Madness, Insanity and Corruption

Charging headlong into terrifying situations is the stock in trade for adventurers. Even the hardiest adventurers can find themselves worn down over time, their performance suffering as they struggle to cope. Witnessing something horrific or terrifying as well as various magical effects can inflict madness on an otherwise stable mind. Certain spells can cause insanity and these rules will be used instead of the spell effects listed.
The rules and madness tables included here are meant to add a sense of realism to the game.
Diseases, poisons and planar effects can all inflict madness. Extended exposure to the presence of a source of strong, unholy evil or deeply corrupt magic, can slowly twist and infect the physical forms of even the most holy of creatures. Some artifacts can also break the psyche of a character who uses or becomes attuned to them.
Resisting a madness-inducing effect usually requires a Wisdom or Charisma saving throw but we will be making a Sanity saving throw instead.
Note: The terms insanity and madness are used interchangably throughout this article.

Sanity (New Ability Score)

Sanity is an optional rule from the DMG that I am thinking about adding to this campaign. Sanity functions as an additional ability score that calls for its own checks and saving throws. It is supported in Foundry VTT but I don't think DnDBeyond does it yet. I may just use something based on Intelligence/Wisdom instead to avoid adding another ability score.
Sanity saving throws are made when experiencing something so horrific that it breaks a creatures understanding of existence, dignity and hope, but a Sanity saving throw can also replace the default saving throw of certain spells that affects the psyche (such as Dissonant Whispers).
Situations that might trigger this are:

• when a character interacts with text or other media that disturbs the mind
• to overcome effects of madness conditions
• to understand something alien or horrific in nature.
• when confronted with a terrifying visage
• taking psychic damage
• Witnessing the death of a loved one
• A nightmare or darkest fear made real
• Shattering the character’s fundamental understanding of reality
• Witnessing a person transform into a horrid or unnatural creature
• When a character makes an attack roll, an ability check, or a saving throw, they must apply their current Stress Score as a penalty to the roll.

A failed Sanity save might result in short-term, long-term, or indefinite madness. Any time a character suffers from long term or indefinite madness, Sanity is reduced by 1. If Sanity is reduced to 0, the character becomes catatonic and loose their minds permanently. A Greater Restoration spell can restore Sanity lost in this way, and a character can increase his or her Sanity through level advancement.
Psychic damage often represent magic that tear at the mind of creatures targeted by the spells. When a player character is targeted by a spell of 1st level or highrer that deals psychic damage, the DM might ask them to roll a Sanity saving throw instead of Intelligence or Wisdom. Monsters that are targeted by such spells are assumed to have a Sanity score equal to their Intelligence score, and all aberrations are considered proficient in such saving throws.

Madness Chance

Any effect, including spells, that calls for a Sanity saving throw carries a chance of inflicting madness. If a creature fails their Sanity saving throw by 5 or more, they suffer from a madness effect either determined by the DM as apprpriate for the situation, or rolled randomly.

Madness Effects

Madness can be short-term, long-term, indefinite or permanent. Most relatively mundane effects impose short-term madness, which lasts for just a few minutes to a few hours. More horrific effects or cumulative effects can result in long-term or indefinite madness.

• A character afflicted with short-term madness is subjected to an effect for ldlO minutes.
• A character afflicted with long-term madness is subjected to an effect for ldl0 x 10 hours.
• A character afflicted with indefinite madness gains a new character flaw that lasts until cured.
• A character afflicted with permanent madness can only be cured by a casting Wish or Miracle to remove it.

Bestow Curse: In place of the normal options of this spell, you can afflict the target with a short-term madness effect chosen at random. If you use a spell slot of level 5 or higher, you instead afflict the target with a long-term madness. If you use a spell slot of level 9, you afflict it with an indefinite madness.
Related: Curses

Natural Recovery

Natural recovery is greatly influenced by the cause of the condition.

Exposure

Usually this can be cured naturally by resting away from any source.

Instant Contact or Direct Magic

Short or long term madness will alleviate itself given time. There is no natural recovery from indefinate or permanent insnaity.

Removing Insanity with Magic

The spells that can potentially remove insanity are discussed below.

Calm Emotions

This spell cannot directly remove an insanity, but it can temporarily mitigate the effects of temporary or indefinite insanity. While the spell is in effect, the targets act calmly and ignore behavior changes caused by temporary or indefinite insanity. This spell has no effect on those suffering from permanent insanity.

Dispel Evil

Depending on the source of the madness, may remove all short-term and long-term insanities, one indefinite insanity, or permanent insanity.

Heal

In addition to its normal effects, heal removes all forms of temporary insanity. You may choose to allow this spell to remove one indefinite insanity per casting, in addition to its other effects. This also applies to the mass heal spell.

Mind Blank

While the spell is in effect, the subject automatically succeeds at all saving throws against madness.

Miracle

This spell can remove all insanities. Miracle even heals permanent insanity. This effect should be viable even in a campaign where magic does not normally affect insanities.

Remove Curse

Depending on the source of the madness, may remove all short-term and long-term insanities, one indefinite insanity, or permanent insanity.

Restoration, Lesser

If the caster chooses, lesser restoration can remove all-short term insanity or a long-term insanity instead of its normal effects.

Restoration, Greater

If the caster chooses, greater restoration can remove all short-term and long-term insanities, one indefinite insanity, or permanent insanity, rather than the normal effects of the spell.

Wish

see Miracle.

Medicinal Treatments

As long as a character can afford the correct herbs and alchemical substances and is able to ingest them, the symptoms of long-term or indefinite insanity can be ignored.
Ingesting these substances and drugs does not make a character immune or even particularly resistant to future insanity.
Long-term alchemical treatment can remove indefinite insanities, just as the use of the Medicine skill can. Each day that the medication is taken is treated as a day of downtime towards removing the insanity.

A DC 20 Alchemist’s supplies check
Alchemical base: aqua vitae
Reagents:

A DC 20 Herbalism check
Primary component: Juniper or Fleshwort
Secondary component: Angel Skin or Darkberry or Vampire Dust

Potions

Blood of the Mountain King

Potion, very high strength ★ ★ ★ ★ Alchemical base: rectified spirit Reagents: 1+4+5+6
Drinking this crimson ichor removes any exhaustion you are suffering and cures any disease or poison affecting you. In addition, for the next 24 hours, you regain the maximum number of hit points for any Hit Die you spend.
A non-dwarf creature that benefits from this potion can’t do so again until it finishes an extended rest.
This removes all insanities and prevents new ones for 24 hours.

Elixir of Good Health

Potion, high strength ★ ★ ★ Alchemical base: aqua vitae Reagents: 1+2+6
When you drink this potion, it cures any disease afflicting you, and it removes the blinded, deafened, paralyzed, and poisoned conditions. The clear red liquid contains small bubbles of light.
Can remove all short-term and long-term insanities, one indefinite insanity or permanent insanity.

Hexbreaker

Potion, high strength ★ ★ ★ Alchemical base: aqua vitae Reagents: 2+3+5
Drinking this plum-colored potion causes all curses affecting you to end on you. If a curse removed in this way is caused by a cursed magic item, its curse remains, but the potion breaks your attunement to the object so it can be removed or discarded.
Can remove all short-term and long-term insanities, one indefinite insanity or permanent insanity.

Herbal Treatments

Kava Root Tea

it can temporarily mitigate the effects of temporary or indefinite insanity for 4 hours.

Feverbalm Tea

1d10 hours after the tonic is consumed, a creature removes one level of Madness.

Lavender Oil

Adding Lavender to teas can temporarily mitigate the effects of temporary or indefinite insanity for 4 hours.

Tahlia’s Respite

This balm cannot directly remove an insanity, but it can temporarily mitigate the effects of temporary or indefinite insanity for 8 hours.

Willem’s Cure-all

In addition to its normal effects, balm removes all forms of temporary insanity.

Witch Ward

Can remove all short-term and long-term insanities, one indefinite insanity or permanent insanity.
See also: Mental Disorders

Corruption

Sometimes exposure can lead to a corruption of the individual rather than madness.
If a character completes a long rest near a source of strong, unholy evil or deeply corrupt magic, they must roll a Wisdom saving throw. The DC of the saving throw is outlined below, and is dependent on the character's current Corruption level and proximity to the source of evil. On a failure, the character suffers 1 point of Corruption. When a new tier of corruption is achieved (Mild to Moderate, Moderate to Severe), roll a d8 on the Corruption Effects Table below to determine the effect of that character's corruption. Corruption effects a re cumulative with previous e ffects as higher t iers are achieved. Effects fade when enough corruption points have been cured to lower the character's tier of corruption (Moderate to Mild, Mild to None). If a character reaches 12 or more Corruption points, the OM decides whether or not the character dies instantly, or goes insane and becomes an NPC under their control. A character with 12 or more corruption points cannot be brought back to life or restored to player control until they are brought below 12 corruption points.
Corruption can be cured naturally by resting away from any source of corruption, at a rate of 1 corruption point per week of rest. Otherwise, a Lesser Restoration spell can cure 1 corruption point, and a Greater Restoration spell can cure ld4 corruption points.

Corruption Tiers Table

Distance	No Corruption (0 Points)	Mild Corruption (1-2 Points)	Moderate Corruption (3-8 Points)	Severe Corruption (9- 11 Points)	Dead/Insane (12+ Points)
within 5 miles	10	12	14	18	-
within 1 mile	12	14	18	22	-
within 500 feet	14	18	22	25	-

Corruption Effects Table

d8 Mild Corruption Moderate Corruption Severe Corruption 1 Hallucinations Seeping Sores Warped Spine 2 Hoarder Moral Decay Murderous 3 Compulsive Distracted Withered Flesh 4 Cough Jittery Paranoid 5 Trusting Rotten Joints Mark of t he Cursed 6 Reckless Body Parasites Broken Will 7 Scent of Decay Chronic Fatigue Eyes of Shadow 8 Mildly Phobic Moderately Phobic Severely Phobic

Corruption Effects

Many of the following corruption effects carry some form of mechanical detriment, but the real fun is being aware and weaving them into narrative and roleplaying scenarios. Consider how some of these effects might alter a social encounter, or adjust the character's reaction to a particular event. Don't be afraid to remind a player of their corruption should a moment arise where they may have an opportunity to incorporate it.

Body Parasites

Parasitic worms infest and writhe throughout your innards. Any hit points regained through spending Hit Dice are halved.

Broken Will.

Your willpower has crumbled, leaving your mind vulnerable. You have disadvantage on Wisdom ability checks and Wisdom saving throws.

Chronic Fatigue.

Your body has difficulty with continuous physical activity. If you do not take a short or long rest directly after a combat that lasted more than 1 minute, you suffer 1 point of exhaustion.

Compulsive.

You begin to exhibit a mild, compulsive ritual of the DM's choice. This can manifest as categorizing collected loot, or needing to thoroughly clean yourself after every challenge, for example. You take 1.5 times as long to complete a short rest.

Cough.

You develop an uncontrollable cough that creeps up every now and then. You have disadvantage on Dexterity (Stealth) checks.

Distracted.

Your mind has grown scattered and easily clouded. You have disadvantage on Intelligence ability checks.

Eyes of Shadow.

Your eyes grow jet black and empty, your pupils becoming small glowing points of green flame. You gain Darkvision for 60 feet, but also gain Sunlight Sensitivity. You have disadvantage on attack rolls and on Wisdom (Perception) checks that rely on sight when you, the target of your attack, or whatever you are trying to perceive is in direct sunlight.

Jittery.

You become far too easy to spook or startle. You have disadvantage on initiative rolls.

Hallucinations.

Strange visions and sourceless whispers occasionally tug at your perception. You have disadvantage on Wisdom (Perception) checks.

Hoarder.

You are compelled to collect anything and everything of mild value you can. Simple trinkets stumbled across must be gathered and carried, if able, until at carrying capacity.

Mark of the Cursed.

A black curse on your very soul resists divine energies. Any hit points you would regain via spells are halved.

Mildly Phobic.

You acquire a mild fear of a certain creature type of the DM's choice. During the first round of combat with a creature of the chosen type, you are frightened.

Moderately Phobic.

You acquire a moderate fear of a certain creature type of the DM's choice. When you enter combat with a creature of the chosen type, you must make a Wisdom saving throw (DC is 10 + your total corruption points). On a failure, you are frightened of them for 1 minute.

Moral Decay.

Your disposition towards the world around you has shifted towards the darkness that twists within you. Your alignment shifts once either laterally or towards evil. Good can shift to Neutral. Neutral can shift to Evil. Lawful can shift to Chaotic. Chaotic can shift to Lawful. This shift is the DM's choice, and should be relayed to the player in secret.

Murderous.

You suffer irresistible murderous urges at the sight of the helpless. If any creature you can see is incapacitated (friend or foe), you must spend your turn moving directly toward that creature and attacking it, if possible.

Paranoid.

You no longer trust even your closest allies. You no longer count as a "friendly" creature to anyone, nor does anyone count as a "friendly" creature to you, in regards to abilities or spells. The only creature your beneficial spells and abilities can target is yourself.

Reckless.

You've become impulsive in the face of dangerous situations. The first attack made against you in any combat encounter has advantage on the attack roll.

Rotten joints.

Your joints begin to suffer from internal decay and degeneration. You have disadvantage on Dexterity ability checks.

Scent of Death.

Your body has begun to emit a terrible stench of rotting flesh. You have disadvantage on Charisma (Persuasion) checks.

Seeping Sores.

Painful sores cover your body, making it difficult to exhibit a ll of your strength. You have disadvantage on S trength ability checks.

Severely Phobic.

You acquire a severe fear of a certain creature type of the DM's choice. When you enter combat with a creature of the chosen type, you become frightened of the creature for 1 minute and must make a Wisdom saving throw (DC is 10 + your total corruption points). On a failure, you are stunned. You can repeat this saving throw at the end of your turn.

Trusting.

You become too eager to accept others at face value. You have disadvantage on Wisdom (Insight) checks.

Warped Spine.

Your spine has become twisted and hunched. You have disadvantage on Dexterity ability checks and Dexterity saving throws.

Withered Flesh.

Your flesh has pulled tight against your skeleton, making your visage terrifying to most. You have disadvantage on Charisma ability checks and Charisma saving throws.

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