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Madness

Edit
Mental illness

This is how it feels sometimes.

Madness or insanity was a broad term describing a variety of mental illnesses, conditions, symptoms, and disorders that could affect people in subtle or dramatic ways.[1][2][3][4] In the Realms, they were commonly called afflictions of the mind.[5]

Causes[]

Pandemonium berk

A planar traveler experiencing the maddening winds of Pandemonium.

Terrible shocks were a reliable source of sanity loss, especially for those that pursued dramatic and perilous events like adventurers. These could be events of "mundane" grief and horror—having a friend die, coming across a gory scene, or being tortured—or distinctly supernatural—seeing someone turn to stone from a medusa's gaze, witnessing an alien planar being or even a god in the flesh.[6] The skills and worldview of someone informed what affected them to an extent—a martial warrior would likely be inured to physical violence but broken by supernatural threats, while mages could more easily intellectualize the supernatural but be revolted by mundane carnage. Priests were usually inured to mundane and magical perils, but were particularly sensitive to spiritual affronts and blasphemous deeds that threatened their divinely-ordered worldview. Roguish sorts could more easily protect their mental health with a perceived distance born of cunning, secrecy, and aloofness—until the moment their stratagems collapsed and it all became distinctly personal.[7]

Those who made direct telepathic contact with other beings were at risk of being damaged by the experience if they were sufficiently strange or shocking. It was dangerous for humans to come into contact with the minds of aberrations like beholders, morkoths, and cloakers, and it was a struggle to interface with like treants and phycomids. Planar beings like elementals (including golems) and fiends were also dangerously alien, including when facilitated by contact other plane.[8][9] It was also hazardous for initial expectations to be harshly subverted—such as discovering that the telepathic target was actually a disguised doppelganger—or making contact with those already under mind-influencing effects like charming or dominating magic. Most insidiously, it was risky for a telepath to come into contact with those suffering mental illness, as it could spread from person to person, even in the course of healing them.[10]

“
I wonder what a mind flayer's brain tastes like.
”
— Volo[11]

Other, more obscure forms of sanity erosion could be found in the world, such as:

  • Even a sliver of divine omniscience could drive a limited mortal mind mad.[12]
  • Eating illithid brains caused madness in the consumer.[11]
  • The plane of Pandemonium innately assailed inhabitants with mental strain, likely driving them to some form of madness, minor or major. Signs of this mental instability were regarded as a good trait for companions in the Outer Planes, as it indicated they had visited Pandemonium and returned mostly intact.[13]
  • The Spellplague caused physical and mental changes in those it touched, often for the worse. The plaguechanged were usually violently mad,[14] and creeping madness caused further mental damage.[15]
  • Hill giants that were starved into insanity became known as mouths of Grolantor, driven by an incurable hunger and anxiety.[16]

Magic[]

Insane wizard UA

A wizard that has lost his sanity but not his power.

“
Necromancies and thaumaturgies should never be cast lightly, for the power of the weave can destroy as well as create. And even my hands cannot heal their minds, though I have spent hours upon hours here trying to comfort them.
”
— Mystra, regarding those at the House of the Golden Quill[17]

Arcanists that specialized in strange and alien magics were much more likely to stress their minds with alien knowledge, which eroded their sanity and ability to live in the mundane world. These included necromancers, alienists, fleshwarpers, aberrant minds, and anyone else who dealt with horrors best left beyond comprehension.[18][19]

Some spells created extraordinary anxiety and fear in the target, causing them to be wracked with panic. While these were relatively gentle compared to other mental attacks, they still left lasting mental wounds that could worsen over time. This included spells like fear, doom, cause fear, scare, and symbol of fear.[20] Terrifying illusions, if believed in, were also perfectly capable of shocking the victim and damaging their mental state as if they had seen the real thing.[21]

Many spells (mainly enchantment magics) directly influenced the mental state of the target, and in some cases caused thoughts and behaviour described as mad or insane; many of these could be found as part of the Madness domain:

  • Bolts of devilment left the target reeling in confusion, unable to act or even form coherent thoughts.[22]
  • Confusion caused a generalized disordering of thoughts, random behavior, and potentially self-destructive decision-making.[8] Spells that caused similar effects included chaos,[23] sphere of chaos,[24] insanity,[25] rigid thinking,[26] symbol of insanity,[27] and jester song.[28]
  • Cloak of insanity caused a kind of surface-level insanity in the target, which then protected them from mental attacks and psychic intrusions.[29]
  • Chaos field left a powerful mark on reality, including driving living creatures mad.[30]
  • Maddening scream left the target screaming incomprehensibly as their mind broke.[31]
  • Righteous wrath of the faithful, which filled allies with a fierce battle madness directed at enemies.[32]
  • Touch of madness, which left the victim dazed and confused as their mind clouded over.[33][34]

Magical Items[]

“
Volo, ye are the fool of fools. Illithid brains are poisonous, and drive humans insane with a flood of memories at every bite. Er, ask me not how I know this.
”
— Elminster[11]

Many magical items could be used to cause general mental unwellness similar to confusion, temporarily or permanently. This included the harp of Pandemonium,[35] harp of discord,[35] scarab of insanity,[36] and Joril's dagger.[35]

Cursed magical items sometimes imparted some sort of self-destructive behavior in the bearer:

Duration[]

Acquired mental illness could be fitted to three broad categories, depending on their severity, duration, and how they could be addressed:[2][4]

  • Short-term "temporary insanity" usually lasted from minutes to days as the mind reeled from some immense shock, psychic assault, or revelation, and displayed obvious behavioural changes in that time. After they gathered their wits and recovered, there was still usually signs of the experience remaining as strange quirks and mannerisms.[2][4]
  • Long-term "indefinite insanity" was the typical persistent form of mental unwellness, often lasting for months or years at minimum. It required dedicated treatment in the form of friendly company, medication, therapy, and good rest. Even after the most serious symptoms and triggers were addressed, the patient was still marked by the experience for the rest of their life.[2][4]
  • "Permanent insanity" was the most severe form, and was generally incurable even with the assistance of powerful magics. The individual suffered an irrevocable and massive shift in their ability to address reality and the nature of their own thoughts, never to be restored. They might be left unable to function and survive, or be left almost entirely undisturbed until the moment it was triggered without warning.[2][4]

Treatment[]

“
Hi, I'm Well-Adjusted Al, and my prices are sensible. I used to be called "Crazy Al," but therapy has convinced me that selling plate armor for 3 gold pieces and a small duck was no way to get ahead in business.
”
— Well-Adjusted Al, proprietor of Well-Adjusted Al's General Store[41]

In the Realms, it was understood that the best treatment for mental illness was found at home. Those in distress were first tended to by local priests and respected elders like family matriarchs, who kept company with the afflicted and let them speak of what troubled them while sipping on calming herbal teas and cordials. Priests and temples then took the lead on therapeutic, medicinal, and magical healing for mental afflictions and assisting the friends and family throughout the process. This level of care earned priesthoods the genuine and wide-reaching appreciation of folk on Toril, adding to the temporal power of the churches.[5]

Clerics provided the bulk of magical treatment and healing. This included inducing peacing sleep, invoking dreams to open the mind, and various other mental enchantments to soothe and rest. Specific spells included:[5]

  • General-purpose healing spells such as restoration[42] and heal could cure or mediate most illnesses,[43][44] with limited wish[45] and wish able to address more powerful afflictions.[46][47]
  • Atonement helped resolve the trauma of evil actions.[47]
  • Calm emotions[48] and pacification could temporarily suppress some mental afflictions and magical influences.[49]
  • Feeblemind could be used as a kind of treatment for extreme mental illness, as it caused the stoppage of all thoughts and granted the target relief from mental anguish.[5]
  • Psychic chirurgery could be used to cure all manner of mental conditions.[50]
  • Remove fear could be used to reduce the magnitude of recent fear-based trauma.[21]

Medicines were a vital part of not just physical but also mental healthcare in the Realms. Alchemists, local wise women, and traveling priests provided remedies that helped address symptoms and further other treatments.[5]

  • Tea made from feverbalm could temporarily suppress some mental afflictions.[51]
  • Noblestalk was a mushroom that helped to heal certain neurological illnesses.[39]

Types of Madness[]

Jon Irenicus, Shattered One

Jon Irenicus giving someone mental illness.

Afflictions of the mind took many forms, and was rarely simple and clear to understand. Delusions presented false aspects of reality and the self; anxieties, obsessions, and compulsions dominated thoughts and behaviours; mood could be driven by depression and mania; and dissociation blocked out parts of memory and personality. Some specific afflictions of the mind included:[52]

Places of Treatment[]

Institutions that gave treatment were available for the care of the unwell, such as temples, asylums, and hospitals. Though this (usually) meant a certain level of professional care, it also meant a disconnection from home and familiar faces, and a dependence on strangers in a strange place. Some places even mistreated their patients, whether from negligence or malice.[20]

  • The Cloister of St. Ramedar was an Ilmatari temple that specialized in treating the mentally ill.[66]
  • The House of the Golden Quill in Waterdeep provided care for those mentally damaged by magic.[67]
  • The Sanatorium of Helm's Hold became an asylum for those with spellscars and corresponding mental instability.[68]
  • Thornthar was a lodge for housing and caring for retired servants of Cormyr, especially those with senility.[69][70]
  • Spellhold was ostensibly a place of safety and treatment for those with mental instability and magical power, but was really more of a prison and laboratory used by the Cowled Wizards.[35]
  • Zellix the mind flayer operated an asylum in order to lure in and detain the mad, who Zellix believed had the tastiest brains.[71]

Sufferers of Madness[]

Notable Individuals with Madness[]

Creatures with Madness[]

Some kinds of creatures were particularly likely to have mental instability, or had patterns of thought that resembled it:

  • Beholders had a unique kind of insanity endemic to their kind comprised largely of chronic xenophobia and paranoia. The rare few sane beholders were outcasts among their kin, and regarded as dangerous threats.[78]
  • Derro were prone to eccentricities and quirks, in some cases turning into full madness.[79]
  • Duergar had a kind of shared psychic trauma from ancestral mind flayer torments, exacerbated by alcohol.[80]
  • Kuo-toa were chronically insane after surviving the influence of mind flayers.[81]
  • Medusae were turned into monsters by their pride, vanity, and lust for power. This transformation could drive them mad, and having to subsequently live with their condition usually broke them.[82][83][84]
  • Nothics were arcanists physically and mentally broken by the pursuit of dark and dangerous lore.[82]

Powers with Madness[]

Cleric of Tharizdun

A cleric of Tharizdun invoking the power of madness.

While it was normal for beings of power to have eccentricities and inscrutable goals, some had such strong obsessions, compulsions, and disordered thoughts that they could only be described as mad. Many of these gods also embodied the Madness domain, and their instability was passed on to their divine servants, followers, and magical boons.[85] The spells that they granted to their priests often warped the perception of reality or thought processes, such as bolts of bedevilment, confusion, insanity, maddening scream, phantasmal killer, rage, touch of madness, and weird.[86][87] Such gods included:

Appendix[]

Behind the Scenes[]

While various forms of mental illness have been used from the start in the Dungeon Masters Guide 1st edition, their appearance and use is defined more by dramatic conventions in ancient and modern storytelling than precise medical understanding. Ed Friedlander advised that given the widespread prevalence and harsh impact of mental illness in real life, tabletop insanity should ideally take an unrealistic form—heroically grand (and entertaining) fixations, compulsions, fears, and delusions that drive rather than hinder gameplay and the enjoyment thereof.[96]

External Links[]

References[]

  1. ↑ William W. Connors, Steve Miller (August 1997). Domains of Dread. Edited by Miranda Horner, Cindi Rice. (TSR, Inc.), p. 152. ISBN 0-7869-0672-3.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Andy Collins, Jesse Decker, David Noonan, Rich Redman (February 2004). Unearthed Arcana. (Wizards of the Coast), pp. 199–201. ISBN 0-7680-3131-0.
  3. ↑ 3.0 3.1 Gary Gygax (1979). Dungeon Masters Guide 1st edition. (TSR, Inc.), p. 84. ISBN 0-9356-9602-4.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Jeremy Crawford, Christopher Perkins, James Wyatt (December 2014). Dungeon Master's Guide 5th edition. Edited by Scott Fitzgerald Gray, et al. (Wizards of the Coast), p. 259. ISBN 978-0-7869-6562-5.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Ed Greenwood (2021-04-19). Mental Health in the Realms (Tweet). theedverse. Twitter. Archived from the original on 2021-04-19. Retrieved on 2025-05-28.
  6. ↑ Andy Collins, Jesse Decker, David Noonan, Rich Redman (February 2004). Unearthed Arcana. (Wizards of the Coast), pp. 195–196. ISBN 0-7680-3131-0.
  7. ↑ William W. Connors, Steve Miller (August 1997). Domains of Dread. Edited by Miranda Horner, Cindi Rice. (TSR, Inc.), p. 145. ISBN 0-7869-0672-3.
  8. ↑ 8.0 8.1 Jonathan Tweet, Monte Cook, Skip Williams (July 2003). Player's Handbook v.3.5. (Wizards of the Coast), p. 212. ISBN 0-7869-2886-7.
  9. ↑ Mike Mearls, Jeremy Crawford (2014). Player's Handbook 5th edition. (Wizards of the Coast), p. 226. ISBN 978-0-7869-6560-1.
  10. ↑ William W. Connors, Steve Miller (August 1997). Domains of Dread. Edited by Miranda Horner, Cindi Rice. (TSR, Inc.), pp. 149, 150. ISBN 0-7869-0672-3.
  11. ↑ 11.0 11.1 11.2 Mike Mearls, et al. (November 2016). Volo's Guide to Monsters. Edited by Jeremy Crawford, et al. (Wizards of the Coast), p. 76. ISBN 978-0786966011.
  12. ↑ Eric L. Boyd, Erik Mona (May 2002). Faiths and Pantheons. Edited by Gwendolyn F.M. Kestrel, et al. (Wizards of the Coast), p. 173. ISBN 0-7869-2759-3.
  13. ↑ Wolfgang Baur and Lester Smith (1994-07-01). Planes of Chaos. Edited by Michele Carter. (TSR, Inc), p. Cannot cite page numbers from this product. ISBN 1560768746.
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  15. ↑ Matt Sernett, Erik Scott de Bie, Ari Marmell (August 2011). Neverwinter Campaign Setting. Edited by Tanis O'Connor. (Wizards of the Coast), p. 160. ISBN 0-7869-5814-6.
  16. ↑ Mike Mearls, et al. (November 2016). Volo's Guide to Monsters. Edited by Jeremy Crawford, et al. (Wizards of the Coast), pp. 148–149. ISBN 978-0786966011.
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  18. ↑ Steve Kurtz (April 1, 1995). The Complete Book of Necromancers. (TSR, Inc), p. 43. ISBN 0-7869-0106-3.
  19. ↑ Richard Baker (1996). Player's Option: Spells & Magic. (TSR, Inc), p. 90. ISBN 0-7869-0394-5.
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  27. ↑ Jonathan Tweet, Monte Cook, Skip Williams (July 2003). Player's Handbook v.3.5. (Wizards of the Coast), p. 290. ISBN 0-7869-2886-7.
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  78. ↑ Richard Baker, James Jacobs, and Steve Winter (April 2005). Lords of Madness: The Book of Aberrations. (Wizards of the Coast), pp. 40, 48. ISBN 0-7869-3657-6.
  79. ↑ Mike Mearls, Jeremy Crawford (May 29, 2018). Mordenkainen's Tome of Foes. Edited by Kim Mohan, Michele Carter. (Wizards of the Coast), pp. 158–159. ISBN 978-0786966240.
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  84. ↑ Christopher Perkins, Will Doyle, Steve Winter (September 19, 2017). Tomb of Annihilation. Edited by Michele Carter, Scott Fitzgerald Gray. (Wizards of the Coast), p. 79. ISBN 978-0-7869-6610-3.
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  86. ↑ David Noonan (May 2004). Complete Divine. (Wizards of the Coast), pp. 139, 140. ISBN 0-7869-3272-4.
  87. ↑ 87.0 87.1 87.2 Richard Baker, James Jacobs, and Steve Winter (April 2005). Lords of Madness: The Book of Aberrations. (Wizards of the Coast), pp. 207, 208. ISBN 0-7869-3657-6.
  88. ↑ Colin McComb (October 1996). On Hallowed Ground. Edited by Ray Vallese. (TSR, Inc.), p. 136. ISBN 0-7869-0430-5.
  89. ↑ Colin McComb (October 1996). On Hallowed Ground. Edited by Ray Vallese. (TSR, Inc.), p. 168. ISBN 0-7869-0430-5.
  90. ↑ Colin McComb (October 1996). On Hallowed Ground. Edited by Ray Vallese. (TSR, Inc.), p. 83. ISBN 0-7869-0430-5.
  91. ↑ 91.0 91.1 Richard Baker, James Jacobs, and Steve Winter (April 2005). Lords of Madness: The Book of Aberrations. (Wizards of the Coast), p. 177. ISBN 0-7869-3657-6.
  92. ↑ Robert J. Schwalb (December 2011). “Dungeon Master's Book”. In Tanis O'Connor, et al. eds. The Book of Vile Darkness (Wizards of the Coast), p. 76. ISBN 978-0-7869-5868-9.
  93. ↑ Mike Mearls, Jeremy Crawford (May 29, 2018). Mordenkainen's Tome of Foes. Edited by Kim Mohan, Michele Carter. (Wizards of the Coast), p. 54. ISBN 978-0786966240.
  94. ↑ David Noonan (May 2004). Complete Divine. (Wizards of the Coast), pp. 121, 123. ISBN 0-7869-3272-4.
  95. ↑ David Noonan (May 2004). Complete Divine. (Wizards of the Coast), pp. 109, 118. ISBN 0-7869-3272-4.
  96. ↑ Ed Friedlander (October 1988). “Methods to Your Madness”. In Roger E. Moore ed. Dragon #138 (TSR, Inc.), pp. 38–41.
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