Madness in D&D 5e is an interesting but rarely-used mechanic.
There are many ways that madness can be inflicted upon characters and even more ways that it may manifest. Some may be temporary, lasting only for a number of intense minutes. Still, others may linger for hours, days, or even years.
So let’s peel back the curtain and gaze into the void in today’s article: Madness in D&D 5e!
When to Use Madness in D&D 5e
As mentioned in the beginning of this article, madness is not a commonly-used mechanic in D&D 5e.
To be fair and frank, most adventures aren’t particularly suited for it. While there are certainly terrifying monsters waiting around corners in long-forgotten dungeons, are they so terrifying that just seeing them can cause a mental break?
In most cases, the answer is no.
But two types of stories benefit greatly from using the madness mechanic.
Incorporating madness into a horror game is a great way to create even more dire tension in the story.
The characters are attempting to brave the most foul and depraved experiences that they have ever known. The sheer amount of stress and anxiety that accompanies this is bound to creep up on the characters sooner or later.
In a horror adventure, have madness start small and keep it personal for each individual character. Make it quick moments where, for just a split second, the character’s senses deceive them. Or did they?
Seeing a ghastly figure behind them in a mirror only to turn around and see nothing there. Having their belongings rearranged but intact even though nobody was in the room. These are the kinds of things that a character may try to explain away, but will secretly begin wondering what is happening.
As the horror intensifies, so should the madness.
When facing down or successfully escaping a particularly horrific encounter, have the player make a roll to determine if the madness gets to them. It’s the quiet moments where they finally attempt to rest and catch their breath that the lingering influence of the experience has a chance to seep into their character’s psyche.
To learn more about crafting unforgettable (and possibly traumatizing) horror games, check out our article on Running Horror Games in D&D 5e.
Encounters with Extraplanars
If your story has taken a turn towards the… strange… You will likely find great use of madness in D&D 5e when using creatures of unspeakable and alien natures.
Legendary entities such as Cthulhu inspire the most extreme madness in their minions and enemies alike. With dark origins beyond the realm of mortal knowledge and comprehension, madness is the peanut butter to these stories’ jelly.
Characters might find themselves fighting off madness when attempting to decipher the insane and rambling writings of cultists. Similarly, even paintings or other depictions of these extraplanar creatures may be enough to awaken the darkness within the mind of the viewer.
I strongly recommend checking out what the Dungeon Master’s Guide says about Sanity on page 265 if you are running this kind of game and want to incorporate madness mechanics.
Causes of Madness in D&D 5e
So what causes madness in D&D 5e?
Well, much like in real life, it’s difficult to pin down specific reasons for specific outcomes.
In D&D, you should ask yourself if this makes sense and would make the story more interesting for everyone at the table. If both of the answers are “yes,” why not have the character roll?
There are four common causes of madness in D&D 5e, though this is hardly an exhaustive list. Remember, madness is at the DM’s discretion.
Some spells may cause madness.
A prime example is Contact Other Plane, which allows the caster to contact some mysterious and powerful entity on another plane to ask them five questions.
A character who casts this spell must make a DC 15 Intelligence saving throw. If they fail, they take 6d6 damage and are insane until they finish a long rest.
While the spell says that they can’t understand what others say, can’t read, and only speak in gibberish, this is a great time to roll for a madness effect. Because it lasts until they finish a long rest, roll on the “Long Term Madness” table on page 260 of the Dungeon Master’s guide.
The Symbol spell may also be used to instill madness as a punishment for those who poke their noses where they aren’t wanted.
Poisons or Diseases
Some potent poisons or diseases may also cause madness as a symptom.
The only example of this in the Dungeon Master’s Guide is the Cackle Fever disease. As one of Cackle Fever’s symptoms, a character may develop a form of Indefinite Madness.
This does give DMs plenty of space to be creative though.
Some poisons may be uniquely suited to break a victim’s mind rather than their body with something more closely resembling a bad psychedelic trip than venom.
Similarly, some diseases may cause the infected to suffer from deep hallucinations that slowly fracture the character’s mind.
Madness may be inherent to volatile and extreme environmental conditions. A prime example of this would be the incessant howling of the winds in Pandemonium if the party finds themselves there.
Perhaps my favorite aspect of the various Demon Lords in D&D 5e is how they inspire madness.
While laying eyes on these foulest of entities is enough to cause madness specific to that Demon Lord, the same can occur from spending time in their lairs. In this case, the evil of the Demon Lord is so powerful and concentrated that it alters the environment to wear down interlopers’ minds.
The DM may decide that something within the story is so terrible that it could potentially cause madness in the characters.
Perhaps the party witnessed a particularly gruesome and unnatural enemy committing some atrocious act.
Did they witness something like the tail-end of a pack of gnolls’ raid on a helpless village?
Perhaps they safely got to shelter as a horde of zombies attacked only to spend the next several minutes or hours hearing the screams of those being devoured just outside.
These are experiences that could (and should) have deep and lasting impressions on characters.
In these situations, the DM may have characters roll to determine if the experience has caused some form of madness to take root in their minds. The character may toss and turn in their sleep unable to get the horrifying experience out of their minds, whether or not they were able to escape the experience with their lives.
If it was a particularly close call, this becomes even more effective and believable.
Madness in D&D 5e – Durations and Effects
There are three different durations of madness in D&D 5e: short, long, and indefinite.
Short-term madness lasts for 1d10 minutes. Despite the short duration time, these effects are typically very extreme.
Short-term madness effects range from becoming paralyzed to attacking everything nearby or falling unconscious. The Short-Term Madness table is on page 259 of the Dungeon Master’s Guide.
Long-term madness last for 1d10 x 10 hours. These effects are somewhat less overt than those of short-term madness, but can become a major setback for the party until the madness is cured.
Effect include things like developing severe paranoia, losing the ability to speak, or becoming partially blinded/deafened. The Long-Term Madness Table is on page 260 of the Dungeon Master’s Guide.
Lastly, we have Indefinite Madness. This is a result of something so unbelievably scarring that it has fundamentally shaken a character to their core. Nothing short of a Greater Restoration or more powerful spell can rid a character of this, if at all.
Where short-term and long-term madness have effects that are tied to some kind of mechanic, Indefinite Madness is a bit different. The Indefinite Madness table on page 260 of the Dungeon Master’s Guide lists effects as personality flaws that the character gains.
A character afflicted with Indefnite Madness may find themselves relying heavily on drinking to stay sane.
Rolling For Madness
The DM sets the DC for a saving throw to resist some maddening effect as appropriate. A DC of 11 or 12 is common for most situations. Of course, something particularly scarring may have a higher DC.
Similarly, the DM chooses what kind of saving throw most applies. This will commonly be either a Wisdom or Charisma saving throw.
The Rules as Written for Madness and Sanity in the Dungeon Master’s Guide leave a lot to the DM, which is something that I really like. Situations that could cause madness are going to be wildly different from campaign to campaign.
Curing Madness in D&D 5e
In a pinch, the Calm Emotions spell may be able to temporarily suppress a character’s madness. Just keep in mind that this only lasts for 1 minute, so it’s not likely to be your best options.
However, if the party is trying to be sneaky and a party member is babbling incoherently, it may be worth it to temporarily suppress their madness so you don’t attract a guard’s attention.
If a character is afflicted with either short or long-term madness, using Lesser Restoration will cure them. You need stronger magic (like Greater Restoration) to cure a character’s Indefinite Madness.
It may be possible that a character’s madness is not a result of experiencing some horrible thing and that they have simply had madness thrust upon them. Depending on the nature of what is causing their condition, using a Remove Curse or Dispel Evil spell may work!
Madness as a Character Trait
The Indefinite Madness table on page 260 can also give some inspiration for character flaws and personalities.
A character who is starting the adventure having already been through some kind of traumatic experience may have a type of Indefinite Madness.
It could very possibly add a level of gravity and tragedy to a character. Are they adventuring in spite of this condition or perhaps to get revenge on whatever caused it?
Generally, I recommend going away from the “blabbering loose cannon crazy person” trope when making a character. It is never as fun for anyone as the player may think and rarely adds to the story.
Instead, portraying this condition as a type of “skeleton in the closet” that the character is attempting to overcome (or otherwise adventuring in spite of) adds a deep level of roleplay and humanity to them.
Madness as a Plot Hook
A character or particularly important NPC may be able to be cured of their madness if certain story elements occur.
Perhaps the party’s Noble Rogue went mad after their family were turned into vampires. Laying their family to rest and exacting revenge on the ones who turned them may be what is necessary to solve their affliction.
What about the NPC Wizard who was tasked to retrieve a lost Arcane artifact from a dungeon but their party was destroyed by the horrible creatures inside. Barely escaping with their life and fearing that failing their mission has resulted in something awful, the Wizard haven’t been quite right for days now.
If the PCs can acquire the artifact, however, that might help the Wizard’s condition and get the party a hefty reward!
This can be powerful in setting the mood and expectation for a dungeon. What could be so terrible that witnessing it causes this kind of affliction?
Conclusion – Madness in D&D 5e
Madness won’t work for every game type. Honestly, it won’t work for the vast majority of game types. If your group is going for the classic Sword and Sorcery type D&D game, you probably won’t find much use for this mechanic in a way that feels natural.
But if you’re playing a game where using the madness mechanic would feel natural, it’s a great addition to the story. Nothing adds to the tension quite like the fear of losing one’s mind in the face of unspeakable horrors.
After all, as a certain Clown once said… “Madness is like gravity, all it takes is a little push.”