Sanity Check -- The Craziest Handbook Ever

[PlzBreakMyCampaign]

The Sanity Handbook

What is Sanity?
It's a variant that adds an extra value similar HP that helps you stave off madness.
If you have ever wanted characters to struggle with horror themes, this variant is for you.

Why hasn't this been done before?
It's an adaptation from Call of Cthulhu, so the variant is both meaty and not fully thought out with respect to 3.5.
This means it is not run as often as it should be and makes it the perfect target for a handbook explaining how to use it.

The Source Rules tl;dr Outline:

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• They stole the Call of Cthulhu rules
• An extra knowledge skill
• An extra d% save
• Two shades of crazy
• Forbidden Lore caps max sanity
• Sanity Resistance @meeting monsters = ECL
• Monster's cause sanity damage
• Environmental sanity damage
• Casting causes sanity damage
• Learning spells causes sanity damage
• Specific spell effects & Sanity
• Forbidden Tomes cause sanity damage
• Maximum sanity loss per unwilling thing per session
• Get knowledge while going crazy
• The temporary craziness charts
• Indefinite insanity charts
• You're an NPC at -10 sanity
• Leveling and story rewards
• Temporary insanity aiding
• Check to make drugs
• Using drugs which don't actually cure anything
• Recovering at home
• The list of roleplayable insanities
• A shrink's glossary

The Sanity System, Excluding Magic:

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• You now have an extra damage-able statistic for your mind called Sanity. It starts at 5 x Wisdom Score with a maximum of 99.
• You have an extra resistance for your current sanity total equal to your character level (or wisdom mod for DMs who like easy mode). It applies (usually), only to meeting unusual creature types/sizes. By ECL20, you've seen it all, and if you're still sane, meeting any size or type of non-unique creature won't cause sanity damage.
• When something scary happens, you make a d% saving throw that damages your sanity 0-2 as long as you roll equal to or below your sanity value. If you roll above, you take full sanity damage which is anywhere from 1-24 sanity damage (averaging 4 if all possibilities are encountered equally)
• "Scary" things are the following (although DMs will use their best judgement): seeing a scary monster [the bigger the more sanity damage] (0 - 3d6) or seeing grotesque things like crime scenes, etc (0 - 1d3) or reading [spell] tomes (1+2 - 9+10+18). Many still give damage upon making the save.
• Each unwilling sanity damage event can only cause its maximum sanity damage for that session. New sessions or willing events like casting count as a new instance that can again reach the indicated maximums.
• If you lose 50% of your wisdom score in one roll, you go temporarily insane. 4/5th of the time it only lasts d10+4 rounds and you respond by things ranging from talking too much to becoming helpless. Otherwise it lasts 1d10 x 10 hours and ranges from a phobia to being catatonic. Allies can take a full round action & Heal DC 15 to snap you out of it
• If you lose 20% of your current sanity all within just 1 hour, you don't just have an episode, you are moderately crazy for 1d6 months. This has no additional affect on your sanity score. You can go more crazy later, or gain back all of your sanity and still have the quirk. The affect is sometimes not obvious and the DM doesn't have to declare it right away. This gives time to see what the player wants to roleplay. It ranges from impotence to constant self-sabatoge to really evil things
• Either way, a character who has just gone crazy can make a DC15 wisdom check to gain direct knowledge from the DM like a clue as to the identity of a murderer at the scene, etc. There's no downside to requesting it.
• You never want to hit 0 sanity or you will bleed out start to go permanently insane at -10 sanity. If you go permanently insane you become an NPC in a very bad way. You need either sanity healing at this point, or a therapist (see below).
• Going temporarily or indefinitely insane gives you 1 Forbidden Knowledge rank or 2 if its the first time you've gone nuts. Each rank in Forbidden Lore lowers your maximum sanity score. Without the fixes below its basically a "mother may I" skill.
• Gaining a level gives 1d6 sanity if you can d% roll above your sanity (or not at all for hardcore DMs). Story rewards are encouraged too.
• You and your party will want a therapist (1 for up to 6 people) who does nothing but that. You gain 1 sanity point (up to current maximums) that day after 1d4 hours (only 1 hour if the 2nd to 6th patient) if the therapist can make a DC 20 heal check. A roll of 1 means losing 1 sanity point.
• The only way to become any type of skilled worker in D&D is to invest profession ranks. To maintain a practice in good standing, it seems reasonable to require a PC to not stop practicing that skill, ie they have to keep investing ranks in it to max. Initial ranks of 4 account for education, training, & experience. A party will want their Heal skill user to also dump ranks into Profession(Therapist) so she can make the a full round action Heal DC 15 to set sanity to 0 before a PC would hit -10.
• Drugs for some reason have the sanity gain that does not stack with therapy. The gain also only takes affect at the end of an entire month. They do suppress specific mental illnesses and can be created with minor creation if you can make the DC25 craft(alchemy) check. Otherwise they cost between 30 and 600gp for that month. Note that some of the durations are hard to tell.
• Private care/institutionalization allow a 95% chance per month to wait out your 1d6 months else you lose 1d6 sanity. Since this is loss rather than damage, sanity resistance doesn't apply. If can't get care and your indefinite insanity quirk prevents you from taking care of yourself, you have a 95% chance to live each month or succumb to disease.
• Finally the Aelfborn [DragMag307p68] appear to suffer an indefinite insanity effect rather than each inherent wis penalty at even levels.

The Sanity system & Magic:

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• Spell learned cause sanity loss equal to their level . Sanity resistance does not apply. The source explicitly recommends DMs to restrict classes that know all their spells so that they have limitations similar to a wizards' free level-up spells. Cunning readers will note that my 3.5 fixes already include such a thing...
• Casting spells deals L d6 to caster where L is the level of the spell. 2xL is for DMs on easy mode while just plain L allows certain offensive spells to be free (which feels very against the spirit of the variant)
• Certain spells types modify the the sanity damage as follows (in order): +5 divine, +2 necromancy, +1 invisibility variations, -1 for Abjuration, -50% druid spells (rounded up), -100% (healing)
• Some spells have additional sanity effects: (fear) effects have a sanity check rather than a save but supressing the fear halves (minimum 1) the sanity loss, illusions cause sanity loss as per the creature they represent if believed, bestow curse has a 3d6 maximum sanity reduction+damage option instead of a will save (remove curse only fixes the maximum), Contact Other Plane deals 1 - 4d6 sanity damage instead, Commune has a 3-36 (1-6 if successful) sanity check in lieu of an xp cost, Moment of Prescience can discharge to make the current sanity check as if at maximum sanity, Status allows viewing sanity loss or current maladies, and Symbol of Insanity can cause permanent lunacy without sanity loss. Lastly summons still cause sanity checks.
• Of the healing spells: Lesser Restoration heals 1d4 sanity, Restoration heals 1d6/2CL sanity (max 5d6), Heal saves you the temporary insanity Heal check and restores 10 sanity (see below), Atonement for any sanity damage that was a direct result of atoned actions from when you used to be evil, Greater Restoration heals all sanity damage if above 0, Limited Wish puts you at maximum sanity even after you've hit a -10 sanity score, Calm emotions overrides all behavioral changes during temporary or permanent (but not indefinite) insanity. If allowed in your campaign, wish or miracle can do whatever you want.
• Finally mind blank can't be allowed to simply trump the variant entirely. It's already a must-have. If you allow its affects as per RAW, you might as well not use the variant.

The Indefinite Insanities (Mental Disorders)

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Key:
5 stars: If you can pick this one, do it!
4 stars: It's not the best, but its still good.
3 stars: It's average.
2 stars: This is painful, but you could manage.
1 star: If you haven't built around this, prepare for a world of hurt. If you did, it's probably a 4 or 5 star 
0 star: This will kill you. You're not a PC anymore.

Anxieties:
(Generalized) Motor Tension = -2 hit, Fort, Refl, physical checks
(Generalized) Autonomic Hyperactivity = -2hit, saves, and checks
(Generalized) Expectations of Doom = -2morale hit, saves, and checks
(Generalized) Vigilance = -4morale Will saves and mental checks
Panic Attack = as the state of fear
Agoraphobia = DC15 Will save to go into an open area.
Obsessive-Compulsive Disorder = Either makes you unable to concentrate on anything else until taking a dangerous or hostile obsession or take a 1d10 round ritual to relieve the Compulsion
PTSD = uncontrolled flashbacks, assumably rendering the character unable to act. No duration listed, but probably as long as the trigger is present

Phobias and Manias exist for everything under the sun. Common phobias (spiders, heights, etc) are encouraged for non-mature roleplayers. Mature doesn't mean older. I've seen teenagers able to roleplay things like aerophobia convincingly. Common manias are auromania or manamania for the rogue or wizard, plantamania for the druid, phantasmamania for the spirit shaman, etc. Obviously these range from 5 star Purple gravy to 1 star pink awfulness.

Dissociative Amnesia = DC20 to recall the troubling information. Unfortunately it also can suppress ranks in Knowledge (forbidden lore) which is a great skill after our adjustments.
Dissociative Fugue = self imposed witness protection program.
Multiple Personality Disorder = separate (mental?) ability scores and assumably anything they could influence like skill ranks, levels, casting, etc. Interesting but a 'risky' due to the fact that the player should have no control over which personality rotates when. Assumably a DM would impose the worst one for each circumstance. You better build for versatility...

Anorexia Nervosa = d8/week con damage from not eating. Death without intervention. It would be ironic for an undead/construct character though.
Bulimia Nervosa = secret binges until discomfort or vomiting. If not giving the same result as the above, Deformity(Obese) would be expected. Again, if you build for it, it could work.

Impulse disorders = Compulsive gambling, pathological lying, kleptomania, and pyromania are pretty self explanatory. They basically make you unable to be around any non-hostile NPCs. You'd best steer clear of these, unless you've built your character around these to help mitigate them (ie pyromancer psion).
Intermittent Explosive Disorder = same as the above. Unless your character uses rage regularly, your DM will probably make you go into 'berserk kill mode' when you're meeting the king / trying to help your party.

Mood disorders: Depression or mania. Both are pretty bad. -4 hit, saves, and checks with a predisposition towards drugs and alcoholism.

Personality Disorders all give a -4cha and 1 attitude step toward hostile or 2 steps if fail a charisma check. Note: The rating makes all the below only 1 star. The coloring below assumes that you are a charisma-built character that ... doesn't use charisma checks. Think sorcerer.
    Antisocial = lying, recklessness, etc make it pretty bad.
    Avoidant is very doable.
    Borderline's impulsiveness is bad and the rage might also be bad.
    Compulsive only really has authoritarianism as a potential problem. Doable.
    Dependent requires a (party member) to look up to. Very doable for a cooperative party.
    Histrionic is really annoying and without significant RP, presumably leads to death.
    Narcissistic is tough but doable.
    Passive-Aggressive is crippling. Only play this if you are the kind of person who likes to see the DM twist that request from your ring of wishes
    Paranoid is okay.
    Schizoid is very doable.

Psychosexual disorders: pretty much off the table to all but the most understanding groups. They might think impotence or thinking they are not their own gender to be funny, when actually those are very serious mental problems damaging a very precious area of the psyche.
Psychospecie disorders: as the above, except rather than giving you a long, awful life, you get a fine one until it ends necessarily. You stop eating because you think you don't need to, or you murder because you think you need it to survive.

Schizophrenia = -50%skill mod on attentive skills. Rather crippling considering this includes spot and listen. The categories are flavor and aren't created equally.
    Undifferentiated means you play dumb.
    Disorganized is awful due to the hallucinations.
    Mutism / Catatonic is only okay if you are already taking a vow of silence or are playing a psionic sandwich.
    Paranoid is awful due to the hallucinations.
All the other kinds end up with you killing yourself or others. Unplayable.

Night Terrors / somnabulism = only get 2-3 hours and either awake in a panic or awake somewhere else. See elder evils for long term sleep deprivation.

Somatoform Disorders = the mystery disease causes the standard -2hit, saves, and checks, although it can "cause" worse symptoms like blindness.
(Reverse) Munchausenism = feigning illness in oneself or others (often requiring actually getting others sick). It's the standard -2hit, saves, and checks.
Hypochondriasis = requires a list of expected false self-diagnosis and assumably includes any real diseases the party might encounter. Otherwise rational responses to cure the diseases would be expected. Most fantasy cures aren't harmful (unlike real medicine), so this one might not be bad if you can generate a convincing list, ie. lycanthrope's belladonna, mummy rot's remove curse, etc.
Body dismorphia = requires covering up. This seems to present only a social penalty, although it seems to create a compulsion against the sufferer to show the "affected" parts.

Drug addition has the standard -2morale to hit saves and check but also has (assumably increasing) will saves to relapse/sanity loss if the drug isn't available. Drugs are bad mmmkay?

Miscellaneous:
Quixotism basically makes you unplayable unless you and the DM put limits on it (a trigger or a time of day, etc).
Panzaism is 'too easy' for a scientist academic; just pull all the stops for how obvious supernatural experiences in everyone else's life are physical phenomena that science hasn't "yet" explained. Your DM might not allow you to gain any morale bonii, which turns this blue.
Meglomania would be fun. It's somewhere between the previous two: crushingly irrational overconfidence requiring you to Leeroy Jenkins your party at every opportunity to a minor quirk that others ignore ("your tab is no good here").

Reverse-Engineering further use of the system:

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From the allip example: Any wisdom-draining effects from creatures of madness instead deal a dice level higher, doubled.

Automatic wisdom drain effects that offer no SR or AC (these are few and far between) instead give an indefinite insanity (see the above disorder). These effects are rare, like the Aelfborn or Far Look [DragMag330p27].

Effects that give saves but are assumed to eventually cause the insanity spell instead force up to half of the DC in automatic sanity damage, with 1d2 to 1d6 to 2d6 to 1d10 to 3d6 to 2d10+1 to d% sanity loss upon failing the sanity check (compare Table: Sanity Loss from Creatures & the Severe Shocks table). The Far Realm [MotP212] is the basis for this. Since its about as bad as seeing Orcus or something.

Effects that force saves to avoid wisdom damage (that only hurt the sane) instead force sanity checks or take sanity damage up to the DC. See DragMag330p23's Cerebrotic Marrow, a type of corruption that gives only gives wisdom damage to the Sane who sleep within the effects of a blot/connection to the Far Realms.

Sleep Deprivation is another wisdom-damaging insanity effect that should instead deal sanity damage. As per Elder Evils page 9:

A living creature can go without sleep for a number of days equal to its Constitution modifier (minimum one). Thereafter it is fatigued, remaining in this state for a number of days equal to its Constitution modifier (again, minimum one); if it would become fatigued during that time, it is exhausted instead. Each day after that period, the creature takes 1 point of Wisdom damage. If the total Wisdom damage exceeds its Hit Dice, the creature is affected as if by an insanity spell.

This is quite a brutal and quick effect compared to sanity damage's more subtle and linear one, but they both end up in the same place. If using this sanity variant, it should deal 1d6 sanity damage each day after the first rather than the wisdom damage that has a HD threshold only after being exhausted. The fatigue and exhaustion make sense and should stay. Bonus fluff points is that if the reason a character is being sleep deprived is a choice, rather than an unwilling effect, then it is excluded from the maximum sanity damage per session cap. See the maelphalent [FF120] creature for a reason a PC would chose to sleep deprive herself, even when knowing the threat of insanity.

My Thoughts on the System:

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• A hard-core caster nerf. "When using this option, players should, for the most part, choose spellcasting levels only as multiclass options." Wouldn't it be nice if the boards said, "You can't be the party wizard! That would be too weak!" Since balancing the old T1 classes requires spells known reductions (2 x int mod / level), the variant works as intended without instant lunacy upon becoming a cleric.
• Rules-flexible. Players that wish to roleplay are allowed to bypass the random tables and request certain potential mental disorders, which assumably the DM has okayed. Or the hardcore RAW players could eat whatever the d% gives them. Since rolls should be in the open, this could give a DM uncomfortable side-effects: "Most of these disorders could make players of the afflicted characters uncomfortable and thus are not appropriate for most roleplaying groups"
• A lower power, gritty variant. You aren't a billionaire superman. You're a drug-addicted psycho worried about becoming a vagrant. On the bright side, if you are not a batman wizard, normal methods to help your teammates become more useful. Further fragmentation of knowledge / the heal skill becomes useful too. Fragmenting Heal with Knowledge(therapy) is not recommended.
• Persistent Calm Emotions becomes a catch-all method to "save" a character who's become a lunatic NPC without blow XP or having using the best spell in the game. It's a difficult enough thing to build a character around that its not useful enough to be used to block temporary insanities; just have someone take a full round and a heal check to snap you out of it. But for casters worried about that 0 sanity mark its a great feat-sink and also allows saving allies via persistent, swapped effects. Note though that it does not remove indefinite insanities, so a character can still become heavily crippled even with calm emotions up and running.
• By the time you have an 11th level cleric (13th with my balanced casting progression fix), you never worry about sanity attrition again. Think about having 10 points of hp healing in a damage system where you can only have 99hp. This is however, a drain on the party cleric's resources, which helps prevent Tier 1 soloing everything while the fighter, rogue and ranger feel useless.
• By the time you have an 13th level cleric (16th with my balanced casting progression fix), you won't just be winning the fight against sanity damage, you'll just curb stomp it with greater restoration. Most DMs are okay with pretty much every artificial barrier being overcome in the last few non-epic levels. If you aren't, fair warning.

My Suggestions to Tweak the System:

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• We want to use the system. Places where it says "the GM may rule that ...", in a way that makes the variant less important will be ignored. If it makes the variant more important, however, we will be doing that. This is why mind blank shouldn't be used to nuke the subsystem.
• The learned spells text is a little vague. It might be asking "How many spells learned per level should be free?" If so, I suggest half the spells learned don't generate sanity (or up to 4 if not using my SAD caster fix).
• Greater Restoration and limited wish are powerful because they are costly, even when using my wish conglomeration fix.
• The phrase "aberrations and oozes should be able to be identified by Knowledge (forbidden lore) rather than by Knowledge (arcana) and Knowledge (dungeoneering) respectively" is wrong since both are identified by knowledge (dungeoneering). Instead it probably meant to say dragons rather than oozes. Speaking of using this skill, to make it useful, the creature types need to be shuffled around. Knowledges skills should break down like so

  Arcana: (theoretical magic, constructs, dragons, magical beasts)
  Architecture and engineering (constructions, constructs)
  Dungeoneering (dungeons, aberrations, oozes)
  Forbidden Knowledge (horrible secrets, dragons, aberrations + vermin, outsiders) which also reduces max sanity by 1
  Geography (social studies, plants)
  History (things in the past + humanoids, seasons and cycles)
  Local (anthropology, humanoids, animals + weather)
  Nature (seasons and cycles, weather, animals, fey, giants, monstrous humanoids, vermin)
  Nobility and royalty (heraldry, fey)
  Religion (satan converting catgirls, undead)
  The planes (its ___ outside, elementals)

  Yes this makes the Forbidden Knowledge subskill very important, but simultaneously easy and risky to max. We need to ignore the sidebar saying that there is no skill max ranks. It's a sidebar. Without a cap the skill gives NI infinite bonii which assures the skill can't be used for anything important. Since you can't assign ranks normally, we also allow intelligence to give a bonus to the skill, just as with any other knowledges. If maxed at ECL 20 with a bloodline it can have 26ranks.

Quick Refresher for Players

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• Atleast get 9to11base + 4to6enh + 5inh wis ASAP. Yes your factotum is now SAD.
• Keep your sanity damage low w/ 1hour therapy + Restoration from wands/NPCs every 5-30sanity damage.
• Try not to take (after ECL reduction) 10 / 14-19 sanity damage at once / in an hour unless you are the party encyclopedia and aren't max ranks in forbidden lore for your ECL. This is easy to do as a caster.
• If you do, hopefully you'll just faint-> shaken when woken rather than immediately murdering you allies for a minute or two / get to chose agoraphobia, dissociative fugue, hypochondriasis or panzaism

Quick Refresher for DMs

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• Assuming your players are okay with the pain that will come their way through sanity damage, make sure they are comfortable with you just assigning rolls into values on the fly based off fluff. Note that besides most DMs doing this anyway, the variant assumes such a mechanic is reasonable. Constant random rolls of any type can slow down play and are often not worth the time to do beforehand.
• Players should do most of the legwork for this variant, but you must assign 4/6/8/10ish sanity damage for each new normal/unusual/unnatural/otherworldly creature type they fight with a dice size up or down starting at large
• By the time your players are ECL6, they won't take automatic sanity damage from anything but idols or willing things like tomes/casting. Even then it will only be a bit from big, scary monsters. Feel free to throw lots of different types of monsters at them when they start to become resistant.
• "Extreme sanity loss from spellcasting" assures that even your casters will have problems managing their sanity unless they specifically build around the variant (self-nerfs are a win).
• If a character is sloppy about investing in combating their sanity damage, they may reach 0. They 'bleed out' sanity 1 damage a round unless they recieve sanity healing or a PC has invested in Profression(Therapist) & Heal skill ranks to make a DC15. Otherwise Limited wish is needed.

Discussion Thread