Sanity Rules

Sanity Points

Sanity points measure the stability of a character’s mind. These points provide a way to define a character’s inherent sanity, the most stability a character can ever have, and the current level of rationality that a character has, 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. Upon creation, a character’s current Sanity equals his starting Sanity.

A character’s starting Sanity is also the upper limit of his Sanity that can be restored by the Heal skill (see Skills, later in this section).

After creation, a character’s current Sanity often fluctuates considerably and might never again match his starting Sanity. A change in a character’s Wisdom score changes his starting Sanity in terms of how much Sanity 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.

Maximum Sanity

A character’s maximum Sanity is equal to 99. A character’s current Sanity can never be higher than his maximum Sanity.

Making a Sanity Check

When a character encounters a gruesome, unnatural, or supernatural situation, the GM may require the player to make a Sanity check using a percentile die (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, 1–4 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 can always decide when characters make Sanity checks. Confronting several horribly mangled corpses at one time or in rapid succession may call for just one Sanity check, while the same corpses encountered individually 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 zero 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 and 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).

Losing Sanity

Characters ordinarily lose Sanity in a few types of circum¬stances: 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

Since d20 characters live in a world of magic and monsters, the GM might want to make them less susceptible to Sanity loss caused by encountering strange creatures (see Table: Sanity Loss from Creatures) by allowing them to have a measure of Sanity resistance, which is tied to one of two attributes.

Each character will be allowed to have Sanity resistance equal to his character level and Wisdom modifier, at the discretion of the GM. Sanity resistance is the amount of Sanity loss a character can ignore when he encounters a creature that requires a Sanity check.

The GM may decide that 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 casting or learning spells.


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 cause one of three mentally unbalanced states: temporary, indefinite, and permanent insanity

While temporary insanity and indefinite insanity can be cured, permanent insanity cannot. Permanent insanity occurs when a character’s Sanity is reduced to −10 or lower.

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 to prompt 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 lasts 1d10+4 rounds. If the amount of Sanity lost exceeds the character’s current Wisdom score, the temporary insanity lasts 1d10×10 hours.

Successful application of the Heal skill (Skills, below) may alleviate or remove temporary insanity.

Temporary insanity ends when the rolled duration ends, unless the GM considers it appropriate for it to end sooner.

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 after even 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.

Indefinite Insanity

If a character loses 20% (one-fifth) or more of her current Sanity points in the space of 1 hour, she goes indefinitely insane. The GM judges when the impact of events calls for such a measure.

Some GMs never apply the concept to more than the result of a single roll, since this state can remove characters from play for extended periods. 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.

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.

As a rule, a character suffering from indefinite insanity should be removed from active play until she recovers. At the GM’s discretion, the player of the character might be allowed to use a temporary character until the end of the story. Whether this “stand-in” character is an incidental NPC in the adventure, a character of the same level as the rest of the group, one or two levels below the rest of the characters, or even a 1st-level character, is up to the GM. Different GMs have different ways of handling this transition.
If a character goes indefinitely insane near the end of an adventure, the GM may decide to set the next adventure to begin after the insane character has recovered.

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, he might be deathly afraid of going to sleep if his insanity manifested itself in the form of terrifying night¬mares. The character is in control of his actions, but the experience of insanity has changed him, 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.
A character who has gone permanently insane can never be normal again (in some campaigns, a permanently insane character can be cured with the aid of powerful magic). 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. Even so, a relapse may come quickly. Her calm facade can be destroyed in seconds if even the smallest reminder of what 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, her maximum Sanity and current Sanity can exceed her starting Sanity.

Level Advancement

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 to a character’s current Sanity if she foils a great horror, a demonic plan, or some other nefarious enterprise.

Restoring Sanity with Magic

Magic can easily cure Sanity loss, in which case Sanity becomes little more than a specialized version of “mental hit points” that includes some neat side effects (insanity). Characters can usually restore themselves to full Sanity with a day or two of rest and spellcasting.

• Atonement: Although this spell does not usually restore Sanity, it can be used in those rare cases when a char¬acter’s own actions inadvertently led to an evil act that caused 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 from 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.

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

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

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

• Restoration: If the caster chooses, restoration can restore 1d6 Sanity points per two caster 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.

• Wish: 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.


This section presents a new skill and variant rules for the Heal skill.

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 he 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 −1 to −9. On a successful DC 15 check (requiring a full-round action), the character’s Sanity score improves to zero.

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.

At the end of this time on each day of therapy, the therapist makes a DC 20 Heal check; if successful, 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

Sanity Rules

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