Here is my take on Fear and Madness rules for my Mythos & Madness campaign.
As always (hopefully) I've kept this 'simple' but useful within existing rules mechanics.
Here we go.
When the Investigator PC discovers something that the DM feels may cause fear, revulsion, or terror, a realization of their imminent mortality and a challenge to their inherit sense of safety, he may call for a Fear check.
A Fear check is a Saving Throw (Paralysis). If successful the Investigator pushes on with no penalties.
- Save (Paralysis) or the victim is shaken and receives a -2 to all actions for 1d6 rounds.
- If failed by 5 or more the victim is badly shaken and suffers a -4 to all actions for 1d6 rounds.
- If failed by 10 or more (or a natural 1 rolled) the victim is terrified beyond reason and roll 1d6 for a result below:
1. Fight: You are hit with an adrenal surge and attack the source of terror. You gain a +2 bonus to hit for your frenzy but a -2 penalty to your AC. You will viciously attack the source of terror for 1d6 rounds. Then you may act normally.
2. Sickened: You reel, gagging with revulsion. -4 to all actions for the next 1d4+2 rounds as you struggle to regain control.
3. Shock: You are dazed by the terror. You lose any actions for the next 1d4 rounds. If you recover and the source of terror is still there you suffer a -4 to all actions until the source of terror is defeated, flees, or you can escape yourself.
4. Panic: You begin attacking wildly in a blind panicked frenzy. This lasts for 1d4+2 rounds. Melee or ranged it doesn't matter: randomly determine who you are attacking and gain a +2 bonus to hit for your frenzy but a -2 penalty to your AC. For automatic fire determine a new target for each burst.
5. Blackout: You drop in a dead faint for 1d4+2 rounds. If you awaken and the source of terror is still there you suffer a -2 to all actions until the source of terror is defeated, flees, or you can escape yourself. A character can be awoken from the blackout by an ally with a successful Intelligence check. A Physician adds a +2 bonus to the check, a Scholar with Psychology receives a +4 bonus.
6. Flight: You head away from the source of your terror as fast as you can. This lasts for 1d4 rounds. Make a Save (Paralysis) or drop whatever you are holding. If you cannot flee (trapped in a room, no route out) you must face the terror with a penalty of -4 to all actions until the source of terror is defeated, flees, you can escape yourself, or the length of time rolled expires. A character can be brought out of this state by an ally with a successful Charisma check. A Physician adds a +2 bonus to the check, a Scholar with Psychology receives a +4 bonus.
When confronted by a Mythos being or knowledge gained into the true nature of the universe via tomes, spells, etc the DM will often call for a Saving Throw (Paralysis) or the victim sanity slips. Often this Save will be modified by a penalty if the Thing or Knowledge is particularly alien or horrifying.
If the Saving Throw is failed the Investigator becomes terrified and rolls on the Fear table above.
If failed by 10 or more (or a natural 1 rolled) the victim goes mad and gains one of the following afflictions as chosen by the DM (or he creates one of his own.)
3. Dark Personality
6. Insane Quirk
9. Night Terrors
You self medicate yourself in order to deal with daily existence. To get through the day you must have at least a bottle of drink or a hit of drugs to keep yourself going. If you do not have your daily fix all actions are at -2. When you do have your 'medication' you are only at a -1 penalty.
You must do certain things each day. Compulsions can include such things as having to wash your hands, check your weapons, etc. The DM can call for these randomly (at least one per play session) and you must make a Saving Throw (Paralysis) to avoid doing your little ritual. If you must do it immediately or take a -2 penalty to actions until the ritual is completed. If you fail by 10 or more (or roll a natural 1) you are so distracted by your compulsion you take a -4 to actions until the ritual is fulfilled.
Kleptomania falls under compulsion but works differently. If you fail your Saving Throw you must acquire the object of your desire. You will be at a -2 to actions until you steal it. If you fail by 10 or more (or roll a natural 1) you must have it NOW and will take it despite any consequences.
Particularly dark DM's can come up with more sinister compulsions such as cannibalism or necrophilia.
Such particularly debilitating compulsions may call for a weekly roll instead of a daily roll given the severe social and legal consequences associated with such behavior.
When under stress you must make a Saving Throw (Paralysis) or a darker piece of your psyche emerges. You are more aggressive and every time you are irritated or challenged you must make a Saving Throw (Paralysis) or become violent towards the object of your irritation. This lasts for 2d6+4 rounds. Once it ends you come to your senses, even if still in a fight. You will not manifest this again for 1d6 hours. You gain a +1 bonus to melee/unarmed damage while in this state.
You believe things that are odd and, frankly, not real. Hallucinations are not uncommon. The DM will describe these things as if they are fact to your character. If challenged to the reality of what you believe you must make a Saving Throw (Paralysis). If you fail you refuse to believe what you are told and cling to your reality. If you fail by 5 or more you will be become irrational and refuse to listen. If you fail by 10 or more (or roll a natural 1) you will become physically violent for 2d6+4 rounds.
You are consumed with severe depression. Every day is a struggle to care enough to get yourself together and face the world. All actions are at a -2. If you are prescribed medication this drops to a -1.
You have personality quirks. Severe ones. It can get so bad people become agitated by your presence. You may be paranoid, talk to yourself, wildly laugh inappropriately, constantly fidget, eat odd substances, mimic those around you, or other socially inappropriate behaviors. You may be afflicted with tics, stutters, strange gesturing, tremors, etc. You receive a -2 to Charisma for your quirk. You must make a Saving Throw (Paralysis) each morning. If you fail your particular quirk is particularly bad today increasing your Charisma penalty to -4 for the day.
Your madness builds into a murderous rage. If provoked or if you become angry you must make a Saving Throw (Paralysis) or fly into a rage and attack the source of your anger. This rage will last for 1d6 rounds.
If you fail the save by 10 or more (or roll a natural 1) you will fly into a murderous maniacal rage with a +2 bonus to melee/unarmed damage until the target is dead or you are restrained.
You cut, beat, or burn yourself. When you are stressed you must make a Saving Throw (Paralysis) or be overwhelmed. To calm yourself you damage yourself doing superficial damage. However if you fail the save by 10 or more (or roll a natural 1) you go overboard and do 1d3 points of damage.
There is no rest when you dream. You have vivid nightmares and wake up sweating and screaming. Each night make a Saving Throw (Paralysis). If you fail you are at -1 actions for the rest of the day. If you fail the save by 10 or more (or roll a natural 1) they were exceptionally bad and the penalty is -2.
You have an irrational fear of an object or situation. The DM will choose an appropriate one. When faced with the source of your fear you must make a Saving Throw (Paralysis). If you fail you take a -2 penalty to actions while in the presence of the fear. If you fail by 10 or more (or roll a natural 1) you are paralyzed, unable to act until the source of fear is removed.
Your are a nervous wreck. Your nerves are shot and your defenses against Fear and Madness are low. You take a -4 penalty to Saving Throws involving Fear and Madness.
You also receive a + 1 bonus to initiative from being so high strung,
You hear voices telling you things, arguing with you, taunting, or just giving bad advice. You suffer a -2 to Charisma. You must make a Saving Throw (Paralysis) each morning. If you fail they are exceptionally loud and annoying today and you can't help but talk back to them, increasing your Charisma penalty to -4 for the day. If you fail by 10 or more (or roll a natural 1) you are constantly distracted by them and take a -2 penalty to actions.
When a character goes insane the DM may allow for the character to gain and reveal a small bit of knowledge he gains about the situation or creature which caused his madness. If the DM calls for it a Wisdom check is rolled. If successful a small bit of information is babbled by the poor mad devil. The DM can use this to provide a vital clue to whatever the Investigator's are dealing with.
Investigators afflicted with madness may not always be taken to a care facility for treatment.
If kept out of such places their afflictions can be lessened with medications. The medications give bonuses to Saving Throws associated with Madness afflictions based on the strength of the medication prescribed. They must be taken daily. If they are skipped they then the patient receives no benefit that day.
Moderate Medication, +2 bonus to Saving Throw
Heavy Medication, +4 bonus to Saving Throw (-1 penalty to Int and Wis)
Recovering from an affliction requires a lot of therapy, quite likely medications, and a calm environment for the patient. For each month of treatment the character will get to make a Saving Throw (Paralysis) modified by such things as care environment and drug treatments.
⦁ If the patient makes his Save he is cured of his madness and the affliction is no longer applied.
⦁ If the patient fails the roll he is not cured. He can attempt another Saving Throw the next month as long as the recovery program is followed. If treatment is not given or refused he does not get a Saving Throw for that month.
⦁ If the patient failed by 5 or more the next month's Saving Throw has a -2 penalty.
⦁ If the patient failed by 10 or more (or rolled a natural 1) the next month's Saving Throw has a -4 penalty.
This is the absolute best option for a quick recovery. Working in the patient's home or private institution the care-givers can give the patient their complete attention and private caregivers tend to be more compassionate and considerate. This is the best level of care and it is expensive.
This means being confined to an asylum. The only advantage is that they are cheap or even free if run by the state. Asylum quality varies wildly. Some are run well using the latest methods in therapy; others are absolute Hell-holes that are little better than prisons where the mentally ill are treated as animals. Caregivers, especially in the poorer Institutions are often overworked, underpaid, and very under-qualified for their jobs.
If the patient fails their monthly Saving Throw by 5 or more he must roll immediately roll another at a -4 penalty. Failure at this second Save indicates that he is deteriorating physically and mentally. Healing hit points takes twice as long and the next months Saving Throw is at a further -2 penalty.
Psychotherapy is rare here. The typical treatments involve supervised work, hydrotherapy, electro-shock, confinement, and heavy doses of behavioral medications.
Modifiers to the Monthly Recovery Saving Throw
Psychoanalysis available, +2
Medication, +2 to +4 depending on strength of medication
Private Care environment, +4
Asylum Care environment, 0 to -4 depending on quality of care
Physically and mentally deteriorated, -2
Previous month's Saving Throw failed by 5 or more, -2
Previous month's Saving Throw failed by 10 or more, -4
Refused or denied treatment that month, No Saving Throw allowed
Adventuring that month, No Saving Throw allowed