Sanity

Within the world great dangers lurk just around the corner, ready to lash out and break not only the bodies of those adventurers that happen upon them, but also their very minds. For most adventurers uncommon sights of gore and bestial figures would not scare them easily, but for the common folks, these can drive one to retch or worse, break their mind entirely. It is for this reason that all characters within the world are given a Sanity score to gauge their minds readiness for the dangers from without and from within.

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, permanent, ability scores, including any reductions caused by ability damage, or increases such as from a magical item. 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.

Sanity Score

A character’s Sanity Score is equal to their highest unmodified mental ability score, minus any ability damage taken to those ability scores, plus any enhancements to that ability score, this number is then multiplied by 4, up to a total Sanity Score of 99.

Sanity Threshold

A character’s Sanity Threshold is equal to the modifier of their highest unmodified mental ability score, minus any ability damage to that score, plus any enhancements to that ability, with a minimum Threshold of 0. Whenever 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

A character’s Sanity Edge is equal to half of their 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 Sanity Edge, any dormant lesser madness’s you may possess, manifest again.

Effects of Sanity Damage

When you experience a potential Sanity Attack, you must typically succeed at a mental (Wisdom, Intelligence, or Charisma) 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 the Sanity and Madness table.
You are afflicted with a madness until that madness is removed. You may not always immediately manifest the madness, though. If you are afflicted with madness and then are healed of all Sanity Damage, all of your madness’s become dormant until you accrue further Sanity damage. Typically, a dormant madness does not affect you at all, but some madness’s 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 madness’s, no matter the potency, can be removed only by higher level spells such as Greater Restoration 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 madness’s are cured.
Sanity damage is a separate type of damage from Physical or Magical damage. Unlike Physical or Magical damage, Sanity damage stacks only with itself. Sanity damage does not go away unless reduced or removed.

Example of a Sanity Attack

You witness a small puppy as it comes across what appears to be a woman in a tattered gown weeping to herself in the middle of the street, and approaches her. As it gets near her, she notices the puppy and stops weeping, she then begins to stand up. As she stands her body towers over the small creature as her spine and limbs contort and twist and her eyes begin to glow a bright golden yellow. She opens her mouth to reveal a secondary set of sharp teeth within and releases a cackling howl before lunging toward the puppy, snatching it up in a single swipe, revealing its elongated arms and sharp claws. Its jaw opens wide as lower mandibles extend outwards and it devours the dog. It then turns its eyes to you and grins a bloody grin before leaping away into the darkness of the night.
Those that witness this event, unless they are steeled against such horror are impacted, and are subject to a Sanity Attack. In this case, this type of Sanity attacks your Sanity Score, the GM rolls a d100, and if the result is greater than your Sanity score, you suffer the effects of the attack. If it is lower than you are unaffected by the attack. In this case, on failure, the character suffers 1d4 Sanity damage.

Reducing Sanity Damage

Sanity damage can be reduced in a number of ways. The first is with time and rest, the most common of which is through two applications of the Recuperating downtime action, which for ease of reference requires the following, and provides the following benefits.

• For every 2 Downtime Actions spent Recuperating, for a total of 6 Downtime Days or (DTDs), you can reduce the Sanity damage you have taken by an amount of points 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 (NPC or Player) through the use of the Therapy downtime action, which for ease of reference requires the following, and provides the following benefits.

• For four days of Downtime spent in Therapy, you reduce the Sanity damage you have taken by an amount of points equal to the Wisdom modifier + Proficiency bonus in Medicine of your Therapist, or 4, whichever is greater.

Sanity damage can also be reduced with magic. A single casting of Lesser Restoration reduces Sanity damage by 1d2 points, a creature can be affected in this way once per dawn. The Restoration spell reduces Sanity damage by 2d4 points, once per dawn; and Heal reduces the amount of sanity damage by 3d4 points, once per dawn.
Greater restoration, psychic surgery, and limited wish or a similar spell, 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. The Miracle and Wish spells instantly reduce your Sanity damage to 0, regardless of whether your total Sanity damage was below your Sanity Edge.

Steeled

• After a time, certain horrors no longer impact a character as they would have in the past. A character dealing with the undead for example on a nigh-daily basis no longer has the same chill run up their spine as a commoner would have from seeing one for the first time. This is represented by the Steeled condition.

• Adventurers are by default Steeled against common threats such as owlbears, bandits, basic violence and gore, trolls, and so on, anything beyond these basic threats they are not Steeled against, unless gained from play, class, or lore.
• Commonfolk, such as Civilians are not innately Steeled against anything, except for those gained from lore.

Author: Jokee Smurf, with modifications by Sage T. Young (SerNurp based off of the Sanity rules of Pathfinder 1st edition.