Gaining or Recovering Sanity

Character Sanity Scores

Sanity, Insanity and Disorders

Loss of Sanity

Forbidden Tomes and Knowledge

Types of Insanity

Indefinite Insanity and Disorders

House Rules

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 -1 or greater, but not yet past negative the patient’s Wisdom score. 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.

Mental Therapy

To give useful mental therapy, a therapist must have the Heal skill. Intensive treatment can return Sanity points to a troubled character. However, Sanity points restored in this manner can never cause the patient’s Sanity score to exceed her starting Sanity or maximum Sanity, whichever is lower. A character can have only one healer at a time. See The Heal Skill and Mental Treatment sidebar for a detailed description of how this works.

Such treatment can also be used to help a character snap out of an episode of temporary insanity (for example, from an acute panic attack). It does not speed recovery from indefinite insanity, but it can strengthen a character by increasing her Sanity points.

Recovery from indefinite insanity only comes with time (typically, 1d6 months). It is not dependent upon the character’s Sanity points and is not connected to them. A character can be sane with 24 Sanity points and insane while possessing 77 Sanity points.

Restoring Sanity with Magic

Certain magical spells can cure or reduce Sanity loss. Additionally, normal rest can cure Sanity loss to a limited degree. 24 hours rest can return one Sanity point with a successful DC: 20 Will Saving Throw. Once this saving throw has failed, the rest of the points lost during that encounter may no longer be healed in this way.


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.

Ceremony of Life

In addition to its normal effects, Ceremony of Life restores all lost Sanity points and removes all forms of temporary and permanent insanity.


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 -his Wisdom score. Miracle even heals permanent insanity.


In addition to its normal effects, Resurrection restores 20 Sanity points and removes all forms of temporary insanity.

Resurrection, true

In addition to its normal effects, True Resurrection restores all lost Sanity points and removes all forms of temporary and 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 -his Wisdom score. Wish even heals permanent insanity.

Wish, Limited

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

Alchemical Treatments

Long-term alchemical treatment can restore lost Sanity points, just as use of the Heal skill can. For each month the character takes an accurately prescribed psychiatric medication, she regains 1d3 Sanity points. As with treatment through the Heal skill, long-term drug therapy can never raise a character’s current Sanity above her starting Sanity.

A character cannot regain Sanity from both treatment with the Heal skill and alchemical treatment in the same month.

Treatment Of Insanity

Temporary insanity ends so quickly that schedules of treatment are essentially pointless; it runs its course soon enough that one merely need protect a deranged character from further upset or harm. On the other hand, treatment of permanent insanity has no real meaning. By definition, a permanently insane character never recovers, no matter how good the therapist or the facility. Thus, indefinite insanity is the only form of mental illness that might be addressed by intervention and treatment.

After 1d6 months, if undisturbed by further trauma and with the agreement of the Game Master, an indefinitely insane character finds enough mental balance to reenter the world. Three kinds of nonmagical care may help the character regain Sanity points during this recovery period. When choosing among them, the GM and player should consider the character’s resources, her friends and relatives, and how wisely she has behaved in the past. In most campaigns, the magical treatments described above (see Restoring Sanity with Magic) allow the character to reenter play after a shorter time or with less expense.

Private Care

The best care available is at home or in some friendly place (perhaps a small church or the home of a wealthy friend) where nursing can be tender, considerate, and undistracted by the needs of competing patients.

If mental healing or alchemical medications are available, roll d% for each game month that one or the other is used. A result of 01-95 is a success: Add 1d3 Sanity points for either mental therapy or alchemical medications, whichever is used (a charac ter cannot benefit from both in the same month). On a result of 96-100, the healer fumbles the diagnosis or the character rejects the alchemical treatments. She loses 1d6 Sanity points, and no progress is made that month.


The next best alternative to private care is commitment to a good insane asylum, but these are extremely rare.

Institutions are usually located within the bounds of a temple devoted to a deity of healing, and asylums exist as well, and may be said to have an advantage over home care in that they are relatively cheap or even a free service provided by a government or a powerful church. These institutions are of uneven quality, however, and some may be potentially harmful. Some are creative places of experiment and magic-assisted therapy, while others offer mere confinement. Concentrated and nourishing treatment by strangers is rare.

Therapy using the Heal skill is usually the only treatment available, but in most cases, primitive institutions offer no treatment at all. Sometimes an institution can convey an uncaring sense that undermines the useful effects of alchemical medications, leaving the character with a sense of anger and loss. He is likely to be distrustful of the organization and its motives. Escape attempts are common by inmates, even in the most enlightened fantasy settings.

Roll d% for each game month a character is in the care of an institution. A result of 01-95 is a success; add 1d3 Sanity points if therapy with the Heal skill was available, or 1 Sanity point if no treatment was present. On a result of 96-100, the character rebels against the environment. He loses 1d6 Sanity points, and no progress can be made that month.

Wandering and Homeless

If no care is available, an insane character may become a wandering derelict struggling for survival. Such a wanderer gains no Sanity points unless he is able to join a group of the homeless and find at least one friend among them. To find a friend after joining such a group, the character can make a DC 15 Charisma check once per month. If a friend appears, the character recovers 1 Sanity point per game month thereafter.

For each game month during which an insane character lives as a derelict, roll d%. On a result of 01-95, the character survives. On a result of 96-100, the character dies as the result of disease, exposure, or violence.

Gaining or Recovering Sanity

Crimson Skies PhoenixMark