Adventurers are made of stern stuff and can handle most common dangers. But the minds of mortal beings are fragile. As adventurers encounter real monsters, witness horrible acts, or master forbidden knowledge, their mental resolve is tested, and their ability to function deteriorates. Of all the horrors that adventurers must face, the gradual decline into insanity is the worst. Most veteran adventurers survive only to live out the rest of their days in the cold confines of a sanitarium; and those that do manage to hold on to their resolve have to spend the rest of their lives tormented by horrific nightmares.
(Picture credits go to Warner Bros. and Peregrine Productions)

Incorporating Sanity

• Sanity Attack: Sanity works as an attack against the characters mental resolve. The more horrific the event, the stronger the attack. The strength of sanity attacks increase with character level. The strength of a sanity attack will be judged by the DM. Not all sanity loss comes from Sanity Attacks, some knowledge can hurt your sanity for a set amount of Sanity Points.
• Will Defense: Your will defense determines the strength of your mental resolve. It acts as a “sanity defense.”
• Sanity Points: Sanity Points determine a characters mental stability and resilience. A characters starting sanity points are equal to his or her Healing Surges + Wisdom mod. (Example: If you are a paladin with 10 healing surges per day, and you had a wisdom mod of 12, then you would have 11 sanity points. The + Con mod does not count.)
• Going Insane: When a characters sanity points reach 0 or if a character looses more then 5 sanity points by the end of the game session then they gain a derangement which acts as a disease that gets worse over time. When a characters Sanity reaches the negative half mark of their total sanity points, they become permanently insane. (Example: if a character has a total of 6 sanity points, then -3 would be their negative half mark.)
• Recovering Sanity: Characters may recover sanity points in a verity of ways, receiving therapy, reward for advancing the plot, or defeating horrifying foes. See Sanity Recovery Table.
• Recovering From Derangements: Derangements work like a disease, they get worse over time and a character must role insight checks to determine if the derangements stage changes or stays the same after a certain amount of days. Characters in the party can use their social skills (diplomacy, insight ect…) To help improve the characters condition after the amount of days specified by the derangement.
• Getting Use to Awfulness: Characters naturally get use to horrendous sights quickly, so if they repeatedly encounter the same monsters or mutilated bodies through out a day then the GM should not impose continues sanity attacks.

NOTE: Why healing surges? I use healing surges because, 1. its convenient, and 2. because it they already correlate with some understandable assumptions. Wizards and Warlocks and other caster classes are well versed on all sorts of esoteric and forbidden lore so it makes sense for them to already be slightly mentally unstable, thus they have fewer sanity points, but in turn they have a high will defense, making them better able to withstand the horrors they face. Fighters and other more physical classes have high amounts of sanity points but their minds are more fragile do to their lower will defenses. Divine classes probably have the best sanity, as many of them have high Wisdom and Will defenses. This is due to their strong religious beliefs which provide them comfort in the face of horror. Rogues, Rangers and other classes that both have average will and low healing surges are a mystery to me, I am stumped on how to balance them out with the other classes. Any advice would be greatly appreciated within this regard.

(Example: If a level 1 character saw the grizzly murder of a family member then the experience would be severe. The GM/DM would roll a 1d20 +8 vs that characters will defense. If it beats the characters will defense then they lose 2 points of sanity)

Shock (Near Death Experience)

A brush with death can leave the most prideful individuals humbled. When a character reaches 0 hp and are revived. They suffer 1 point of sanity loss and take a -2 penalty to all skill checks for 1d20 hours.

• Near Death Experience: -1 SP, and -2 penalty to all skill checks for 1d20 hours.

Knowledge (Forbidden Lore and Rituals)

Some knowledge is so alien to mortal understanding that simply learning of its existence can shatter the psyche. While magic and nonhuman races form an everyday part of life, even a seasoned adventurer cannot conquer or understand some things. This type of knowledge permanently erodes ones ability to maintain a stable and sane outlook on life.

• Mastering an Alien Ritual: -1 SP

• Reading a Forbidden Tome: After a 1 week examination period, -1d4 SP upon completion. Requires a DC20 arcana check to comprehend the tome. (Change to DC30 in paragon tier and DC40 in epic tier)

Awfulness (Terrifying sights and severe shocks)

A shocking sight of a more mundane nature can also test the resolve of an adventurer. Severe shocks include witnessing an untimely or violent death, or seeing the site of an unusually gruesome murder. In time one can get use to such sights, but even then the individual must live on with the memories of having seen such things. (NOTE: What constitutes as a sight that can cause sanity loss is largely up to the DM to decide. The following are a few examples!)

Examples

• Surprised to find mangled animal carcass: Sanity Attack, -1 SP
• Surprised to find human corpse: Sanity Attack, -1 SP
• Surprised to find human body part: Sanity Attack, -1 SP
• Finding a stream flowing with blood: Sanity Attack, -1 SP
• Finding a mangled human corpse: Sanity Attack, -1 SP
• Witnessing an unusual paranormal/extra planar phenomenon: Sanity Attack, -1 SP
• Receiving a powerful mental attack from a terrifying creature: Sanity Attack, -1 SP
• Witnessing a friend’s violent death: Sanity Attack, -2 SP
• Meeting someone you know to be dead: Sanity Attack, -2 SP
• Undergoing severe torture: Sanity Attack, -3 SP
• Seeing a corpse rise from its grave: Sanity Attack, -1 SP
• Seeing an evil deity or an extremely powerful entity: -3 SP

Facing the Unimaginable (Monsters)

When people perceive creatures and entities of unspeakable horror, this experience costs them some portion of their minds, since such creatures are intrinsically discomforting and repellent. This instinctive reaction is part and parcel of humans, elves, dwarves, and other humanoid races. Only creatures of truly bazaar or terrifying nature cause sanity loss.

• Creature: (Tiny) Sanity Attack, -1 SP
• Creature: (Medium) Sanity Attack, -1 SP
• Creature: (Large) Sanity Attack, -2 SP
• Creature: (Huge) Sanity Attack, -2 SP
• Creature: (Gargantuan) Sanity Attack, -3 SP

Recovering Sanity

One should never underestimate the strength and adaptability of the mortal mind. With firm beliefs and a balanced life, adventurers can maintain good mental health between and during their exploits. It is usually those that push them selves over the edge that face losing it in the face of horror.

• Killing a terrifying Huge, or Gargantuan monster: Regain 1 SP
• Foiling an Evil Plot: Regain 2 SP
• Character/Story Awards: Regain 1 SP
• Character development: Regain 1 SP

Derangements

The study of mental disorders and aberrant behavior is a fairly new pseudoscience with very few known experts in the field. Treatment methods for disorders are often highly experimental and cruel, making most sanitariums a little worse then prisons. Most psychological theories are primitive and many people still attribute disorders with possession by demons. The best that modern doctors have done is compile a list of disorders and observe the events and features associated with them.

Characters can role for derangements or the DM can choose for them if they deem a derangement to be appropriate for the situation. Derangements work like diseases, they have stages and can get worse over time.

Phobia (Anxiety)

Choose one object or creature to be the subject of the phobia. (usually the thing that caused the character to gain the derangement) The player character now must make a successful insight check to approach or interact with the object or creature, or flee in terror.

Stage 0: The character recovers from the derangement, but will eternally feel uneasy around the object or creature that provoked the derangement.

Stage 1: (Initial stage) Character must make a Moderate DC Insight check in order to approach or interact with the object or creature.

Stage 2: Character must make a Hard DC Insight check in order to approach or interact with the object or creature.

Stage 3: Character must make a Hard DC +2 Insight check in order to approach or interact with the object or creature.

Checks
At the end of every 7 days, the target makes an insight check.

• Lower than Moderate DC: The stage of the derangement increases by 1.
• Moderate DC: No change.
• Higher then Moderate DC: The stage of the disease decreases by 1.

• Paranoia (Dissociative)
• Obsessive Compulsive (Dissociative) (likely the most minor thing that can happen to you)
• Jitters
• Hallucinations
• Lethargy/Depression
• Somnolence (Abnormal drowsiness.)

Permanent Insanity

The careers of most adventurers end in death by the hands of pirates or by horrors within the dark halls of an ancient tomb, but those who survive there trials can never forget the things they have seen. All veteran adventurers react differently. Some turn into raving lunatics and have to spend the rest of their miserable lives going from one asylum to another; and some can only deal with there ailments by endlessly seeking forbidden knowledge. Either way a permanently insane adventurer can never retire to a normal life. Some of the most dangerous villains in the world are heroes that have gone insane.

A character whose sanity falls to the half negative mark of their total sanity points becomes permanently Insane, they fall into a gibbering heap of madness and can only be saved through powerful magics. But even if they are saved, they don’t return without severe mental damage. A character that has gone permanently insane is considered catatonic/dead.

Inspiration from “Variant D20 Rules, Sanity.” Www.d20.org. Jans Carton. Web. 09 Dec. 2010. http://www.d20srd.org/srd/variant/campaigns/sanity.htm