heal: In addition to its normal effects, heal re-
  stores 10 Sanity points and removes all forms of tem-
  porary insanity. 
   
  Mind Blank: While the spell is in effect, the 
  subject is immune to Sanity loss. 
   
  Miracle: This spell can restore a character to 
  maximum Sanity even if his current Sanity has 
  dropped to –10.  Miracle even heals permanent in-
  sanity. 
   
  Restoration: If the caster chooses, restoration 
  can restore 1d6 Sanity points per two levels to the 
  target creature (5d6) instead of having its normal 
  effect. 
   
  Restoration, Greater: If the caster chooses, 
  greater restoration can restore the target creature to 
  its maximum Sanity instead of having its normal ef-
  fect. 
   
  Restoration, Lesser: If the caster chooses, lesser 
  restoration can restore 1d4 Sanity points to the sub-
  ject instead of having its normal effect. 
   
  Wish: This spell can restore a character to maxi-
  mum Sanity even if his current Sanity has dropped 
  to –10.  Wish even heals permanent insanity. 
   
  Limited Wish: This spell can restore a character 
  to maximum Sanity even if his current Sanity has 
  dropped to –10.  Limited Wish does not heal perma-
  nent insanity.  
   
  HISTORIC 
  Many different periods in history dealt with men-
  tally ill patients in many ways.  Though there were 
  many individuals that began to look at the mentally 
  ill seriously throughout history, it is really until the 
  late 20th century that curative treatments were be-
  coming truly beneficial.  If the character is without 
  care, then use the “Wandering and Homeless” treat-
  ment outlined above.  Otherwise, use the methods 
  of institutionalization below depending on the time 
  period. 
   
  The Age of Revolutions (1700s): Institutions 
  were beginning to emerge during this time.  Though 
  there is private care, it was really meant to isolate the 
  person in question from the rest of society rather 
  than an attempt to cure the infliction.   
   
  Use the “Institutionalization” method as de-
  scribed above except change the following: 
   
  Roll d% for each game month a character is in 
  12 
  GAME ENHANCEMENT | Insanity 
  FANTASY AND HISTORIC  
  KNOWLEDGE  
  (HUMOURS) 
   
  A new skill called Knowledge (humours) can 
  serve as the primary way to treat those who 
  have suffered Sanity loss.  Knowledge (humours) 
  is a Intelligence-based skill that cannot be used 
  untrained.  If you use this variant, characters with 
  the Heal skill can only offer immediate care, and 
  cannot offer long-term care.  The Knowledge 
  (humours) skill allows both types of treatment. 
   
  Note: If magical means of restoring Sanity 
  are present in the campaign, the Knowledge 
  (humours) skill is generally not worth including 
  as a separate skill, because characters are better 
  off simply using magic rather than devoting pre-
  cious skill points to such a narrow-focus skill.  If 
  magic means is much more important, and 
  Knowledge (humours) should probably exist as a 
  separate skill. 
   
  
  the care of a monastery.  A result of 01-10 is 
  a success: add 1d3 Sanity points if therapy 
  with the Heal skill was available, or 1 
  Sanity point if no treatment was pre-
  sent. 
   
  On the result of 06-90, no San-
  ity is gained.  On the result of 91-
  100, the character rebels against 
  the environment. He or she loses 
  1d8 Sanity points, and no progress 
  can be made that month.   
    
  The Age of Industrialization 
  and Victorian Era (1800s): During 
  this time, many counties and re-
  gions, especially where there were a 
  lot of growth, were expected to build 
  asylums to house the mentally ill.  
  Treatment was a step up from the 
  previous century, however not by 
  much.  Dorothea Dix and other advo-
  cated for more progressive treatment 
  for the mentally ill as well as more 
  humane standards of livings.  Most 
  institutions were set away from 
  urban centers because the land 
  was cheap and also it was isolated. 
   
  Use the “Institutionalization” 
  method as described above except 
  change the following: 
   
  Roll d% for each game month a 
  character is in the care of a monastery.  
  A result of 01-20 is a success: add 1d3 
  Sanity points if therapy with the Heal 
  skill was available, or 1 Sanity point if no 
  treatment was present. 
   
  On the result of 06-90, no Sanity is gained.  On 
  the result of 91-100, the character rebels against the 
  environment. He or she loses 1d6 Sanity points, and 
  no progress can be made that month. 
   
  Pulp Era and Onward (1930s to 1960s): Things 
  continued to get better until the 1930s were only 
  14% of patients were able to be cured rather then 
  the higher average of 20% in 1900.  
   
  Use the “Institutionalization” method as de-
  scribed above except change the following: 
   
  1930s: Roll d% for each game month a character 
  is in the care of a monastery.  A result of 01-15 is a 
  success: add 1d3 Sanity points if therapy with the 
  Heal skill was available, or 1 Sanity point if no treat-
  ment was present. 
   
  On the result of 16-90, no Sanity is gained.  On 
  the result of 91-100, the character rebels against the 
  environment. He or she loses 1d6 Sanity 
  points, and no progress can be made 
  that month. 
   
  1940s: Roll d% for each game 
  month a character is in the care of a 
  monastery.  A result of 01-25 is a 
  success: add 1d3 Sanity points if 
  therapy with the Heal skill was 
  available, or 1 Sanity point if no 
  treatment was present. 
   
  On the result of 26-90, no 
  Sanity is gained.  On the result 
  of 91-100, the character rebels 
  against the environment. He 
  or she loses 1d8 Sanity 
  points, and no progress can be 
  made that month (the period of lo-
  botomies and electro-shock therapy as 
  curative treatments).  
   
  1950s: The first use of psychiatric 
  drugs to treat patients was during this 
  period.  Roll d% for each game month a 
  character is in the care of a monastery.  
  A result of 01-35 is a success: add 1d3 
  Sanity points if therapy with the Heal 
  skill was available, or 1 Sanity point if 
  no treatment was present. 
   
  On the result of 36-90, no Sanity is 
  gained.  On the result of 91-100, the 
  character rebels against the environment. 
  He or she loses 1d6 Sanity points, and no 
  progress can be made that month. 
   
  1960s: People began to recognize 
  mentally illness early and attempted to 
  correct the problem before institutionali-
  zation became an option.  Roll d% for each game 
  month a character is in the care of a monastery.  A 
  result of 01-45 is a success: add 1d3 Sanity points if 
  therapy with the Heal skill was available, or 1 Sanity 
  point if no treatment was present. 
   
  On the result of 46-95, no Sanity is gained.  On 
  the result of 96-100, the character rebels against the 
  environment. He or she loses 1d6 Sanity points, and 
  no progress can be made that month.   
   
  SANITY AND MONSTERS 
  When people perceive creatures and entities of un-
  speakable horror, this experience costs them some 
  portion of their minds, since such creatures are in-
  trinsically discomforting and repellent.  We never 
  lose awareness of their slimy, fetid, alien nature.  
  13 
  GAME ENHANCEMENT | Insanity 
  SANITY AND MONSTERS 
  Kimagu 
  
  ¹ Only animals or humanoids of truly bizarre or ferocious appearance force such a check. 
  This instinctive reaction is part and parcel of hu-
  mans, elves, dwarves, and other humanoid races.  In 
  this category, we can include supernatural events or 
  agents not always recognized as specifically devoted 
  to these dark gods, such as hauntings, zombies, vam-
  pires, cures, and so on. 
   
  Table 1-7: Sanity Loss from Creatures provides 
  some default Sanity loss values for encountering 
  creatures, based on their type and size.  These are 
  only default values—the Game Master can and 
  should adjust individual monsters he deems more or 
  less horrible than others of their size.  An aasimar, for 
  instance, hardly represents a Sanity-shaking sight, 
  and should probably be treated as a humanoid rather 
  than an outsider.  On the other hand, a vargouille—a 
  Small outsider appearing much like a flying, bat-
  winged head—might provoke a much more visceral 
  reaction than other Small outsiders. 
   
  In addition, certain types of monstrous behavior 
  might force additional Sanity checks, much like 
  those described under “Severe Shocks.”  For in-
  stance, a mind flayer is an unnerving sight, but 
  watching one consume the brain of your best friend 
  should certainly force another check, with losses 
  appropriate to the situation. 
   
  In most d20 fantasy games, no character should 
  need to make a Sanity check when encountering an 
  elf, dwarf, or other standard humanoid race from the 
  Pathfinder Roleplaying Game, or for encountering 
  domesticated or otherwise commonplace animals.  In 
  some cases, even humanoid races such as orcs and 
  goblins might be so common as to not cause Sanity 
  loss either. 
   
  Specific Monsters and Sanity: Some monsters 
  have additional or variant special abilities when us-
  ing the Sanity variant. 
   
  Allip: The allip’s madness ability causes the 
  loss of 2d6 Sanity points rather than the normal ef-
  fect. 
   
  Derro: The derro’s madness ability protects 
  these creatures from any further Sanity loss.  Sane 
  derro (especially derro player characters) track Sanity 
  points normally. 
   
  Monstrous Characters and Sanity: In most 
  cases, the Game Master does not need to keep track 
  of a monster’s Sanity score, but sometimes, espe-
  cially when in the hands of a player, monsters need 
  Sanity scores just as other characters do.  
   
  Although most campaigns that use the Sanity 
  variant limit players to creating characters from the 
  races described in the Pathfinder Roleplaying Game, 
  it’s still easy to envision a world where one or two 
  monstrous races are so common or so integrated into 
  the culture of other races that the Game Master 
  wants to present them as viable player character op-
  tions.  In these cases, the monsters available as 
  player character races should never provoke a Sanity 
  loss from other characters or NPCs, and these crea-
  tures should have a Sanity score and track their San-
  ity losses just like characters made with the Path-
  finder Roleplaying Game races.  A monster should 
  never lose Sanity for seeing others of its races 
  (spectres don’t lose Sanity when encountering other 
  spectres, and so on).  In all cases, what causes Sanity 
  loss for a specific creature is in the hands of the 
  Game Master.    
    
   
  SANITY AND SPELLS 
  Magic relies on the physics of the true universe.  By 
  casting spells, characters visualize the unimaginable, 
  warping their minds to follow alien ways of thought.  
  These visualizations wound the mind.  Although 
  spellcasters expose themselves to such traumas vol-
  untarily, they are shocks all the same. 
   
  In this variant, casting a spell drains a certain 
  amount of Sanity.  This rule represent the fact that 
  spellcasting forces the mind into strange patterns 
  and thought processes with which it is poorly 
  equipped to deal.  The Game Master can choose 
  from the three options presented in the table below, 
  14 
  GAME ENHANCEMENT | Insanity 
  Table 1-7: Sanity Loss From Creatures 
  Monster Type 
  Up to 
  Tiny 
  Small Medium Large Huge 
  Gargan-
  tuan 
  Colossal 
  Aberration, dragon, ooze, outsider,  
  undead 
  1/1d4 
  1/1d4 
  1/1d6 
  1/1d10 1d4/1d1
  0 
  1d6/1d10 
  1d6/2d10 
  Elemental, fey, plant, vermin 
  0/1d4 
  1/1d4 
  1/1d6 
  1/1d8 
  1/1d10 
  1d4/1d10 
  1d4/2d6 
  Construct, giant, magical beast,  
  monstrous humanoid  
  0/1 
  0/1d4 
  0/1d6 
  1/1d6 
  2/2d6 
  2/2d6 
  3/3d6 
  Animal, humanoid 
  0/0¹  
  0/1¹  
  0/1¹  
  0/1d4¹  0/1d4 
  0/1d4 
  0/1d6 
  
  Restoring Sanity with Magic 
  The Sanity mechanic was originally created to mimic the 
  effect of unspeakable horrors would have on normal 
  folk from a world much like our own.  Since d20 fantasy 
  characters live in a world of magic and monsters, how-
  ever, the Game Master might want to make them less 
  susceptible to Sanity loss caused by encountering 
  strange creatures (see Table 1-7: Sanity Loss From 
  Creatures) by allowing them to have a measure of San-
  ity resistance, which is tied to one of two attributes. 
   
  Each character can be allowed to have Sanity re-
  sistance equal to his character level.  Alternatively, each 
  character can be allowed to have Sanity resistance equal 
  to his Wisdom modifier.  (Obviously, the second alter-
  native will produce lower Sanity resistance figures in 
  most cases.)  This number is the amount of Sanity loss a 
  character can ignore when he encounters a creature 
  that requires a Sanity check. 
   
  The Game Master may decide that Sanity resis-
  tance also applies to certain kinds of severe shocks 
  (although it might not apply to personally horrific ex-
  periences, such as seeing a close friend die) and to the 
  casting or learning of spells. 
  deducting a low, moderate, or extreme number of 
  Sanity points from a character who casts a spell.  In a 
  campaign featuring low Sanity loss, a spellcaster is 
  rarely penalized for casting a spell, especially if the 
  Game Master also chooses to give characters Sanity 
  resistance (see the sidebar) in such cases.  In a cam-
  paign featuring moderate Sanity loss, spellcasters 
  face a slightly higher risk of insanity than members 
  of the other classes, even if they have Sanity resis-
  tance.  When using this option, players should, for 
  the most part, choose spellcasting levels only as mul-
  ticlass options.  In a campaign featuring extreme 
  Sanity loss, spellcasters have a difficult time partici-
  pating in adventures regularly because they find it 
  hard to use their classes’ primary abilities without 
  soon going insane.  
   
  In addition to the guidelines presented for each 
  campaign option above, the Game Master is free to 
  impose additional modifiers on the Sanity loss 
  caused by spells of a certain type, a certain school, or 
  even individual spells.  Here are some example con-
  ditions that a Game Master could choose to incorpo-
  rate into a game. 
   
  •Abjurations cost 1 less Sanity point to cast. 
   
  •Divine spells cost 5 additional Sanity points to 
   
  cast. 
   
  •Druids suffers only half the Sanity loss from 
   
  spellcasting (round fractions up). 
   
  •Healing spells drain no Sanity when cast. 
   
  •The invisibility spell, and any variation 
   
  thereof, costs 1 additional Sanity point to cast. 
   
  •Necromancy spells costs 2 additional Sanity 
   
  points to cast. 
   
  •Spellcasters of some classes follow the same 
   
  guidelines of one campaign option, while spell
   
  casters of other classes follow the guidelines of 
   
  another campaign option. 
   
  Learning Spells 
  Learning spells, like casting them, exposes a charac-
  ter to unknowable secrets and can damage and warp 
  the mind.  In this variant, whenever a spellcaster 
  learns a new spell, he loses Sanity points.  In most 
  cases, the Sanity loss is equal to the spell’s level, but 
  if the spell is included in a tome of forbidden knowl-
  edge (see later), the loss can be greater. 
   
  The rules for Sanity loss for learning spells 
  work fine for wizards, sorcerers, and other arcane 
  spellcasting classes that learn spells one at a time or 
  in small groups, but this loss can easily overwhelm a 
  cleric, druid, or other divine spellcaster who gains a 
  new spellcasting level (thereby “learning” an entire 
  level’s worth of new spells all at once).  In such a 
  case, the player and the Game Master should work 
  together to determine a specific number of spells 
  learned once access to a new spellcasting level is 
  gained.  When in doubt about how many spells to 
  allow a spellcaster to learn at any given level, the 
  spell acquisition rate of the wizard class serves as a 
  good baseline. 
   
  Game Masters wanting to add Sanity rules to a 
  magic-rich campaign, or those wishing to preserve 
  15 
  GAME ENHANCEMENT | Insanity 
  SANITY AND SPELLS 
  Table 1-8: Sanity Loss From Spellcasting 
  Spell 
  Level 
  Low 
  Sanity Loss 
  Moderate 
  Sanity Loss 
  Extreme 
  Sanity Loss 
  1st 
  1 
  2 
  1d6 
  2nd 
  2 
  4 
  2d6 
  3rd 
  3 
  6 
  3d6 
  4th 
  4 
  8 
  4d6 
  5th 
  5 
  10 
  5d6 
  6th 
  6 
  12 
  6d6 
  7th 
  7 
  14 
  7d6 
  8th 
  8 
  16 
  8d6 
  9th 
  9 
  18 
  9d6 
  Epic 
  10 
  20 
  10d6 
  
  more of the flavor of a normal fantasy game, can al-
  low any spellcaster to learn a small number of spells 
  at each level without losing any Sanity. 
   
  Sanity-Affecting Magic 
  The following types of magic 
  and specific spells have differ-
  ent or additional effects when 
  the Sanity variant is in use.  For 
  the effects of healing spells and 
  magical means of recovering 
  Sanity, see Restoring Sanity 
  with Magic, presented earlier. 
   
  Fear Effects: 
  Whenever a 
  spell, creature, or other factor produces a fear effect 
  that causes its target to become shaken, frightened, 
  or panicked, replace the saving throw to avoid the 
  effect (if applicable) with a Sanity check.  On a failed 
  check (and sometimes even on a successful one), the 
  subject loses a number of Sanity points rather than 
  experiencing the normal effect of the magic.  The 
  table below provides a summary of the Sanity loss 
  associated with each spell that has the fear descrip-
  tor: 
  In this variant, remove fear does not automatically 
  suppress an existing fear effect on its subjects, but if 
  it is cast on a creature that lost Sanity because of a 
  fear effect within the last 24 hours, that Sanity loss is 
  halved (to a minimum of 1 point) and the creature’s 
  current Sanity is adjusted accordingly. 
   
   Illusions: Illusions, when that are believed, 
  cause Sanity loss just as if the real horrific monster or 
  event were present.  The Game Master can reduce 
  the Sanity loss caused by illusions (or elimi-
  nate it entirely) if such spells 
  appear frequently in the cam-
  paign. 
   
  Bestow Curse: When using 
  Sanity rules, this spell can cause 
  a Sanity check rather that a Will 
  save.  If the victim fails the San-
  ity check, she loses 3d6 points 
  of Sanity.  Unlike normal Sanity 
  loss, this number is also subtracted 
  from the character’s maximum 
  Sanity.  Magic that removes the curse can restore the 
  character’s normal maximum Sanity, but separate 
  magic or the use of the Heal skill is required to re-
  store the character’s current Sanity. 
   
  Contact Other Plane: When using Sanity rules, 
  characters casting this spell risk loss of Sanity instead 
  Plane 
  Sanity Loss  
  Elemental Plane 
  1 
  Positive/Negative Energy Plane 
  1 
  Astral Plane 
  2 
  Outer Plane (demigod) 
  1d6 
  Outer Plane (lesser deity) 
  2d6 
  Outer Plane (intermediate deity) 
  3d6 
  Outer Plane (greater deity) 
  4d6 
  Table 1-10: Sanity Loss From Contact Other Plane 
  Forbidden Knowledge 
  The Sanity rules assume that some knowledge is so 
  alien to human understanding that simply learning of its 
  existence can shatter the psyche.  While magic and 
  nonhuman races form an everyday part of a adven-
  turer’s life, even a seasoned character cannot conquer 
  or understand some things.  Knowledge of these se-
  crets and creatures is represented by a new skill that 
  goes hand in hand with a character’s Sanity score: 
  Knowledge (forbidden lore). 
   
  This type of knowledge permanently erodes a 
  character’s ability to maintain a stable and sane outlook, 
  and a character’s current Sanity can never be higher 
  than 99 minus the modifier that character has in the 
  Knowledge (forbidden lore) skill.  This number (99 mi-
  nus  Knowledge [forbidden lore] ranks) is the charac-
  ter’s maximum Sanity.  
  16 
  GAME ENHANCEMENT | Insanity 
  Table 1-9: Sanity Loss From Fear Descriptors 
  Spell 
   
  Sanity Loss on 
  Failed Check 
  Sanity Loss on 
  Successful Check 
  Bane1 
  — 
  — 
  Cause Fear 
  1d6 
  1 
  Doom 
  1d6 
  — 
  Fear 
  2d6 
  1 
  Phantasmal Killer2 
  — 
  — 
  Scare 
  1d6 
  1 
  Symbol of Fear 
  2d6 
  — 
  Weird2 
  — 
  — 
  1 Bane works normally because its effect is less severe than that of the 
  shaken condition. 
  2 Phantasmal Killer and weird work normally because those spells so 
  not produce shaken, frightened, or panicked effect (the GM could rule 
  that a Sanity check takes the place of the Fortitude save to avoid 
  dying from fear; in such a case, failing the check results in permanent 
  insanity).      
  Gustave Dore 
  
  of Intelligence and Charisma.  Whenever a character 
  casts this spell, she must make a Sanity check.  If the 
  check fails, the character loses Sanity depending on 
  the plane that the character was trying to contact, 
  according to the table below.  Unlike the Intelli-
  gence and Charisma reduction caused by the normal 
  version of the spell, the Sanity loss does not go away 
  after a week—the loss is permanent until restored by 
  another spell or through the use of the Heal skill. 
   
  Commune: When using the Sanity rules, re-
  place this spell’s XP cost with a Sanity check 
  (1d6/3d6), made as a free action immediately after 
  the spell’s duration expires. 
   
  Insanity: Instead of experiencing this spell’s 
  normal effect, characters who fail the saving throw to 
  resist the spell become permanently insane as de-
  scribed in this variant (but suffer no Sanity loss). 
   
  Moment of Prescience: In addtion to the spell’s 
  normal benefits, a character with an active moment 
  of prescience effect can make one Sanity check as if 
  her current Sanity equaled her maximum Sanity.  
  The character need not use the effect on the first 
  Sanity check she is required to make, but must 
  choose whether or not to use this benefit before 
  making any Sanity check during the spell’s duration. 
   
  Status: In addition to the spell’s normal effect, 
  the caster can sense whenever the subject suffers 
  Sanity loss, temporary insanity, indefinite insanity, 
  or permanent insanity during the spell’s duration. 
   
  Summon Monster: If a character summons a 
  monster that causes Sanity loss by means of a sum-
  mon monster, summon nature’s ally, planar binding, 
  or planar ally spell, she suffers the usual Sanity loss 
  for casting the spell and must also make a Sanity 
  check because of the monster’s presence. 
   
  Symbol of Insanity: Instead of experiencing 
  this spell’s normal effect, characters who fail the sav-
  ing throw to resist the symbol become permanently 
  insane as described in this variant (but suffer no San-
  ity loss).  
   
  FORBIDDEN TOMES 
  Obscure tomes add ranks to a character’s Knowledge 
  (forbidden lore) skill and teach arcane spells.  Study-
  ing and comprehending these books causes all that 
  we know to become like shadows.  The burning 
  power of a greater reality seizes the soul.  Whenever 
  KNOWLEDGE (FORBIDDEN LORE) (NONE) 
  You know That Which Should Not Be Known.  You 
  have had horrible supernatural experiences and read 
  forbidden tomes, learning truly dark secrets that have 
  challenged everything you thought you knew.  Since 
  these revelations defy logic or commonly accepted fact, 
  it does not matter how intelligent or wise you are when 
  using this skill—only how much exposure to these dark 
  secrets themselves you have experienced. 
   
  Check: Answering a question about the horrible 
  deities and secrets that lurk at the edges of reality has a 
  DC of 10 (for really easy questions), 15 (for elementary 
  questions), or 20 to 30 (for difficult or really tough 
  questions).  Unlike in other fields of study, there are 
  almost no really easy questions associated with this 
  dark knowledge. 
   
  You can use this skill to identify monsters and 
  their special powers or vulnerabilities.  In general, the 
  DC of such a check equals 10 + the monster’s HD.  A 
  successful check allows you to remember a bit of useful 
  information about that monster.  For every 5 points by 
  which your check result exceeds the DC, the Game 
  Master can give another piece of useful information. 
   
  The Game Master can decide which monsters are 
  subject to the Knowledge (forbidden lore) skill and 
  which monsters are subject to one of the Knowledge 
  skills described in the Pathfinder Roleplaying Game.   
   
  Action: Usually none.  In most cases, making a 
  Knowledge check doesn’t take an action—you simply 
  know the answer or you don’t. 
   
  Try Again: No.  The check represents what you 
  know, and thinking about a topic a second time doesn’t 
  let you know something that you never learned in the 
  first place. 
   
  Special: You cannot gain ranks in this skill by 
  spending skill points.  You can only gain ranks by read-
  ing forbidden tomes or having experiences with horri-
  ble creatures.  Each rank you gain in this skill perma-
  nently reduces your maximum Sanity by 1 point: the 
  more you know about the horrible truths underlying 
  reality, the less capable you are of leading a normal life. 
   
  A character’s first episode of insanity (that is, an 
  occurrence of temporary or indefinite insanity) bestows 
  2 ranks in the Knowledge (forbidden lore) skill, thereby 
  lowering his maximum Sanity by 2 points.  Each time a 
  character fails a Sanity check and endures another epi-
  sode of insanity, he gains an additional rank in Knowl-
  edge (forbidden lore). 
   
  You cannot take the Knowledge (forbidden lore) 
  skill during character creation.  However, the skill has 
  no maximum rank; your level does not limit the number 
  of ranks in Knowledge (forbidden lore) that you can 
  acquire. 
  17 
  GAME ENHANCEMENT | Insanity 
  FORDBIDDEN TOMES 
  
  we try to retreat from the experience or hunger 
  greedily for more, it destroys our confidence in what 
  we once believed, opening us up to the all-
  encompassing truths of dark deities. 
   
   
   
  For each such book encountered, the Game 
  Master must set the examination period, the Knowl-
  edge (arcana) DC to understand it, the number of 
  spells contained in it, the Sanity loss that occurs 
  upon beginning the examination, the Sanity loss that 
  occurs upon completion of the examination, and the 
  ranks of Knowledge (forbidden lore) gained from 
  studying the book.  While the Game master is free to 
  set these parameters at any values that he feels are 
  appropriate, Table 1-11: Example Forbidden Tomes 
  provides some suggested combinations of each of 
  these parchments.   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
  Table 1-11: Example Forbidden Tomes 
   
  Examination 
  Period 
  Knowledge 
  (arcana) DC to  
  Understand Tome 
  Number of 
  Spells Contained 
  in Tome 
   
  Initial Sanity 
  Loss 
   
  Sanity Loss upon 
  Completion 
  Knowledge 
  (forbidden lore) 
  ranks gained 
  1 week 
  20 
  0 
  1 
  1d4 
  1 
  1 week 
  20 
  1 
  1d4 
  1d4 
  1 
  1 week 
  25 
  2 
  1d4 
  2d6 
  1 
  2 weeks 
  25 
  1d4 
  1d6 
  2d6 
  2 
  2 weeks 
  25 
  1d6 
  1d10 
  2d6 
  2 
  2 weeks 
  25 
  3 
  1d6 
  2d6 
  2 
  2 weeks 
  30 
  1d6+1 
  1d6 
  2d6 
  3 
  3 weeks 
  20 
  1d4+1 
  1d10 
  2d6 
  2 
  3 weeks 
  25 
  1d6 
  1d6 
  2d10 
  2 
  3 weeks 
  30 
  1d4+5 
  1d10 
  3d6 
  3 
  18 
  GAME ENHANCEMENT | Insanity 
  
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  System Reference Document. Copyright 2000, Wizards of the Coast, Inc.; Authors Jonathan Tweet, Monte Cook, Skip Williams, based on material by E. 
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  Insanity: A Game Enhancement Copyright 2005, 2009 Alea Publishing Group. 
   
   
   
  19 
  GAME ENHANCEMENT | Insanity 
  
  The Open Game Content 
   
  Insanity: A Game Enhancement ™ is done under version 1.0 of the Open Game License and the draft version of 
  the d20 System Trademark Guide and System Reference Document by permission of Wizards of the Coast. APG’s 
  intention is to open up as much of this game enhancement as much as possible to be used as Open Game Content 
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  However, publishers who wish to use the OGC materials from this game enhancement are encouraged to contact 
  either cguill@aleapublishing.com or jraynack@aleapublishing.com if they have any questions or concerns about 
  reproducing material from this game enhancement Insanity: A Game Enhancement in other OGL works. APG 
  would appreciate anyone using OGC material from Honor and Corruption in other OGL works to kindly reference 
  Insanity: A Game Enhancement as the source of that material within the text of their work and if so used, must bear 
  the COPYRIGHT NOTICE: “Insanity: A Game Enhancement  Copyright 2005, 2009, Alea Publishing Group.” 
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  GAME ENHANCEMENT | Insanity 
  
SOURCE: textdata/thevault/Pathfinder/1st Edition/3rd Party/Alea Publishing - Insanity Rules.pdf