Sanity – Rules

In the game, insanity is induced by traumatic experiences and ghastly comprehensions connected to the Cthulhu Mythos.  The duration of the insane state depends upon the number or proportion of Sanity points lost. Three states – temporary insanity, indefinite insanity, and permanent insanity -can result.

Playing Insanity
The threat of insanity in the Call of Cthulhu rules characterizes the Mythos in a way which allows no compromise.  Exposed to it, few sane humans freely choose the Mythos, for the Mythos is intrinsically loathsome and foul.  The connection of Sanity points and Cthulhu Mythos points emphasized the power of the Mythos, which corrupts and ruins by proximity and association.  The sanity rules prove to use our own fragility, All that which we thought strong becomes delusory and false, while madness sometimes becomes a necessary condition for truth.  Humor and laughter around the game table become vital counterbalances.  Good feelings promote harmony and cohesion during the darkest moments in the game.

Dealing with the Verge
If an investigator has even one point of Sanity remaining, the player has form control.  The aesthetics of how the player chooses to present a nearly-mad investigator represents the essence of roleplaying. As the investigator weakens, evidence of the weakening should become apparent.  Thus near-insanity call for stronger roleplaying, not for less player control.
Such an investigator should speak about his mental condition, so that the others understand the situation, and can act with due regard and sympathy.  It is not good roleplaying to murmur “My guy’s Sanity Points are low.”  Such a statement is dull and makes nothing happen.  But a player who can vividly describe his investigator’s anxiety or terror, and relate the affects the game, deserves applause.
If an investigator has ten or fewer Sanity Points, he or she certainly knows the situation is serious.  In such straits in  real life, most people would pull back from the action and perhaps put themselves in sanitariums. So should investigators.

The Quality of Insanity
Investigator insanity characterizes the power of the Mythos by causing the investigator to adopt behavior which is limited in what it can achieve, yet expressive and interesting to roleplay.  Even as indefinitely-insane investigator does not always have to be parked in a sanitarium, if a good alternative can be negotiated with the keeper.  The choice can be serious, or conceivably eccentric and twisted, or even ridiculous, but is should not upset the tenor of the game.
As a minor example, suppose that an investigator shows insanity by obsessively insisting on wearing two hats day and night.  He argues that were he not to do so, his head would be unprotected if he tipped his hat to a lady while the sky was falling.  Since hats can be seen, keeper characters freely notice the comment or criticize the foible.  In defense, perhaps all the investigators begin to wear two hats.  No restaurant will seat them, since their behavior is so uncouth.  That two-hatted madman never left the game – the game widened to accommodate him.
A player may try to act out too many elements of his investigator’s insanity. If that gets in the way of the game, the keeper must quash the interruption.   Not to do so would be unfair to the other players.
This edition of the rules offers a more realistic version of the gamut of insanity.  That is useful information from which to start, but information should not control the direction of the game.  Waste no time trying to reproduce a particular disorder: let the way your investigator handles lengthy insanity evolve. it will, over time.

Treatment of Insanity
Temporary insanity ends quickly enough that schedules of treatment are entirely pointless.  On the other hand, treatment of permanent insanity mostly has no meaning, since by definition the character will never recover. No matter how good the facility. Temporary insanity concludes soon enough that one merely need protect the sufferer from further upset or harm.  Similarly, permanent insanity is essentially beyond treatment because its boundaries and duration are determined solely by the keeper. Only indefinite insanity offers real scope for intervention and treatment.
After 1D6 game months, therefore, safe from further trauma and with the agreement of the keeper, the indefinitely insane character find enough mental balance to re-enter the world.  Three sorts of care might have helped to get the character to this point.  In choosing among them, keeper and player should consider the character’s resources, his/her friends and relatives, and how wisely he or she behaved in the past.

Private Care
The best care available is at home or in some friendly place where nursing can be tender, considerate, and undistracted by the needs of competing patients. If Psychoanalysis or Psychiatric Medications are available, roll D100 for each game month that one or the other is used.  A result of 01 – 95 is a success; add 1D3 Sanity Points for Psychoanalysis or Psychiatric Medications, whichever (but not both) is used.  On a result of  96-00, the analyst fumbles or the character rebels against taking  the drugs.  The character loses 1D6 Sanity points, and no progress is made during teh next game month.

Institutionalization
The next-best care is commitment to an insane asylum.  Asylums may be said to have an advantage over home care in that they are relatively cheap or even a free service provided by the state.  But in any of the game eras, these institutions are of uneven quality, and some may be potentially harmful.  Some are creative places of experiment and advanced therapy, while other merely offer rude confinement.  Presently, in the United States, most institutions are full or accessible only to the criminally insane. In any era, concentrated and nourishing treatment by strangers is rare.
Supervised activity, manual therapy, psychiatric medications, and hydrotherapy are frequent, as in electroconvulsive treatment today.  Psychoanalysis is unavailable , and some time an institution can convey an uncaring sense that undermines the useful effects of psychiatric medications, leaving teh character with a sense of anger and loss, and likely to be distrustful of outpatient support once he or she has left the institution. Roll D100. A result of 01-95 is a success: add 1D3 Sanity points for psychiatric medications. On a result of 96-00, the character rebels against taking drugs.  He or she loses 1D6 Sanity points, and no progress can be made during the next game month.

Wandering and Homeless
The Investigator becomes a wandering derelict, struggling for survival.  The wanderer gains no Sanity points unless able to join a group of the homeless, and finds at least one friend among them.  To find a friend, roll equal to or less than current Sanity + POW on D100 each game month.  If a friend appears, add 1 Sanity point per game.
Each game month, roll D100 for survival.  On a result of  01-95, the character survives. On a result of 96-100, the character dies of disease, exposure, or murder.

See Also: Medications & Treatments, Therapies, Mental Disorders, Psychiatric GlossaryTemporary InsanityIndefinite Insanity, and Permanent Insanity.