Sanity

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No game involving the Cthulu mythos is complete without the risk of going insane. As such, we will be using the Pathfinder rules for Sanity in this campaign. The Paizo information on Sanity and Madness is below, with a few slight adjustments to be used in this campaign.

An abundance of horrors can scar a being. Wounds and fatigue can ravage the flesh. Poisons and venoms can putrefy a creature from within. Curses and hexes can assault the body and soul through supernatural means. But of all the horrors a hero might face, few are as debilitating or insidious as those that assault her sanity.

The game already features many threats that can erode a character’s sanity. The insanity spell can cause a character to act confused until its effect is removed. Insanity mist is an inhaled poison that deals Wisdom damage. The allip, an undead creature created when a soul is lost to madness, features several madness-themed abilities.

For some games, presenting the weakening of sanity and the onset of madness as assaults on a creature’s Wisdom score or the randomness of the confused condition might be enough. But running a horror-themed game often necessitates a more robust and nuanced system. In the following system, the mental resilience of a creature is based on the totality of her mental being and mental strengths, rather than her weaknesses, improving her chances to weather and triumph against a vast array of sanity-threatening horrors.

Sanity Score, Edge, and Thresholds

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.

Creatures that possess minds but that have an immunity to mind-affecting effects are not immune to sanity damage. The mental barriers they have do help shield them from sanity damage, however. At the GM's option, the immunity to mind-affecting effects may increase the creature's sanity threshold or grant a bonus to the Will save to reduce sanity damage depending on the type of horror encountered and the source of the immunity to mind-affecting effects.

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 Table: Lesser Madness or Table: 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.

While these rules introduce a number of spells, feats, monsters, or other effects that deal sanity damage, the GM is also encouraged to create her own sanity-damage-dealing effects in her horror game. The table below gives a number of examples of situations that might cause a character to take sanity damage.

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.

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Situation DC Failure Success
The first time a character encounters a dead body 10 1d3 sanity damage 0 sanity damage
The first time a character encounters a gruesome scene of death 12 1d6 sanity damage 1 sanity damage
The first time a character encounters a horrifying creature* 10 + CR of the creature Sanity damage equal to 1/2 the creature’s CR Sanity damage equal to 1/4 the creature’s CR
Each time a character encounters a qlippoth or other creature with a particularly horrific appearance 10 + CR of the creature Sanity damage equal to the creature’s CR Sanity damage equal to 1/2 the creature’s CR
Each time a character encounters a Great Old One 15 + CR of the creature Sanity damage equal to double the creature’s CR Sanity damage equal to the creature’s CR

* Horrifying creatures are typically aberrations, evil or chaotic outsiders, and undead. “Each time” could mean the first time for each creature type, or each time a creature encounters a new kind of specific creature of that type (for example, the first time a creature encounters a skeleton and then again the first time the character encounters a wraith), at the GM’s discretion.

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.

Reading A Madness Stat Block

Madnesses are formatted in the same way as other afflictions, with the following changes.

Save: Unless the character has gained the madness via the sanity system, this is the save necessary to avoid contracting the madness. It is also the base saving throw needed to cure the madness (see Curing Madness below) and the saving throw the effects of the madness require. If, during the course of treating a madness, the affliction’s DC decreases, that new reduced saving throw also becomes the DC the afflicted character must succeed at to avoid any of the madness’s effects. It’s possible to suffer from multiple forms of the same madness. If a character becomes afflicted with a form of madness from which he is already suffering (even if it takes a slightly different form, such as phobias of different objects), the current DC of that madness increases by 5. All madnesses are mind-affecting effects.

Onset: When a character suffers madness from the sanity system (due to a sanity attack that deals sanity damage greater than or equal to his sanity edge), this onset time does not apply. Use this entry only when the character contracts the madness in other ways. During the onset time, the character gradually gains the madness effect, rather then suddenly experiencing the full effect after a number of days.

Effect: This is the effect of the madness. An afflicted character typically suffers this effect at all times, but some madnesses manifest only during certain situations. For complex effects or effects that rely on roleplaying, the description section of the madness contains a more detailed description of the effect. If you’re using the sanity system, this effect manifests as long as the madness is not dormant.

Dormancy Effect: If the madness was inflicted due to the sanity system, the afflicted character suffers this effect while the madness is dormant. Otherwise, ignore this entry.

<caption>Table: Lesser Madnesses</caption>
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d% Madness
1–10 Delirium
11–22 Delusion
23–32 Fugue
33–42 Hallucination
43–54 Mania
55–66 Melancholia
67–76 Night terrors
77–86 Paranoia
87–100 Phobia

<caption>Table: Greater Madnesses</caption>
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d% Madness
1–18 Amnesia
19–30 Catatonia
31–48 Cognitive block
49–66 Disassociated identity
67–78 Psychopathy
79–85 Psychosomatic loss
86–100 Schizophrenia

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.

Section 15: Copyright Notice

Pathfinder Roleplaying Game Horror Adventures © 2016, Paizo Inc.; Authors: John Bennett, Clinton J. Boomer, Logan Bonner, Robert Brookes, Jason Bulmahn, Ross Byers, Jim Groves, Steven Helt, Thurston Hillman, Eric Hindley, Brandon Hodge, Mikko Kallio, Jason Nelson, Tom Phillips, Stephen Radney-MacFarland, Alistair Rigg, Alex Riggs, David N. Ross, F. Wesley Schneider, David Schwartz, Mark Seifter, and Linda Zayas-Palmer.

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Sanity

Dreamers Deep - A Strange Aeon's Campaign Lord_Telarus