Stark Staring Mad

I like insanity rules.  I like that there's a psychological element to the game.  I've seen other sanity mechanics, but I wanted to make my own.  Here they are.

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1. Whenever you see something terrible, you gain 1 Insanity Point. 
2. Whenever you gain insanity points, roll d20 + Wisdom mod.  If you roll higher than your current amount of insanity points, nothing happens.  (But the points don't go away.)
3. If you roll equal-to-or-less than your Insanity Points, you have a breakdown.  This lasts until your friends can calm you down (a few rounds away from the stressful) or you cry yourself to sleep.
4. At the end of your breakdown (if you had one), make a save.  If you fail the save, reduce your insanity points to 0 and gain a permanent madness.  If you succeed on your save, reduce your sanity points by 1.

Breakdowns (d4)

1. Fainting.
2. Flee in terror.
3. Hide.
4. Stand there babbling/worshipping.

Permanent Madness (d20)

1. Phobia. (Must make Wis check to endure fear.)
2. Kleptomania. (Urge to steal things from vendors, Wis check to resist.)
3. Minor hallucinations. (Senses become unreliable, e.g. listening at doors)
4. Nightmares. (Con check to sleep unaided.)
5. Voluble Paranoia.  (Cannot talk without talking about conspiracies, penalty to social interaction.)
6. Substance Abuse.  (Wis check to pass up an opportunity, penalty if you go without it.  This includes sex addiction.)
7. Amnesia.  (Lose some XP, but it will return slowly, as memories are recovered.)
8. Alien Hand Syndrome.  (One arm basically becomes an NPC.  Roll a starting reaction roll for it to see how it feels about you, and then roll again during stressful situations.)
9. Nervous twitches.  (Penalty to fine tasks, picking locks, climbing walls, firing bows.)
10. Murderous psychosis.  (Wis check to avoid flying into a rage during combat, this gives no bonuses but it prevent you from retreating.
11. If you roll 11-20, it's the DM's choice of whatever's most appropriate.

You can get rid of insanity points by doing extremely normal stuff.  Getting drunk with your friends, working on a farm and milking cows, drinking wine while staring at the ocean, and taking long, introspective showers.  You can remove 1 insanity point per week if you are relaxing in peaceful, sane surroundings.

Obviously, it's more dangerous to keep adventuring once you've got Insanity Points on your character sheet, so after a PC picks up 1 or 2, they should maybe start thinking about going back to town.

A PC cannot normally get more than one Insanity Point from the same source.

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I like this method because it still links insanity to both Wisdom and saves, so people with low wisdom will suffer more breakdowns, while higher level characters will have a lower chance of permanent madness.  They probably got enough of that at lower levels anyway.  It also gives characters a reason to stay in town and just be normal people for a little while.  Read some books, tell stories in the tavern, bang the innkeeper's daughter, whatever.

If you do the math, the level 1 PC who sees five things that give him +1 insanity point each has got close to a 50% chance of being insane by now.  Math is funny like that.

I think that insanity points should be given out when a player knows and accepts the risk.  Less of "you open the door and see Cthulhu's penis so now you gain 5 insanity points" and more of "Are you sure you want to transcribe the spell out of the squidlord's tome?  The letters are literally crawling across the page."  Or better yet, "Are you sure you want to torture the prisoner to find out where the rebel base is?  That sort of thing can scar you for life."

I'm not saying the first kind is bad either.  Sometimes the party needs to be surprised with the cuttlefish of cthulhu (if you know what I mean).