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Sanity Meter

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"Like many games with a Lovecraftian bent, it implements a sanity meter, as though sanity is like diesel oil or something, and you can get a reading on it by sticking a dipstick in your ear."

Some games will try to measure how bad or good you're being, on the basis that the game is set in a moral universe. This ain't one of those games. This is one of those games where the very nature of reality is mutable, there are things out there beyond human imagining that mean us ill, and you've encountered several of them first hand. After a while, that's really going to wear on a person...

The Sanity Meter measures how well you've managed to keep your mind together when facing the horrors from beyond reality's edge. This comes vaguely in three shapes, which can often overlap:

  1. Some kind of fear/panic level that gauges how much of a Nervous Wreck your character is and increases with every scary monster or event you encounter. When filled up you'll helplessly run around in panic or even die from fear.
  2. Some kind of madness/derangement level, that gauges how psychologically unstable or Ax-Crazy your character is. When filled up, you'll be put into an Asylum, randomly destroy objects or become a spree-killing Serial Killer.
  3. Some kind of trauma level, that gauges how heavily your Trauma Button has been pushed and how much you suffer from Psychological Horror or Personal Horror. When filled up, you reach the Trauma Conga Line, turn to an Empty Shell, or even have a Death by Despair.

Some games will actually merge the Sanity Meter and the Karma Meter, on the grounds that doing enough horrible things may either give you Post Traumatic Stress Disorder or disconnect you from the activity altogether. Others will let you ding the Sanity Meter to power awesome spells. Either way, you'd better keep all your marbles clutched tight, 'cause it looks like Cthulhu's coming around again.

Compare Morale Mechanic, where the combatants' morale and fighting spirit are the ones being measured. See also Intoxication Mechanic, wherein a player character consuming mind-altering substances causes an Interface Screw.

"Sanity Meter in video games causing various Interface Screws on decrease" is, by the way, patented by Nintendo, the publishers of Eternal Darkness.


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    Anime & Manga 
  • Nyaruko: Crawling with Love!, being one big love-letter to the Cthulhu Mythos, references SAN points pretty often, such as when Mahiro sees Nyarko brutally slaughter a nightgaunt. In fact, the opening theme for the 2013 series is underscored by a repeated chant of "SAN-chi, pinchi!" (often misheard as "sons of bitches") which means "Your SAN points are in danger!"
  • In Psycho-Pass, the titular Psycho Pass is a mental scan which includes a sanity meter (or, more accurately, a stress meter).
  • Puella Magi Madoka Magica features Soul Gems, which appear to keep track of their owner's health or ability to use magic. No one seems to be quite sure, but it's very clear that allowing one to stop glowing completely would be a very bad idea. Corruption spreading through a soul gem is actually its owner's despair. As it becomes more corrupted, they lose touch with reality to a greater extent and draw closer to outright madness until finally, they become a Witch.

    Board Games 
  • Fantasy Flight Games' Arkham Horror and Mansions of Madness both feature a sanity stat, naturally, since they are both Call of Cthulhu licenses. Encounters with monsters and mythos horrors can lower the characters' sanity. Strangely enough though, being reduced to 0 sanity is not terminal in either game, being mostly a speedbump in the former, and increasing the chance of your character doing horrible crazy things in the latter.
  • Betrayal at House on the Hill features sanity as one of your stats. Like all of the other stats, it is used for various challenges, and if it falls to 0 your character dies.

  • Rick Fortune of the Dice Man game comic series had a Sanity score — dropping to zero or below ended the game as you went mad. A character you were protecting so they could testify in court in one scenario also had a score — letting it drop too low meant you failed as they turned into a gibbering wreck unable to do so.
  • In the Fighting Fantasy series:
    • House of Hell: You collect FEAR points when something eerie happens. If your total ever equals or exceeds your FEAR score, you instantly die. Notably, it's literally impossible to get through the book if you roll poorly on your FEAR score — you must score at least 7 points, which is the minimum FEAR score.
    • Beneath Nightmare Castle, a book based on Lovecraftian Horror, have a WILLPOWER meter for your character, where every time something scary happens to you, you'll need to roll against your current WILLPOWER tally to determine the outcome. It will decrease regardless of the results, and once your mental strength gets too low you'll succumb easily to whatever horrors you can encounter.
  • The Forbidden Gateway series of books, being inspired by Lovecraftian Horror, have your character, a private investigator of the supernatural, having an Endurance score. Scary encounters will drain Endurance points, and when the Endurance reaches zero the player then passes out from shock before awaking and suddenly forgetting his name, mission, and everything else important to him.

  • In Labyrinths of Echo, denizens of the World of the Rod (where the series takes place) can apparently sense a person's insanity as an acrid smell ("scent of insanity"), not unlike that of excrement—and the madder the person, the stronger the smell around them. The protagonist, coming from another world altogether, never perceives this smell, although on at least occasion (after reading the Book of the Burning Pages), another character senses it coming from him.
  • Ursula K. Le Guin's short story SQ is a fable about the development of a scientific, accurate method of measuring a person's sanity (the Sanity Quotient score) and the unfortunate effects it has on society.
  • Threadbare: Generica Online has an interesting variant where Sanity is both a measure of your ability to act rationally, and one of the primary pools that skills draw power from. Most Sanity-based skills are spells, so magical classes tend to be very calm and rational until they've spent a few battles healing all their allies and they are literally down to the dregs of their Sanity. There are also a few spells and effects that attack Sanity, most of them associated with the Cultist Job.

    Tabletop Games 
  • In a bit of a borderline example, most Fate-based games (Spirit of the Century, The Dresden Files...) don't have an explicit distinct sanity system, but do already resolve mental/emotional conflicts using the same rules as physical ones (having a separate "mental" or "composure" stress track is practically the default). A character can thus already find themselves just as affected by psychological trauma as by any bodily injury using just the stock rules. (The Fate version of the Call of Cthulhu WW2 supplement Achtung! Cthulhu does somewhat unsurprisingly add its own CoC-inspired set of sanity rules on top of this.)
    • Mental stress tracks are also popular resources for powering up magic, with the risk of madness for using too much.
  • All characters in Anathema have a will score, which represents their will to live. It can be raised and lowered in a variety of ways. When a human's will hits 0 they commit suicide. When a shroud's will hits 0 they suffer utter annihilation.
  • Blades in the Dark has Trauma, which mounts up over time. When a player character hits four Trauma, five with certain upgrades, they're no longer functional enough to go a-thieving and has to retire. Said retirement" can involve Taking the Heat for the crew, reducing their Heat.
  • Call of Cthulhu pretty much pioneered the Sanity Meter. Each character starts with some measure of Sanity out of 100. When encountering a Mythos horror, or something just plain horrific, they roll their Sanity score, then roll again to see how many Sanity points they lose (the range goes higher if the first roll failed, e.g. "roll for 1d6/1d20 SAN"). SAN points can be regained through psychotherapy and successful adventuring, but learning more about the Mythos permanently decreases your maximum Sanity. In fact, it is absolutely impossible to learn everything about the mythos without your SAN falling to 0 first.
    • A form of Sanity Meter is actually implemented in the First-Person Shooter Call of Cthulhu: Dark Corners of the Earth, where the longer you spend looking at (or just being around) the horror scenes, the more disturbed the protagonist becomes, eventually bringing in Interface Screw and, at one point, suicide.
    • In another take on Lovecraft RPGs, Trail Of Cthulhu, the Sanity Meter is broken down into two parts: Stability and Sanity. Stability is one's in-the-moment appearance of rationality, while Sanity is one's ability to convince oneself that human lives and interests matter in the face of a Cosmic Horror Story. Secret cultists who are nuttier than a bag of fruitcakes and yet still interact with society on a relatively normal level have high Stability but low Sanity. Stability can regenerate, but once a character loses Sanity points, they're generally not getting them back.
    • Parodied in Toon. One of the settings in the Tooniversal Tour Guide supplement is "Crawl of Catchooloo", where exposure to the eldritch but otherwise strait-laced minions of the Elderly Gods drives the 'toon PCs sane (since they're already crazy to begin with). Sane PCs become boring, unremarkable characters with pointlessly dull interests.
    • Arkham Horror, being Cthulhu Mythos The Board Game, also makes use of sanity rules. Seeing monsters and casting spells are the primary cause of sanity loss, but many encounters can also trigger it. Being reduced to zero sends you to Arkham Asylum (not that one) with some items lost. (Before long, you'll regain enough Sanity to leave ... but you'll be back. Oh yes. This game takes hours.)
  • The various gamelines in the Chronicles of Darkness world all have something similar to a sanity meter crossed with a Karma Meter. It represents how well your character is able to hold themselves together in the face of the world, and how much they're able to relate to others. If you commit a "sin" (something which goes against your moral code), you may lose a point, and you may also gain a Derangement, which is some specific mental illness (Obsessive-Compulsive Disorder, Paranoia, Megalomania, etc), often something which relates to the specific way in which you sinned.
    • For standard humans, there is Integrity, which represents one's ability to deal with the horrors of the world. If your character ever ends up changed into a supernatural being, Integrity is replaced by a different meter, depending on what they become.
    • For example, if your character becomes a vampire, Integrity is replaced by Humanity, which measures your ability to empathize with human beings and recognize them as more than just walking blood bags. If your Humanity drops to 0, your character has completely lost touch with humanity and becomes an NPC.
    • In Werewolf: The Forsaken, your character has a Harmony meter, measuring their ability to balance their human, intellectual side with their animal, bestial nature. Tip too far in one direction or the other and you risk becoming spiritually unbalanced.
    • Changeling: The Lost has a Clarity rating for its characters, which represents how well a person's able to hold it together after being put through hell at the hands of The Fair Folk. Murder and theft count as sins, but so do taking psychotropic drugs and experiencing unexpected life changes.
    • The Trigger Points system in Hunter: The Vigil, prior to the changes introduced in the "God-Machine" update, tracked sanity not so much in how moral you were but in how much you had skewed your Code to avoid Morality degeneration in pursuit of your Vigil. If you traded out enough killing-related ones you were likely to end up a slasher.
    • Beast: The Primordial has Satiety, which acts as a kind of three-way cross between a Sanity Meter, a Karma Meter, and a Mana Meter. The premise of the game is that your soul has been replaced by an incarnation of primordial horror, and you have to keep it fed by inflicting pain and suffering on others. Satiety is the measure of how well-fed your Soul is: at high Satiety the Horror is well-fed and sleepy, and generally leaves you alone, while at lower Satiety it grows restless and starts pushing at you to attack or destroy, to inflict the suffering that the Horror feeds on.
    • In Mage: The Awakening, Integrity is replaced by Wisdom, which represents not only your morality but also your ability to judge when and how to use magic properly. If you run around casting spells willy-nilly, you're in danger of losing your connection to other human beings and declaring yourself a god.
    • Fan gameline Leviathan: The Tempest has Tranquility, which measures the degree to which a Leviathan can keep its Warring Natures in check. Tranquility is a twelve-box track, with the divine nature starting in the top box and expanding downwards, the bestial nature starting in the bottom box and expanding upwards, and the human nature occupying however many clear boxes remain between the other two. When the last Tranquility box is filled in, the two natures come into direct conflict. If the divine nature wins, the Leviathan becomes an Ophion, a psychopathic demigod incapable of seeing other sapients as anything but pawns to be manipulated, rivals to be overcome, or both. If the bestial nature wins, the Leviathan becomes a Typhon, a feral monster ruled entirely by its instincts.
    • Fan game Genius: The Transgression has Obligation, which is a hybrid sanity meter, karma meter, and Comes Great Responsibility. The more the Genius violates social norms and/or dips into doing very nasty things with Mad Science, the further they lose themselves to their Inspiration. If they bottom out, everything they are is burned away by Inspiration, leaving them as one of the Illuminated, who care only for whatever mad theories they have conceived, to the point they would willingly rip the heart out of a child if they felt it would advance their work. This is actually the rarer of the two ways to become Illuminated (Geniuses keep tabs on each other and are quite willing to Shoot the Dog if necessary); a Genius who delves too far into their personal madness risks becoming an Unmada, and if an Unmada does the same thing and screws up they become Illuminated.
  • Don't Rest Your Head has a Madness dice pool. Usually up to 6 can be used at any time (and they are required to use the Madness Talents); the more are used, the more likely you are to spend a "fight" or a "flight" reaction. If none of these are available, the character snaps. When it comes to its senses, the reactions are back, but one Discipline die gets replaced by a Madness die. Which allows more powerful uses of one's powers, but also makes it more likely to snap again. And if all Discipline gets consumed, well...
  • Eclipse Phase has Stress points inflicted by traumatic situations. With large quantities of Stress inflicted at once causing derangements or disorders and a Lucidity trait that determines how much Stress a character can accumulate before suffering a mental breakdown, or irreversible catatonia. And it's one of those games where dying is among the least sanity-reducing events.
  • Exalted has the Limit meter, which measures mental and emotional stress. Max it out, and it drops back down to zero...because you've just unleashed all that stress in an outburst of insanity that can last anywhere from a few hours to several months.
    • The Chimera rules in the Lunars book also work like this, only fused with a sort of mutation meter: if you undergo this break in the Wyld, and you're a Lunar without moonsilver tattoos, you gain a permanent point of Limit. By about five or six, Lunars with tattoos will try to kill you on sight. When it hits ten, your mind and body are both reduced to screaming madness.
    • Inverted with Alchemicals, whose Limit-equivalent, Clarity, makes them more coldly logical as it climbs...and then played straight with Dissonance, Clarity's gremlin twin, which causes Alchemicals who have developed Gremlin Syndrome by using Voidtech to become steadily more sadistic as it rises.
  • While GURPS doesn't have a sanity meter in the basic game (though it's very easy to add one, considering the system), it does include Fear checks whenever a PC encounters something particularly or personally terrifying. The basic game includes a massive table of effects that can be caused by fear, from becoming somewhat shaky to falling into a coma.
    • GURPS Horror (for the system's 4th Edition) adds rules for Stress, Derangement, and Insanity.
    • GURPS Pyramid Magazine № 3/103 (Setbacks) includes an article titled Mad as Bones by C. R. Rice, which contains a full-fledged sanity system.
  • Palladium's RPG system has a horror factor stat for how monsters affect your sanity, simply by looking at them.
  • Recent editions of Paranoia elevate Moxie from a mere "figure out unfamiliar stuff in a hurry" stat to this trope. At zero Moxie, you completely Lose It and go berserk until stopped (usually via termination). You can stress yourself out voluntarily for a short-term sdvantage, or lose a point automatically when Friend Computer actively pays attention to you (because even if its "help" is actually helpful for once, you're still waiting for the other shoe to drop, if not now then later).
  • The Dungeons & Dragons setting Ravenloft, based on Victorian horror, adds to the traditional saving throws of Fortitude, Reflex, and Will by adding saving throws for Fear, Horror, and Madness. In second edition, when Ravenloft first became a full-fledged campaign setting, Fear, Horror, and Madness were added to the five saving throw categories. In third, they became extensions of Will saves.
    • Other D&D settings in 3.5 can use the Depravity system from Oriental Adventures and Heroes of Horror to effectively create this. Exposure to evil could cause you to become increasingly unstable and malevolent. Or you could just take Pure Soul and No-Sell it.
  • Red Markets calls it Humanity and divides it into three tracks: Detachment, Trauma, and Stress. Every five Humanity damage suffered in a given track forces the Taker to take a "Regret", what most games would call a disorder. Though they can have dependents to help them recover Humanity between sessions.
  • In the Star Wars: Saga Edition RPG there is an implicit sanity meter (which only the DM can see) for Force-using characters. If one of these PCs uses the Force in a way that is considered evil they start to move towards the Dark Side of the Force. This differs from the Force alignments in the video games because once the PC gains enough dark side points the player loses control of them, and they become an evil NPC.
  • Unearthed Arcana, the d20 System rewrite of Dungeons and Dragons, has sanity rules described in detail here.
  • The Madness Meters in Unknown Armies. There are five; Isolation, Helplessness, Violence, Self, and The Unnatural. Depending on how well you roll when confronted with triggers, you fill them with either a Failed notch or a Hardened notch. The more Failed notches you gather, the more likely you are to break down crying when you experience a trigger; the more Hardened notches you gather, the more immune you become to the trigger (to the point where a character with all Hardened notches in their Violence meter becomes a sociopath who doesn't really see the problem with carving a guy's face off with a potato peeler, and is only vaguely aware that others might not feel like he does).
  • Vampire: The Masquerade has a Humanity meter for vampires; the lower it becomes, the greater the chance that a character will Frenzy, causing them to lose all control and attack targets randomly (both enemy and friendly targets) until it fades away.
    • A character's Humanity stat in the table game did much more than it did in Bloodlines. The Humanity stat for vampires is curious in that it did double duty as Sanity Meter and Karma Meter, but does not stop you from picking up mental illnesses for other reasons. The Humanity Meter indicates what sort of wrong doing bothers a particular character, where a saintly person might feel guilty for selfish thoughts, most humans draw the line at theft, and a person low on the meter might be fine with Pragmatic Villainy but still be bothered by "Acts of Casual Perversion" or however it was phrased. Humanity kept the character from giving in to the monstrous barbarism ("Beast") of their undead state, but it didn't protect them from suffering OCD, schizophrenia, or other forms of mental illness. You could be a paranoid schizophrenic saint who had their "Beast" on quite a leash— as a starting character.
    • Low humanity vampires also found it excruciating to act during the day, had extreme difficulty in mimicking human physiology when it would help them (for example, warming your skin so a potential meal you were attempting to seduce wouldn't realize you were a corpse), and at Humanity Zero, a character would pretty much become a mad dog who had to be put down. Many princes of the Camarilla (the "less evil" faction) would put a vampire down before Humanity 0 just because they had already become so violent, inhuman, and Ax-Crazy that they would threaten The Masquerade just by existing.
    • The game also featured alternative moral systems which were horrifying and outright evil by pretty much anyone's standards, but kept the Beast at bay. Such characters dove headfirst into being monsters to avoid becoming berserk, mad killing machines. For examples, one path says be God's personal scourge, another mandates you should be a ruthless bastard with Chronic Backstabbing Disorder, and a third suggests you become an emotionless killer and student of death. Characters on these paths used very dark Blue-and-Orange Morality to remain less insane than the Beast.
    • Vampire: The Dark Ages featured alternate paths than Humanity which would be similar to Humanity and served a similar purpose. For example, the Road of Heaven put religious duties first, human ethics second, but the overlap between them was very high. Such a character fought the Beast with their faith.
  • Warhammer Fantasy Roleplay and Dark Heresy both have Insanity Points, which measure just how unhinged you've gotten by your adventuring. Encountering a sanity-blasting scene makes you test your willpower, with failure leading to one or more automatic insanity points.
    • In Warhammer Fantasy Roleplay you need to make a willpower roll for every Insanity Point you gain above 5; failure on this roll or reaching 12 insanity points resets your points to 0 and gives you a major derangement that will cripple or render your character unplayable right off the bat. On average, a bad roller will get two-three insanity points per session; double that estimate for a magic user. Unless you have a Gold Wizard, a very lucky brain surgeon or a Priest of Shalliya amongst your list of friends, insanity points and derangements are incurable.
    • Dark Heresy has a 0-100 score on insanities: You automatically start getting some minor derangements once you get over 30, with the number and severity increasing for every 10 over that. Once you reach 100, your character is unplayable. Unlike in WFRP insanity can actually be a good thing as it makes you more resistant to fear: A character with more than 80 insanity points can stare down an Eldritch Abomination without much trouble, but at that point the voices in his head will already be doing far worse to him on a daily basis. On average, a session of Dark Heresy is about six-eight insanity points for an unlucky roller, with about two-three more per session for being or standing too close to a psyker. Insanity points can be bought off during reconciliation time for about 100 XP a point.
    • Other games in the 40K RPG line handle insanity as well as Corruption Points in different ways. Deathwatch Space Marines who gain too much Insanity suffer from varying levels of the "Primarch's Curse", which is dependent on their chapter; they're immune to effects from Corruption (which tends to lead to madness and mutation) unless they hit 100 points at which point they're removed from play permanently. Black Crusade characters are immune to Insanity (they don't gain points, but certain fears can cause them to get disorders on bad rolls), since they serve the Gods of Chaos - they are considered to have already reached the end of the 100 point score of the other games and come around again. Only War and Rogue Trader treat it similarly to Dark Heresy, although Rogue Trader expansions Into the Storm and The Soul Reaver give options for certain Xenos characters. Both the Orks and Dark Eldar are effectively immune to insanity, not because of innate wholesomeness but because they're already inherently insane by human standards, and there's no functional difference between "Normal Ork" and "Extra Crazy Ork".
  • The attempt to make a Wheel of Time RPG based on 3rd Edition Dungeons & Dragons rules had this for male channeler characters. As male channelers eventually go insane, each time the character gains a level or uses too much power, he has to roll a die to determine how much sanity he loses. There was also a table laying out what psychoses the characters should manifest at what levels of sanity.

    Video Games 
  • Several variants of Angband implement a sanity readout, usually in the form of "Current Sanity/Max Sanity" due to the typically text-based nature of said games. Notable variants include Cthulu Band and Tales Of Middle Earth, which borrows a number of elements from the former.
  • Alice from American McGee's Alice has two meters. Her Strength of Will is how much ass-kicking she can deliver while her Level of Sanity is how much more ass-kicking she can receive. She gets more sanity by drinking the life essence of creatures she's killed. Of course, when you're wandering around in your own head, and the creatures you're killing are your own inner demons made manifest, it makes a certain amount of sense that taking them down would improve your sanity. It's technically a Health Meter in all but name: Word of God said that plot-wise, this was just a more interesting way for Alice to restore lost health than finding bandages or medicine lying around Wonderland like it's often done in games like this.
  • Amnesia: The Dark Descent has a sanity system tied to the fear Daniel is experiencing. With the levels going from "Crystal clear" to "A slight headache" to "Head is pounding and hands are shaking" to "...", it drains whenever you either look directly at a monster, linger in the dark, or encounter something horrific. Regarding the Interface Screw, it can range from a drunken haze to having a Freak Out, laying down and dragging yourself along in a panic while insects crawl along your field of vision, and paintings becoming grotesque. Once it's low enough, the monsters will be alerted and chase after you even if you don't mess up and make noise or reveal yourself. The only way to restore it is to solve puzzles and make progress, whereupon the screen is taken by a lilac haze and you hear a noise similar to a sigh of relief; there is a "Sanity Potion" item in the game's files, but it was Dummied Out during development, and it can only be found in custom stories.
  • Arknights has one in the roguelike Integrated Strategies game mode's third season "Mizuki & Caerula Arbor" in the form of Light meter, starting at 100 and drains when the player loses life seals or getting certain encounters. High Light gives the player a chance of receiving a helpful buff called Enlightenment on a die roll; at low Light they will instead receive Rejections, which are debuffs that can only be suppressed by sending the afflicted Operator away or using certain Collectibles. Low Light also raises the chance of the player being afflicted by "the Call of We Many", which carry random effects both beneficial and detrimental, and symbolizes Mizuki succumbing to the influence of the Seaborn hive mind.
  • In Bloodborne, the Insight mechanic and the Frenzy meter count as this. Insight is gained either from using certain items or from encountering and slaying bosses. The more Insight you have, the more you see of this world: more enemies show up, enemies gain new attacks, and the enemies get harder. (Plus, there's the Amgydalas just hanging onto the walls that you can see once you have enough Insight.) Most dangerously, though, is: having a great amount of Insight greatly reduces resistance to the "Frenzy" status effect, which allows certain enemies to kill you almost instantaneously. However, Insight can be spent either by summoning another Hunter online or through the Insight shop in the Hunter's Dream.
  • The RPG Maker game Blood Ties has an orb in the lower right corner which represents sanity. It's rather easily drained, but this is understandable considering the main character is a little girl who finds herself home alone at night. Using the teddy bear Save Point fills it back up again.
  • Blue Planet: The last mission of War in Heaven Act 3 takes place inside the Nagari network, as Noemi must obtain information on the Shivans and the impending apocalypse. There is a sanity meter, which can be lowered in numerous ways; it doesn't help that the information you're trying to gather is itself detrimental to the human mind.
  • Bungo to Alchemist's Epiphany mechanic, with a gauge that fills up every time a writer takes damage, and two writers' getting their gauges full at the same time triggers a Combination Attack. How fast the gauge fills up is determined by the writer's Sanity, which is divided into 5 ranks; those with higher Sanity are tankier but get their Epiphany gauge filled slower.
  • Cataclysm features a morale system, which measures how well your character is mentally holding up against the horrors of the zombie apocalypse. Events such as getting sick or killing zombie children lower it, while actions such as eating good food or listening to music increase it. While you can't actually lose your mind, a character with poor morale will fight more poorly, get a penalty to experience gain, and if morale gets low enough they will refuse to craft or work on a vehicle. Conversely, a character with high morale will gain stat boosts and will learn more quickly.
  • Clock Tower:
    • Clock Tower: The First Fear has this if Jennifer panics a lot. When Jennifer's panic meter is blue, she's normal and can probably take a hit from most traps (not counting instant kill ones, or any member of the Burroughs family). As her panic meter changes color (from blue to yellow to orange to red), she becomes weaker. Once it's red, not only is she likely to die instantly from the different traps in the mansion, she also starts tripping when she runs. If Bobby is near when this happens...
    • In Clock Tower 3, if it fills, Alyssa starts running around uncontrollably.
    • Haunting Ground has a very similar concept. If Fiona reaches "panic mode", she becomes disoriented and cannot be well controlled by the player (to the point where the entire screen goes monochrome and disables use of the inventory/item menu).
  • Despite pointing out this trope's illogicality in his Amnesia: The Dark Descent review, Yahtzee himself uses sanity as a mechanic in his game The Consuming Shadow. You lose sanity when you are struck by enemies, flee from them (ostensibly as a result of fear or doubt), or through plain old poor luck in events. It is restored by receiving uplifting messages from those supporting you or doing good things for people. A shorter, non-permanent boost can be had by taking illegal drugs to numb yourself to the horrors happening around you. Notably, sanity is also your Mana Meter; using the various incantations in the game, even the beneficial ones, drains your sanity as your dabbling with occult forces you to accept the dreadful possibilities that it entails.
  • The RPG Maker game Crimson Light has a white box in the upper left corner which represents Unelma's fear level. When it turns red, she's in trouble.
  • Crusader Kings III has a Stress meter to indicate a character's mental state. There are many events that can cause a character's stress level to rise (death of close family members/loved ones, taking actions that run counter to their traits, etc.), and when their Stress rises above a certain threshold, they will suffer penalties depending on the amount of accumulated stress, up to and including death at the highest level.
  • In Cultist Simulator, you can gain two different types of insanity, in the form of Dread and Fascination cards. These cards expire on their own, or you can use a countering influence to cancel them out. Occasionally, an action will spawn that automatically picks up one kind of insanity; if it accumulates three cards, feed it an antithetical card fast or it's Game Over.
  • In Darkest Dungeon, the heroes' stress bars act as secondary health meters: when a hero's stress reaches 100, they go insane. Typically, this results in an Affliction, one of several mental disorders, which can cause them to do erratic and harmful things like skipping a turn, refuse support abilities (especially healing) used on themnote , stressing out their comrades or even outright attacking them. If they become stressed over the 200 threshold, they'll scream and have a Heart Attack, that either drops them straight into Death's Door, or if they are already there, they'll flat out die; unlike dying from enemy attacks, there's No Saving Throw. However, there's a chance their insanity is the rare and positive Virtuous type instead, reducing stress or bolstering either themselves or their teammates; additionally, they gain a shield against Heart Attacks (a Virtuous hero that reaches 200 stress loses their Virtue and all of their stress instead). The one exception to that is the Flagellant, a class that is exempt from the resolve check roulette – he always goes Rapturous, an affliction exclusive to him that makes him act slightly erratically and swaps his ability to dodge for sheer attack power. It's a valid strategy to intentionally drive him insane solely for the double-edged affliction.
  • DC Universe Online: In the Justice League Dark: Shattered Gotham raid, you have a 0 - 100 Madness meter that passively increases over time. The higher it gets, the more damage you deal, but you also take increasing damage over time, and at 100, your whole team would get wiped instantly. Shazam's Wisdom of Solomon allows you to lower the Madness meter when needed.
  • Dead by Daylight: Some killers have the ability to perform physical or mental afflictions instead of just injuring their victims. The Doctor in particular has the ability to drive survivors insane by using magic-powered electroshock mis-therapy, which causes static to appear around their character health indicator. At higher levels, the player will start seeing / hearing hallucinations and the survivor will have occasional uncontrollable fits of screaming, which easily alerts the doctor where they're hiding. At the highest level, survivors will have to stay still for a few precious moments to get a grip and restore a fraction of their sanity.
  • Dead In Vinland has an inverted Sanity Meter in the form of Depression. As with the other Multiple Life Bars, hitting 100% kills the character — in this case, they're Driven to Suicide. (The icon for the Depression meter is actually a noose.) The higher a character's Depression, the more certain mental skills are penalized. Things that can increase Depression include everything from getting in arguments with other party members, to doing difficult tasks like chopping wood or mining, to participating in a human sacrifice or finding supernatural horrors like what appears to be a gate to a zombie-filled underworld, to eating unappetizing food.
  • In D'LIRIUM, Sanity Meter is increased when killing enemies, or if the player is attacked in certain ways. If it gets to 100, the player dies and awakens in a Personal Hell.
  • In Don't Starve, your character has a sanity meter that slowly erodes as you Go Mad from the Isolation. There are some things that make it go down quicker, like eating raw meat or mushrooms, and some things that can make it go back up, like consuming good food cooked in the Crock Pot, creating a new prototype with the Science Machine or Alchemy Engine, or wearing a garland of pretty flowers. As your sanity goes down, various dark shadowy creatures start to randomly phase in and out of view... and when it gets really low, they all turn hostile.
  • Used in Dreams in the Witch House (2023) where the Player Character, Walter Gilman's mental wellbeing can be gauged through his Sanity stat, which starts out at 10, but it increasingly lowers as he experiences more and more supernatural events and his Occult stat rises. Completing a task on his to-do-list or doing something comforting, like talking to one of his friends, allows him to occasionally replenish a little bit of Sanity.
  • DREDGE has a "panic" meter, represented by a single twitching eye that grows larger and more erratic as your fisherman travels at night, or through fog or certain especially dangerous locations. At high panic, you may find your boat attacked by sea monsters or crashing into rocks that aren't really there.
  • Dr. Jekyll and Mr. Hyde (NES): Dr. Jekyll's Anger meter increases as he takes hits from passersby. Once the meter is full, he turns into Mr. Hyde and must kill a certain amount of enemies before reaching Jekyll's location, or else death by lightning strike ensues.
  • Dwarf Fortress: In Fortress Mode, your civilians each have their own measure of how content they are, rising and falling according to various things that trigger positive and negative thoughts. If it gets low enough, they'll eventually start throwing temper tantrums, which tends to result in a tantrum spiral from angry dwarves lashing out at others (though other emotional breakdowns are not as dangerous). If they're outright miserable long enough, they can go permanently insane, in four different flavors. There's also a trait that tracks how used to tragedy they are, reducing the impact of negative thoughts. And as of the DF2014 update there's also a Sanity Skill in the form of Discipline, which reduces the odds of panicking when in combat.
  • Elona has a sanity stat. It is, however, mistranslated and actually a measure of insanity, as the healthiest possible level is 0. As it increases you are more vulnerable to effects that cause the insanity status which causes you to lose control of your character. Given the happenings of Elona fan theory suggests that this is an accurate translation, everyone in Elona is already insane, and that sanity only causes repeated suicide attempts, hence the random poisoning, bleeding, dizziness, and nausea that sanity brings.
  • Minhyuk, the protagonist of the RPG Maker game ENIGMA: An Illusion Named Family, is afraid of the dark. Going for too long without lighting a match causes his Fear meter to drain; let it empty completely and he loses control, running away in a panic. If he winds up running into the killer in this panicked state, it's an instant game over.
  • Eternal Darkness popularized the Sanity Meter in video games. Encountering monsters drains Sanity, and as the meter decreases, you experience hallucinations, from a canted view, unnerving sounds, or harmless changes to the scenery, to more extreme cases like your character's head falling off and reciting Hamlet, a healing spell backfiring and "killing" your character, or even Interface Screws like the game switching to another video input, lowering the volume, or "deleting" your game instead of saving it. Aside from all of these "flavor" effects, if the character's sanity is at zero, any further sanity loss will instead drain health. You can restore big doses of Sanity with the right magicks and items, or smaller amounts by performing Finishing Moves on downed monsters.
  • In E.Y.E: Divine Cybermancy performing evil acts has a chance of causing bouts of madness, as does taking large amounts of damage in a short time span. Madness has varying effects such as paralyzing terror, paranoia (can't stop shooting), or hallucinations. Going insane is - for the most part - a temporary annoyance, as it can be quashed down by performing "Maintenance" with only a short combat down-time.
  • Fahrenheit has a Sanity Meter for each primary character. It's more about emotional stability than actual sanity, however; once it reaches zero, the character experiences a complete mental breakdown, and it's game over. It also functions comparably to a Karma Meter: carrying out morally suspect actions will cause it to drop, and vice versa.
    • Tyler gets one moment at the end of the game, where he has to choose between his duty to the NYPD, or his long-time girlfriend that he loves who is leaving the rapidly freezing north for Florida. Interestingly, regardless of which choice you take, his sanity meter gets dinged (taking about a 50% loss if he leaves, and a whopping 95% crash if he stays). In both cases, it's entirely irrelevant, however: he's never seen again.
  • The Nightmares quality in Fallen London is an inverted sanity meter - it starts at zero, and increases as you go through particularly horrific experiences. At eight you Go Mad from the Revelation. It can be brought back down through particularly soothing experiences, writing down some of your darker secrets in journals, telling a friend about your fears (which increases their Nightmares slightly), or laudanum abuse. Once you Go Mad from the Revelation, it can be easily brought back down through actions in the special location you're sent to, but once you become sane again, you will lose most of your dream progress, making it the most punishing of the four Menace locations. And considering that you access one of the other Menace locations by dying, it seems that going insane is a Fate Worse than Death.
    • Sunless Sea, in the same setting, has your Terror meter, which measures a whole bunch of stuff, but sanity is in there somewhere. Delving into eldritch stuff, spending long periods at zee, going too close to the Dawn Machine, clicking the "Lose Your Mind" option at Kingeater's Castle and so on cause your Terror to climb, and your crew will mutiny if it gets too high.
    • Sunless Skies keeps the same mechanic, but tweaked. If terror reaches 100 that's (probably) it for your captain as usual, but the game provides opportunities to lower it in exchange for a recurring nightmare that will come to haunt you at a later date. These recurring nightmares stack, and if you have too many of them going on at once that's definitely it for your captain. This time, there's also Spectacles in the background that can both raise and lower terror during the time you're witnessing them, so making a stop at a soothing sight to calm down is perfectly valid.
  • Present in Fear & Hunger and Fear & Hunger: Termina as a persistent challenge to deal with thanks to the highly stressful nature of both the dungeons and the Termina festival as a Mind meter, made ever more difficult by the fact it doubles as a Mana Meter for often life saving spells. Letting it hit 50 will have the protagonist contemplate suicide (with you able to oblige at any time afterwards), and in the first game forces party members to stay behind (dying of a heart attack if not given a Mind restoration item). If it hits 0 for everyone, they develop a fear of everything, saddling you with a massive Damage-Increasing Debuff in combat against everythingnote .
  • Five Nights at Freddy's:
    • The Player Character in the first game can hallucinate, causing messages and extreme close-ups of enemies to flicker across the screen, freaky sounds to play, posters to change, and allow Golden Freddy to spawn in. Notably, there's nothing the player can do to prevent sanity loss: the protagonist hallucinates more and more as the week goes on, no matter how well you play.
    • This returns with a vengeance in Five Nights at Freddy's 3 where hallucinations of the past two games' antagonists appear both in your cameras and your office. Staring at them for more than a glance will prompt them to jumpscare you, disabling your ventilation and other systems, causing you to briefly blackout until it's fixed. In a game where having a visual of your enemy is critical for your survival, this is a huge issue.
    • This carries over into the Bedroom level of fan game The Joy of Creation: Reborn, represented by a light near Bonnie's door, starting at Green (max sanity), and draining into Red (insanity), where prolonged exposure to darkness and the animatronics makes the protagonist go insane, forcing you to keep the light on as long as possible and avoid looking at them.
  • Domark's 1985 Friday the 13th: The Computer Game on the Commodore 64, Amstrad and Spectrum (it's nothing like the NES version) has a sanity/fear meter that raises as the game goes on. It's represented as a kid's head, with the hair starting to stand on end as you get more frightened. If the meter maxes out, you die of fright. This almost never happens in-game, but it does increase the chances of seeing hallucinations (a pile of skulls covered in blood, someone with a machete through their head, etc) accompanied by a blood-curdling scream. Surprisingly effective for 16-colour graphics!
  • Friday the 13th: The Game has a fear system for the players controlling counselors. Seeing dead friends and being chased by Jason causes counselors to become more fearful, which not only makes it easier for Jason to find them using his "Sense" skill, but also makes counselors more likely to trip while running, makes tasks like repairing a phone box or gassing up a car harder, and blacks out the edges of the screen, making it harder to see where you're going. At higher levels, it also becomes harder to break free from Jason if he grabs you. Each counselor also has a "Composure" stat which dictates the rate at which fear takes hold: higher composure means fear increases more slowly.
  • Garfield's Scary Scavenger Hunt: Garfield has a "Scare-o-Meter" that increases whenever he gets scared by one of the monsters or other creepy sights in the mansion. When it reaches its maximum, he panics and runs out of the mansion, ending the game.
  • The Geneforge series has a very simple (and invisible) one. It increases every time the PC uses a canister. Use too many and people will start to notice it and react to the PC differently. The PC will also occasionally go into an uncontrollable rage and attack people.
  • GhostControl Inc.: All of your workers have a sanity meter that takes hits when out in the field. You need to restore it at the base in-between missions.
  • Green Hell has a sanity system. Traumatic events will lower it; things like leeches or rashes are minor annoyances that only degrade a small amount of sanity, but major events such as parasitic worms burrowing into your skin or eating human flesh lowers it sharply. At around 50%, you start hearing insane whispers and screaming inside your head; below 20%, imaginary tribal warriors will continually spawn in to kill you. Eating good food, getting a full night's sleep on a proper bed, and staying near a lit fire helps raise your sanity back up.
  • Haunting Starring Polterguy: Each member of the Sardini family gets one in the form of a "fear level". It starts at "calm" and successively reaches "low", "medium", "high" and "very high", together with a picture that shows how terrified they are. On "very high" level, they will completely panic and escape the house, as long as a door is nearby (if not, they'll just flee to another room and finally calm down again if you don't scare them again).
  • In the horror game Knock-Knock, after you reach the final levels, the game gets a massive difficulty spike and gives you a Sanity Meter, which drains while you're in the woods and if you are touched by the Guests. What makes it specially bad is that, by the ending, if the bar is very small or empty (there are no ways to refill it), you will get a Game Over the instant you attempt to leave the house, preventing you from finishing the game and having to start over.
  • Kuon: Although it's less deep than some; as the characters exert themselves or are thrust into particularly haunted areas, the screen around the player starts to swirl, giving the sense that the characters are out of breath. This can be fixed through meditation, although if it happens in combat then you are in trouble.
  • In Lobotomy Corporation, each employee has a Sanity meter alongside their Health - and this being set in a facility where they have to work with barely-containable eldritch horrors, there are a number of ways they can lose their marbles: witnessing other people die, be dealt White or Black damage (White only targets sanity, Black targets both Sanity and Health) from escaped abnormalities, be assigned to work on an Abnormality they're too unskilled to handle (such as a Level 1 Agent dealing with any Abnormality above ZAYIN-Class) and other fun events. Going at 0 Sanity will trigger Panic into that employee, after which they're capable of a variety of reactions such as going run around screaming across the entire facility or go on a murderous rampage - the only reliable way to cure them of insanity is by hitting them with White-damage dealing Weapons, which will refill their sanity without harming their health.
  • Lone Survivor has a hidden but very extensive meter, tracking almost everything the player does, and leading into one of three endings. (In the alpha, it tracked negative actions, but responses to the original trailer convinced the dev to add positive actions as well.) In general, sleeping well, eating right, and interacting with other living things will boost the meter, while using pills, staying up when tired, and killing rather than avoiding monsters will decrease it.
  • In Lost Dimension, SAN is one of the three main meters each unit has. It's used alongside GP to use Gifts, and also decreases whenever a character is attacked. When it's depleted for an enemy, it will be Dazed and miss a turn, but allies instead become Berserk, which fully restores their HP and massively increases their attack power, but also lowers their defense, forces them to attack the nearest units whether they are friend or foe, inflicts Fear on nearby allied units, which causes them to lose SAN even faster, and gives you a score penalty at the end of the mission. In some cases, having a character go Berserk near a strong enemy can be beneficial, as long as you keep them far enough from allies.
  • Lusternia has one, which is gradually eroded by spending time on The Astral Plane or inside Muud. It causes the player to hallucinate, and cancels a lot of the commands you enter.
  • Played with in Max: An Autistic Journey. The game has a meter showing Max's mood, on a scale from calm to panicking. Since this is a "day in the life" story rather than a horror game, the things that make Max's meter go up are mundane, such as being late for school or getting in trouble with his teacher. This is intended to show non-autistic players that things that seem mundane to them can be terrifying to people on the autism spectrum. Also, the meter is only affected by story events, not by gameplay. When the meter goes too high up, the player will often have to play a minigame where they help Max breathe slowly to calm down.
  • Maze: Subject 360 has a fear bar at certain points. When it gets full you need to use a dreamcatcher to "collect" objects representing your fears.
  • In The New Order Last Days Of Europe, while Sergei Taboritsky already isn't the most sane ruler of the mod, once you reach the superregional level, he reveals his true objective: to put Alexei Romanov back on the Russian throne. Since Alexei is long dead, Sergei undergoes a progressive Sanity Slippage, as represented by The Clockworks. The clock may be slowed or accelerated by certain events but never reversed, and once it reaches Midnight, Sergei realizes that Alexei is dead, dies from shock, and things rapidly go From Bad to Worse.
  • The Outlast Trials: The Pusher, one of the game's Ex-Pops, will spray you with gas from his mask. This gas will deplete your meter, then eventually you'll start hallucinating Skinner Man, one of the more challenging enemies to evade, since he can see you anywhere you go. And don't think that it being in your mind doesn't mean it can't hurt you. Unless you find an antidote for the temporary psychosis, don't stop running while you recover your sanity.
  • Oxygen Not Included: Each of your Duplicants has a Stress Meter that can go up for a number of reasons, including if their food/decor needs are not met, if there's too little (or too much) oxygen in the station's atmosphere, or if they don't get a good night's sleep. If the Stress meter gets too high, it triggers that Duplicant's Stress Response, which include Vomiter (the Duplicant pukes, making a mess and stressing out other Duplicants), Binge Eater (the Duplicant eats way more food than usual), Ugly Crier (sits on the floor and cries Ocular Gushers, ruining decor), or Destructive (the Duplicant gets mad and starts smashing equipment, potentially breaking vital life support mechanisms). Fortunately there are a number of ways to de-stress your Duplicants, including beautiful decorations, good food, or a session on a Massage Table.
  • Phasmophobia has a sanity system that dictates whether the ghost can start a Hunt, whereupon it'll try to track down and kill players. Different ghosts have different thresholds for being allowed to huntnote , and if there's more than one player then the team's average sanity is the deciding factor. Ghost events (moments when the ghost makes a non-hostile appearance), using Cursed Possessions, certain unique ghost abilities and staying in darkness reduce sanitynote , while staying in brightly lit areas slowly restores it and taking Sanity Pills instantly recovers a chunk of it, with the amount recovered depending on the difficulty. Tarot Cards can either drain or recover sanity depending on which card is drawnlist . The sanity of each player can be tracked in a display screen on the truck, including average team sanity in multiplayer, though in Nightmare mode the screen is broken, so the only way to know what sanity you're at is by asking the ghost with the Ouija board cursed possession, which isn't a guaranteed spawn.
  • The [adult swim] flash game Schizo-Phrenzy has the sanity meter count as health. As it decreases, it increases enemy generation rate, flashes a random image, and eventually leads to yodeling. Up to five pills can be stocked to restore the meter.
  • In the Flash game Scooby-Doo and the Creepy Castle, Scooby has a fright meter shaped like a thermometer, which is called his "Fright Factor"; whenever the player fails to stop the ghost in time and Scooby gets scared by him, it rises, and if it rises to a critical point, he'll run out of the castle and lose one of his three lives. Scooby Snacks, which can be found in certain places, lower it by one level.
  • The Shadow Hearts series has Sanity Points (SP), which deplete by 1 with each combat round. Once it hits zero, the character goes Berserk, attacking randomly without player input; if they end a battle in Berserk status, they can't remember the events of it and thus gain no experience points. Harmonixers lose Sanity Points faster when they use their Fusion abilities (demons and/or spirits attack their sanity), but they start with about twice the SP of any other character. Except Johnny Garland, because he never had the training to handle it.
  • The Aspiration Bar in The Sims 2, which goes up when they get their wants fulfilled and goes down when they get their fears fulfilled. They receive a mental breakdown when it gets too low, to the point where they hallucinate a therapist to help them get back up their feet.
  • Vampiric thirst in in The Sims 4 can't kill a vampiric Sim, but it functions like this. As it gets lower, they'll start to act erratically, creepily complimenting the necks or heartbeats of nearby mortals and eventually, if it gets too low, autonomously taking a bite out of some nearby mortal. (This can have unpleasant side effects if they're trying to be a Vegetarian Vampire or there's too many horrified witnesses about.)
  • In 60 Seconds!, each family member can lose sanity from a variety of factors such as being left alone for too long (so no, you can't conserve food and water by not bringing any family members), not having anything to distract them from the day-to-day tedium, or doing immoral actions like raiding other people's shelters. Losing too much sanity will cause them to start looking crazed and potentially destroying random items in the shelter, and letting them stay in that state for too long will cause them to run out of the shelter and never be seen again.
  • The Thing (2002) gives your party members sanity meters. If a Thing tries to eat them, they won't react well. (Not uncommonly, one of them is a thing, and the others utterly freak out when they're betrayed.)
  • In We Happy Few, the player has a meter measuring how much of the Joy drug is in their system. As the meter fills things look nicer, brighter and cheerier. If it fills completely then they’ll suffer from a “Joy Overdose” which makes them act like a batshit loon who thinks they’re puking up rainbows and butterflies. It makes it much harder to act stealthily, and makes all your actions slower and weaker. Or alternatively if you REALLY overdose on joy, then you can suffer from “Memory Loss” where everything turns gray and black, everyone has red eyes and demon voices, and your character realizes just how much joy they’ve been taking. Actions are even slower, and you’re much more suspicious in this state.
  • World of Horror: Your protagonist has a Reason stat which serves this purpose, alongside their Stamina. As your Reason is whittled away, the resulting Sanity Slippage can lead to your character hurting themselves, developing paranoia, or even worse outcomes. Dip down to zero and it's Game Over.
  • World of Warcraft:
    • The battle with Yogg-Saron uses this. Players start with 100, and Yogg has numerous abilities that reduce it. The only way to recover sanity is to stand in one of the green beams of light (sanity wells) situated around the room. If a player reaches 0 sanity, they go insane and begin to attack all the other players in the room until they are killed (the player will actually start seeing all his fellow players as Faceless Ones, servants of Yogg-Saron). This not only hurts the group by losing a friendly player, but said player can also kill other players while insane.
    • On top of that, every so often players have to go inside Yogg-Saron's mind and attack his BRAIN while he's casting an induce madness spell. Failing to get out of Yogg-Saron's head in time will cause the people inside to instantly go insane.
    • Inverted with Meng the Demented of the Spirit Kings encounter, who has an Insanity meter. He alternates between attacking the tank and running away while reflecting his attackers' damage back at them; how full his meter is determines how damaging his abilities are, and when it fills, he changes tactics.
    • In a Vision of N'Zoth, you're given a sanity meter that slowly drains over time or when you're damaged by certain attacks, but can be increased in capacity and restored with certain upgrades. Having the meter depleted will immediately take you back to reality unless you're in a group, in which case another group member can donate their sanity to you.
    • A mechanic similar to the above is used in both of the fights against N'Zoth in Ny'alotha, the Waking City. Like with Yogg-Saron, having the meter reach 0 will result in you being charmed, but every few minutes, you can restore your lost sanity using your legendary cloak in the first fight or the Heart of Azeroth in the second. Having said cloak equipped was the one thing keeping him from charming you right off the bat.
  • Sanity is one of the most important features in Yandere Simulator:
    • The main character's sanity meter is represented by a cardiograph. If it's slow and pink, she's relatively normal. If it's rapid and red, she's "visibly insane". When this happens, her head twitches, she sports a Slasher Smile, and she has Empty Eyes with a shadow over them. She will also take longer to kill people in more sadistic, prolonged ways with sanity-affected animations enabled. However, played with: it actually doesn't measure sanity itself, since the protagonist is always crazy. What it does measure is how well she can stay composed enough to keep her Mask of Sanity on.
    • Kidnapped victims have a sanity meter that decreases as the main character psychologically tortures them. When their sanity reaches 0, they become permanently mind-broken and can be ordered to kill the main character's current rival and then commit suicide afterwards.
    • In the finished game, Senpai will have a sanity meter that decreases every time he sees something horrifying like blood or corpses and it will be one of the factors that determine which one of the game's Multiple Endings you get. If you force Senpai to repeatedly watch people he's very close to like his childhood best friend or sister die right in front of him, don't expect to get a happy ending... especially if he finds out you were the one responsible for their deaths.

    Visual Novels 
  • The player characters in the Boyfriend To Death series have this as well as a Life Meter. If either one of these empty completely, expect a bad ending.
  • The It Lives series features one of these in the form of a "Nerve Score", which ranges from 0 to 100. Making the right choices, hanging out with friends, acquiring weapons, and so on raises your Nerve Score, while encountering monsters, making incorrect choices, and getting injured lowers it. The main character and their friends all have Nerve Scores, and anyone with a Nerve Score has the potential to die if it's too low. In the first game, the Nerve Score's main function is determining whether a character survives the Final Battle. In the second game, each character has a "moment of truth", whereupon their success or failure is dependent on their nerve score. In Chapter 15, the group's Nerve Scores are totalled up, and if the value is too low, the person with the lowest nerve score (excluding the main character) will die. In the final chapter, the main character is thrust into a live-or-die situation where their Nerve Score determines how much time they have to escape a Death Trap (if their Nerve Score is really low, they aren't given a chance to escape and they will automatically die).
  • As the game is part of the Boyfriend to Death 'verse, The Price of Flesh also has a sanity meter, and it's an especially critical component to survival in Mason's route.
  • Tokyo Dark: Ito's two of four meters are Sanity (duh), and Neuroticism; if the latter gets too high, the former will decrease faster and become harder to regain. Having having too low sanity while in Aokigahara will unlock the "Nothing Is Real" ending.
  • Akiha's hair in Tsukihime is actually a sanity meter of sorts. The redder it gets, the closer she is to falling into madness from drawing too much upon her demonic powers. It's not actually until her eyes turn red that she loses it, however. Normally, she should have had the strength to better resist that, but she's giving half of her life-force away to Shiki. On another note, the one time she actually does go insane, it's possibly the result of a partial possession by a mad ghost whom she accidentally "ate".
  • Your Turn to Die has Hallucinations which serve as a Type 3, representing how well — or how poorly — Sara is coping with the events of the Deadly Game. Allowing this to rise too high can lead straight to a Bad Ending. Fortunately, there's a treatment option that becomes available... But it can only be used safely twice.

    Web Comics 

    Real Life 
  • The Holmes and Rahe stress scale works in a similar way, assigning point values to various stressful events, then using the total as a predictor of illness.
  • The Global Assessment of Function was used to give a rough-and-ready assessment of how much symptoms of mental illness affect a person's life; 80-ish is asymptomatic, above that is superior function, and by the time you get to 50 and below the toll is heavy. Generally speaking, below 20, a person is a danger to themselves and others. 0 represents insufficient information.