What Is Sanity?
Sanity is the natural mental state of ordinary life. Normal mental balance is endangered when characters confront horrors, entities, or activities that are shocking, unnatural, and bewildering. Such encounters cause a character to lose points from his Sanity score, which in turn risks temporary, indefinite, or permanent insanity. Mental stability and lost Sanity points can be restored, up to a point, but psychological scars may remain.

Insanity occurs if too many Sanity points are lost in too short a time. Insanity 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 experiences an emotional shock. The character’s Sanity may be regained after a few minutes, recovered after a few months, or lost forever.

A character may regain Sanity points, and even increase her Sanity point maximum. However, increasing a character’s ranks in the Knowledge (forbidden lore) skill always lowers her maximum Sanity by an equal amount.

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 d20 character’s life, even a seasoned adventurer cannot conquer or understand some things. Knowledge of these secrets 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 the character has in the Knowledge (forbidden lore) skill. This number (99 minus Knowledge [forbidden lore] ranks) is the character’s maximum Sanity.

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.

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 GM can give another piece of useful information.

Knowledge (the planes) is still the relevant skill for learning or knowing about outsiders, rather than allowing them to be iedntified by Knowledge (forbidden lore). Aberrations and oozes should be able to be identified by Knowledge (forbidden lore) rather than by Knowledge (arcana) and Knowledge (dungeoneering) respectively.

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.

You cannot gain ranks in this skill by spending skill points. You can only gain ranks by reading forbidden tomes or having experiences with horrible creatures. Each rank you gain in this skill permanently 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 episode of insanity, he gains an additional rank in Knowledge (forbidden lore).

For example, Caldark has 1 rank of Knowledge (forbidden lore) after reading a strange manuscript. She then steps outside, sees a chaos beast, and goes indefinitely insane, her raving mind failing to understand the strange creature she has encountered. Since she has never gone insane before, her player adds 2 ranks of Knowledge (forbidden lore) to Caldark’s character sheet. Now Caldark’s Maximum Sanity is 96 (99 minus 3 ranks of Knowledge [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.

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 numerous shocks and horrid revelations.

Sanity is measured in three ways: starting Sanity, current Sanity, and maximum Sanity. Starting and current Sanity cannot exceed maximum Sanity.

Starting Sanity
A character’s starting Sanity equals his Wisdom score multiplied by 5. This score represents a starting character’s current Sanity, as well as the upper limit of Sanity that can be restored by the Heal skill (see The Heal Skill and Mental Treatment, later in this section). After creation, a character’s current Sanity often fluctuates considerably and might never again match starting Sanity. A change in a character’s Wisdom score changes his starting Sanity in terms of what treatment with 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 (and sometimes much more often than) his hit points.

Making a Sanity Check
When a character encounters a mythos 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 succeeds (in this case, none); 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 automatic (no Sanity check is allowed); the character who chooses to undertake the activity forfeits the indicated number of Sanity points.

In most cases, a new Sanity-shaking confrontation requires a new Sanity check. However, the GM always gets to decide when characters make Sanity checks. Confronting several mythos creatures at one time or in rapid succession may call for just one Sanity check, while the same mythos creatures encountered singly over the course of several game hours may require separate checks.

Going Insane
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 Sanity 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 details.

A GM’s description of a Sanity-shaking situation should always justify the threat to a character’s well-being. Thus, a horde of frothing rats is horrifying, while a single ordinary rat usually is not (unless the character has an appropriate phobia, of course).

Maximum Sanity
Ranks in the Knowledge (forbidden lore) skill simulate a character’s comprehension of aspects of the dark creatures at the edges of reality. Once gained, this horrible knowledge is never forgotten, and the character consequently surrenders mental equilibrium. A character’s Sanity weakens as his comprehension of these hidden truths increases. Such is the way of the universe.

A character’s current Sanity can never be higher than 99 minus the character’s ranks in the Knowledge (forbidden lore) skill. This number (99 minus Knowledge [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 unimaginable, when suffering a severe shock, after casting a spell or when learning a new spell, when being affected by a certain type of magic or a particular spell, or when reading a forbidden tome.

Sanity Resistance
Each character can be allowed to have Sanity resistance equal to his character level. This number is the amount of Sanity loss a character can ignore when he encounters a creature that requires a Sanity check.

Sanity resistance also applies to certain kinds of severe shocks (although it might not apply to personally horrific experiences, such as seeing a close friend die) and to the casting or learning of mythos spells.

Insane Insight
A character who has just gone insane may have an insight into the situation or entity that provoked the insanity. The player needs to make a DC 15 Wisdom check to gain the insight. Information provided by this sudden burst of awareness is up to the GM, but it may include something about a creature’s origin or a fact about its nature (feeding habits, natural habitat, weakness), a clue to the identity of a murderer at a murder scene, or some hint at a location of great importance.

Types Of Insanity
Character insanity is induced by a swift succession of shocking experiences or ghastly revelations, events usually connected with dark gods, creatures from the Outer Planes, or powerful spellcasting.

Horrifying encounters can result in one of three states of mental unbalance: temporary, indefinite, and permanent insanity. The first two, temporary insanity and indefinite insanity, can be cured. The third, permanent insanity, results when a character’s Sanity points are reduced to -10 or lower. This condition cannot be cured.

Temporary Insanity
Whenever a character loses Sanity points equal to one-half her Wisdom score from a single episode of Sanity loss, she has experienced enough of a shock that the GM must ask for a Sanity check. If the check fails, the character realizes the full significance of what she saw or experienced and goes temporarily insane. If the check succeeds, the character does not go insane, but she may not clearly remember what she experienced (a trick the mind plays to protect itself).

Temporary insanity might last for a few minutes or a few days. Perhaps the character acquires a phobia or fetish befitting the situation, faints, becomes hysterical, or suffers nervous twitches, but she can still respond rationally enough to run away or hide from a 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 6-8: Duration of Temporary Insanity to see whether the insanity is short-term or long-term. After determining the duration of the insanity, roll d% and consult either Table 6-9 or 6-10 to identify the specific effect of the insanity. The GM must describe the effect so that the player can roleplay it accordingly.

Successful application of the Heal skill (see The Heal Skill and Mental Treatment, below) may alleviate or erase temporary insanity.

Temporary insanity ends either when the duration rolled on Table 6-8 has elapsed, or earlier if the GM considers it appropriate to do so.

After an episode of temporary insanity ends, traces or even profound evidence of the experience should remain. No reason exists why, for instance, a phobia should depart from someone’s mind as quickly as a warrior draws his sword. What remains behind after a brief episode of temporary insanity should exert a pervasive influence on the character. The character may still be a bit batty, but her conscious mind once again runs the show.

If the amount of Sanity lost exceeds the character’s current Wisdom score, consider the temporary insanity to always be of the long-term variety.

Table 6-8: Duration of Temporary Insanity

d%Temporary Insanity TypeDuration
01-80Short-term1d10+4 rounds
81-100Long-term1d10×10 hours

Table 6-9: Short-Term Temporary Insanity Effects

01-20Character faints (can be awakened by vigorous action taking 1 round; thereafter, character is shaken until duration expires).
21-30Character has a screaming fit.
31-40Character flees in panic.
41-50Character shows physical hysterics or emotional outburst (laughing, crying, and so on).
51-55Character babbles in incoherent rapid speech or in logorrhea (a torrent of coherent speech).
56-60Character gripped by intense phobia, perhaps rooting her to the spot.
61-65Character becomes homicidal, dealing harm to nearest person as efficiently as possible.
66-70Character has hallucinations or delusions (details at the discretion of the GM).
71-75Character gripped with echopraxia or echolalia (saying or doing whatever those nearby say or do).
76-80Character gripped with strange or deviant eating desire (dirt, slime, cannibalism, and so on).
81-90Character falls into a stupor (assumes fetal position, oblivious to events around her).
91-99Character becomes catatonic (can stand but has no will or interest; may be led or forced to simple actions but takes no independent action).
100Roll on Table 6-10: Long-Term Temporary Insanity Effects.

Table 6-10: Long-Term Temporary Insanity Effects

01-10Character performs compulsive rituals (washing hands constantly, praying, walking in a particular rhythm, never stepping on cracks, constantly checking to see if crossbow is loaded, and so on).
11-20Character has hallucinations or delusions (details at the discretion of the GM).
21-30Character becomes paranoid.
31-40Character gripped with severe phobia (refuses to approach object of phobia except on successful DC 20 Will save).
41-45Character has aberrant sexual desires (exhibitionism, nymphomania or satyriasis, teratophilia, necrophilia, and so on).
46-55Character develops an attachment to a “lucky charm” (embraces object, type of object, or person as a safety blanket) and cannot function without it.
56-65Character develops psychosomatic blindness, deafness, or the loss of the use of a limb or limbs.
66-75Character has uncontrollable tics or tremors (-4 penalty on all attack rolls, checks, and saves, except those purely mental in nature).
76-85Character has amnesia (memories of intimates usually lost first; Knowledge skills useless).
86-90Character has bouts of reactive psychosis (incoherence, delusions, aberrant behavior, and/or hallucinations).
91-95Character loses ability to communicate via speech or writing.
96-100Character becomes catatonic (can stand but has no will or interest; may be led or forced into simple actions but takes no independent action).

Indefinite Insanity
Table 6-11: Random Indefinite Insanity

d%Mental Disorder Type
01–15Anxiety (includes severe phobias)
16–20Dissociative (amnesia, multiple personalities)
21–25Eating (anorexia, bulimia)
26–30Impulse control (compulsions)
31–35Mood (manic/depressive)
36–45Personality (various neuroses)
46–50Psychosexual (sadism, nymphomania)
56–70Schizophrenia/psychotic (delusions,hallucinations, paranoia, catatonia)
71–80Sleep (night terrors, sleepwalking)
81–85Somatoform (psychosomatic conditions)
86–95Substance abuse (alcoholic, drug addict)
96–100Other (megalomania, quixotism, panzaism)

If a character loses 20% (one-fifth) or more of her current Sanity points in a single roll, she goes indefinitely insane. An episode of indefinite insanity lasts for 1d6 game months (or as the GM dictates). Symptoms of indefinite insanity may not be immediately apparent (which may give the GM additional time to decide what the effects of such a bout of insanity might be).

Table 6-11: Random Indefinite Insanity is provided as an aid to selecting what form a character’s indefinite insanity takes. (The mental disorders mentioned on this table are explained later in this section.) Many GMs prefer to choose an appropriate way for the insanity to manifest, based on the circumstances that provoked it. It’s also a good idea to consult with the player of the afflicted character to see what sort of mental malady the player wishes to roleplay.

The state of indefinite insanity is encompassing and incapacitating. For instance, a schizophrenic may be able to walk the streets while babbling and gesticulating, find rudimentary shelter, and beg for enough food to survive, but most of the business of the mind has departed into itself: She cannot fully interact with friends, family, and acquaintances. Conversation, cooperation, and all sense of personal regard have vanished from her psyche.

It is possible for characters with indefinite insanity to continue to be played as active characters, depending on the form their madness takes. The character may still attempt to stumble madly through the rest of an adventure. However, with her weakened grasp on reality, she is most likely a danger to herself and others.

Characters suffering from indefinite insanity are in limbo, unable to help themselves or others. The Heal skill can be used to restore Sanity points during this period, but the underlying insanity remains.

After recovery, a victim retains definite traces of madness. For example, even though a character knows he is no longer insane, she might be deathly afraid of going to sleep if her insanity manifested itself in the form of terrifying nightmares. The character is in control of her actions, but the experience of insanity has changed her, perhaps forever.

Permanent Insanity
A character whose Sanity score falls to -10 goes permanently insane. The character becomes an NPC under the control of the Game Master.

A character with permanent insanity may be reduced to a raving lunatic or may be outwardly indistinguishable from a normal person; either way, she is inwardly corrupted by the pursuit of knowledge and power. Some of the most dangerous cultists in the world are characters who have become permanently insane, been corrupted by forbidden knowledge, and “gone over to the other side.”

A character might be driven permanently insane by forces other than dark gods or forbidden knowledge. In such cases, moral corruption need not necessarily occur. The GM might decide to consider different sorts of permanent insanity, rolling randomly or choosing from among the mental disorders on Table 6-11: Random Indefinite Insanity, above.

A character who has gone permanently insane can never be normal again (a permanently insane character can be cured with the aid of 9th level magic or mythic effects). She is forever lost in her own world. This need not mean a lifetime locked away from society, merely that the character has retreated so far from reality that normal mental functions can never be restored. She might be able to lead, within restricted bounds, a more or less normal life if kept away from the stimulus that triggers strong responses in her individual case. Yet a relapse may come quickly. Her calm facade can be destroyed in seconds if even the smallest reminder of what it was that drove her mad disturbs her fragile equilibrium. In any event, the eventual fate of a permanently insane character is a matter for individual Game Masters and players to decide.

Gaining Or Recovering Sanity
A character’s Sanity score can increase during the events of a campaign. Although a character’s Sanity score can never exceed 99 minus her Knowledge (forbidden lore) ranks, her maximum Sanity and current Sanity can exceed her starting Sanity.

Level Advancement
A character’s current Sanity can become higher than her starting Sanity as a result of gained levels: Whenever a character gains a new level, she rolls 1d6 and adds the result to her current Sanity.

Story Awards
The GM may decide to award increases in character’s current Sanity if they foil a great horror, a demonic plan, or some other nefarious enterprise.

The Heal Skill And Mental Treatment
The Sanity rules presented here provide a new use for the Heal skill, allowing trained healers to help characters recover lost Sanity points. The DC and effect of a Heal check made to restore lost Sanity depend on whether the therapist is trying to offer immediate care or long-term care.

Immediate Care
When someone suffers an episode of temporary insanity, a therapist can bring him out of it—calming his terror, snapping him out of his stupor, or doing whatever else is needed to restore the patient to the state she was in before the temporary insanity—by making a DC 15 Heal check 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 successful DC 15 check (requiring a full-round action), 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 therapist must spend 1d4 hours per day doing nothing but talking to the patient. If the therapist makes a DC 20 Heal check at the end of this time, the patient recovers 1 Sanity point. A therapist 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 she regresses mentally due to horrors suddenly remembered.

Restoring Sanity with Magic
The way that Sanity loss and magic healing interact can greatly affect the feel of your game. Some magic can cure Sanity loss. As detailed below.

Although this spell does not usually 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 quest or geas is combined with the atonement spell, Sanity points are not restored until the task is completed. A successful use of the atonement spell can restore all Sanity lost through the direct result of the evil acts for which the character atones.

Calm Emotions
This spell cannot restore Sanity directly, but it can temporarily mitigate the effects of temporary or permanent insanity. While the spell is in effect, the targets act calmly and ignore behavior changes caused by Sanity loss.

In addition to its normal effects, heal restores 10 Sanity points and removes all forms of temporary insanity.

Mind Blank
While the spell is in effect, the subject is immune to Sanity loss.

This spell can restore a character to maximum Sanity even if his current Sanity has dropped to -10. Miracle even heals permanent insanity.

If the caster chooses, restoration can restore 1d6 Sanity points per two levels to the target creature (max 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 effect.

Restoration, Lesser
If the caster chooses, lesser restoration can restore 1d4 Sanity points to the subject instead of having its normal effect.

This spell can restore a character to maximum Sanity even if his current Sanity has dropped to -10. Wish even heals permanent insanity.

Wish, Limited
This spell can restore a character to maximum Sanity even if his current Sanity has dropped to -10. Limited wish does not heal permanent insanity.


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