Sanity: Each creature has a sanity score, along with a sanity edge and a sanity threshold. These values depend on the creature’s current ability scores and ability damage. Increases and penalties to ability scores (even temporary increases and penalties) adjust these numbers. Each discrete instance in which a creature takes 1 or more points of sanity damage is called a sanity attack, regardless of what caused the sanity damage.
Since effects that deal sanity damage are always mind-affecting effects, mindless creatures are immune and do not have a sanity score, sanity edge, or sanity threshold.
Sanity Score: Your sanity score is equal to the sum of your mental ability scores (Charisma, Intelligence, and Wisdom) minus any ability damage taken to those ability scores.
Sanity Threshold: Your sanity threshold is equal to the bonus of your highest mental ability score minus any ability damage to that score (minimum 0). When you experience a sanity attack, if the sanity damage from that attack equals or exceeds your sanity threshold, you gain a madness, either lesser or greater depending on the relation of your current sanity damage and your sanity edge (see below).
If your sanity threshold is 0, you always suffer a madness upon taking 1 or more points of sanity damage.
Sanity Edge: Your sanity edge is equal to 1/2 your sanity score. When you experience a sanity attack that causes you to gain a madness (see Sanity Threshold), compare your total amount of sanity damage to your edge to determine the potency of the madness. If your current sanity damage is less than your sanity edge, then you manifest a lesser madness.
If your current sanity damage is equal to or greater than your sanity edge, you manifest a greater madness instead.
Furthermore, when you accrue total sanity damage equal to or greater than your edge, any dormant lesser madnesses you have manifest again.
Effects of Sanity Damage
When you experience a potential sanity attack, you must typically succeed at a Will saving throw to shake off or reduce the sanity attack’s damage.
Whether this saving throw is successful or not, if the sanity damage from a single sanity attack is equal to or greater than your sanity threshold, you gain a madness with a potency based on the relation between your total sanity damage accrued and your sanity edge (lesser if the total sanity damage is below your sanity edge, greater otherwise). In most cases, GMs should choose a madness that reflects the horror faced or your deep fears and potential mental breaking points rather than rolling on tables. For instance, if you gain a lesser madness due to an encounter with a mummy or some other undead that features a fear effect, it might make sense to choose the phobia madness. If you already suffer from delirium and gain a greater madness, it might make sense for that madness to be increased to schizophrenia. However, when a random madness is appropriate, the GM can generate one by rolling on a table for lesser or greater madness.
You are afflicted with a madness until that madness is removed. You may not always manifest the madness, though. If you are afflicted with madness and then are healed of all sanity damage, all of your madnesses become dormant until you accrue further sanity damage. Typically, a dormant madness does not affect you at all, but some madnesses feature an effect that occurs only while that madness is dormant. A lesser madness that becomes dormant does not manifest again until you take sanity damage equal to or greater than your sanity edge. A greater madness stays dormant only as long as your total sanity damage remains at 0. Dormant madnesses, no matter the potency, can be removed only by miracle or wish.
Lastly, if your total sanity damage equals or exceeds your sanity score, you become insane as per insanity (no saving throw) until all your sanity damage is healed and all your madnesses are cured.
Reducing Sanity Damage
Sanity damage can be reduced in a number of ways. The first is with time and rest. For every 7 full days of uninterrupted rest, you can reduce the sanity damage you have taken by amount of equal to your Charisma modifier (minimum 1). Instead of relying on your own strength of personality to reduce the effects of sanity damage, you can seek out a single confidante, mentor, priest, or other advisor. You must meet with that person regularly (at least 8 hours per day) and gain guidance during the 7 days of rest. At the end of the rest period, the ally can attempt a Wisdom or Intelligence check (whichever score is higher) with a DC of 15 if your sanity damage is below your sanity edge or 20 otherwise. If the ally succeeds at this check, you can add the ally’s Wisdom or Intelligence modifier (whichever is higher) to the amount of sanity damage you remove.
Sanity damage can also be reduced with magic. A single casting of lesser restoration reduces sanity damage by 1d2 points up to once per day; restoration reduces sanity damage by 2d4 points up to once per day; and heal reduces the amount of sanity damage by 3d4 points up to once per day.
Greater restoration, psychic surgery, and limited wish reduce your total sanity damage to 0 if your total sanity damage was already below your sanity edge; otherwise, these spells reduce your total sanity damage to 1 point below your sanity edge. Miracle and wish instantly reduce your sanity damage to 0, regardless of whether your total sanity damage was below your sanity edge.
Madness
Fractures, cuts, and abrasions wound the body, but madness undermines the mind, spirit, and personality. Suffering from madness can be terrifying, causing those afflicted to act contrary to their desires or reason.
Madnesses are afflictions, similar in structure to poisons, diseases, and curses. They are used as part of the sanity system as an outcome of severe assaults on a character’s sanity, but GMs can use madness in other cases as well. Because madnesses are presented as afflictions, they can be used with the sanity and madness systems.
If you’re using the rules for sanity and madness, when those rules call for a character to gain an insanity, roll d%. The character gains a lesser madness on a roll of 1–70%, and a greater madness on a 71–100%. Once the potency of the madness is determined, roll on the appropriate table (Table: Lesser Madness and Table: Greater Madness) to determine the kind of madness the character gains, or select an appropriate madness that fits the situation.
The madnesses in this section are works of fantasy. None are statements about or descriptions of existing maladies.
Curing Madness
Each madness has a DC representing its strength. Among other things, that DC specifies the saving throw the afflicted character must succeed at to recover from the madness.
Recovering from a madness without magical aid is a lengthy process requiring significant rest. After 7 consecutive days of uninterrupted rest, the afflicted character can attempt a Will save against the madness’s current DC. If she succeeds, the DC is reduced by a number of points equal to 1/2 the character’s Charisma modifier (minimum 1). Instead of relying on her own strength of personality to reduce the effects of madness, a character can also seek out a single confidante, priest, or other advisor. The recovering character must meet with that person regularly (at least 8 hours each day) and gain guidance during the 7 days of rest. At the end of the rest period, the ally can attempt a Wisdom or Intelligence check (whichever is higher) with a DC of 15 for a lesser madness or a DC of 20 for a greater madness. On a success, the recovering character can reduce the madness’s DC by 1/2 the ally’s Wisdom or Intelligence modifier (whichever is higher, minimum 1) in addition to the decrease for resting. The character suffers the madness’s effect until the DC is reduced to 0.
Certain spells can also aid in recovery from madnesses or cure them outright. Lesser restoration has no effect on greater madnesses, but reduces the current DC of one lesser madness afflicting the target by 2, up to once per day. Restoration and heal reduce the current DC of one lesser madness afflicting the target by 5 or of one greater madness afflicting the target by 2, up to once per day each. Greater restoration, limited wish, and psychic surgery all either cure the target of all lesser madnesses or reduce the DC of one greater madness by the spell’s caster level (caster’s choice), while miracle or wish immediately cure a target of all lesser and greater madnesses.