Dungeons & Dragons: How To Implement Madness

Madness is a pretty difficult concept to roleplay in Dungeons & Dragons. While being in full control of your character, you need to deliberately take actions that don't make sense and may even contradict your character's personality and motivations. The Dungeon Master's Guide has some optional rules for when your characters come into contact with maddening experiences or magical effects.

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Using these well can be a challenge. Many of the options on the madness table are either punishing debuffs or roleplaying prompts that completely override a character's existing personality. Applying the right finesse and knowing when to go off-book can help you keep madness interesting.

When To Use Madness Effects

Madness is divided into three categories in the Dungeon Master's Guide.

• Short-term effects with a strong immediate impact. These last a few minutes at most but can outright remove the player's control of their character.
• Long-term effects with a lingering negative impact typically prevent the character from taking a specific type of action and can last for several days.
• Indefinite madness lasts until cured with greater restoration. These have no direct mechanical impact but instead, impose new character traits that can alter a player's decision-making.

Each of these fits well into certain scenarios that make use of their effects the best.

• Short-term madness works best when applied in time-limited situations. You can treat them as powerful debuffs inflicted by specific monsters and spells that are able to warp the targets mind.
• Long-term madness fits best as a consequence of exploration, such as with cursed items or traps. It has a longer scope than a single combat encounter but isn't a permanent affliction.
• Indefinite madness works best as a narrative tool, when the PCs have been exposed to something traumatising or suffer a harsh mental attack.

Indefinite madness is unlikely to be cured in most low level campaigns. You should be cautious about giving these effects to players without covering it in a session zero.

Using Short-Term Madness

The DMG's table for madness effects is a mixed bag but can broadly be divided into a few categories, each of which is trying to fit a different gameplay theme or narrative trope. Its a good idea to look through the table ahead of time and replace any options that don't fit the tone of your game.

Madness

Effects

Gameplay Impact

Unable To Act

Most of the short term madnesses fit this category, varying between paralysed, stunned or compelled to flee for the duration. The player doesn't get to do much to interact with this madness.

If these effects happen in combat, the character might as well be reduced to zero HP. In most other situations the party can just wait for the madness to pass.

Limits Player Options

Examples of this include losing the ability to speak or having disadvantage on all skill checks for the duration.

How penalising this is going to be will depend wildly on the character being affected. A spellcaster who loses the ability to speak loses almost all of their abilities, while a barbarian can ignore the effect.

Wacky Madness

Effects like "doing whatever a person instructs" or "feels an overpowering urge to eat dirt".

These don't really do anything besides set up a rather stiffly scripted comedy scene. Unless you have some stellar roleplayers, these options are more of a nuisance than anything. Especially if rolled repeatedly.

Potentially Lethal

The 10% chance that you have to spend the next 1d10 minutes (up to 100 rounds of combat) randomly attacking your party.

Some groups will enjoy the drama of having to incapacitate a friend without hurting them. Others will see this as a waste of time and resources.

One option that can work well is to pre-roll the type of madness an effect will produce so you can set the scene appropriately. If you know how a cursed item is going to compel its finder to chew on the walls you can foreshadow it with the appearance of the environment.

Using Long-Term Madness

Long-term madness effects follow similar rules to the short-term table but last between ten and 100 hours. This means that a poor roll on the table can prematurely retire a character, as the rogue now has disadvantage on all attack rolls for an entire week and can no longer sneak attack for the duration of the campaign.

Other effects on a table can be taxing on the DM. Giving a character long-term blindness means changing how you approach every scene that relies on visual storytelling.

Another madness effect forces a saving throw against confusion every time the character takes damage, slowing combat significantly.

With the steep cost that long-term madness can inflict, you will want to be sparing about using it. You might also allow the players to spend inspiration to reroll what madness they are afflicted with, to avoid the most debilitating options.

Using Indefinite Madness

Indefinite Madness works in a completely different way to the other two madness mechanics. These are additional character flaws a character gains that do not directly impact their ability to roll skill checks or participate in combat.

Instead of rolling on the table for indefinite madness, we recommend that you negotiate with the player on which option they think makes sense for their character and allows for a good story:

An indefinite madness that causes the PC to fixate on an in-character goal is often more narratively interesting than 'you rolled under a 15 and are now an alcoholic.'

The indefinite madness options on the d100 table can be used as starting points or to model a new equivalent option. This is something that will be with the character for a long time, so you don't want to foist the player with something that overrides their character's personality entirely.

If you apply indefinite madness as a result of a non-magical trauma, you might allow the players to work through it in roleplaying and downtime rather than slapping a greater restoration on the problem of PTSD.

Roleplaying Madness

There are some rather broad challenges that can come up when trying to fit madness into a game with serious roleplaying. Especially if you don't replace some of the sillier options.

Madness appears and recedes in singular dramatic moments rather than being any accumulation of stress over a period of time. Most of the madness effects make no mention as to how the person responds to the cause of their distress.

Dungeons & Dragons doesn't have mechanics for trauma therapy so the best the mechanics can provide for curing a debilitating mental illness is to slap a greater restoration spell on the person and have all symptoms instantly disappear.

Its generally a bad idea to use the mechanics to represent mental conditions experienced by your players or people you know. Some of the madness options are designed to resemble obsessive compulsions or stimming behaviors, and you may want to remove these options from your game. As always, use safety features like an X card to protect your group.

Most methods for expanding the madness mechanics or personalising it to a character and setting are going to require skilled roleplaying and nuanced DMing.

This also means giving sanity a bigger role in your story than the variant rules are able to provide, requiring you to largely ground it in the players' roleplaying or to borrow stress mechanics from other systems such as Call of Cthulhu or Blades In The Dark.

In a purely roleplaying context, there are a few alternative ways to handle a madness-inducing effect:

• Inspiring hatred, with the character feeling compulsions to combat the source of the effect. If its a creature, like an illithid, they may harbour a long-term hatred for their kind.
• Compromised judgments, with the player making suboptimal but narratively coherent decisions. You might represent this mechanically by limiting the time they have to consider their next action or giving inspiration for following the first thought that occurs to them.
• Long-lasting fears. Rather than a singular "run away from this combat" type fear response, you might list down triggers that cause them to feel this same fear, such as fighting in tight spaces or against a particular enemy.

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