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I'm running a campaign using the Madness optional rule. I understand for the most part how it works but my question is, can the PCs tell they have levels of madness? If their characters have never experienced it before, how would they know if something is wrong that needs to be "cured"?

I was thinking maybe they sense or feel something is off. Is there an official answer in the text?

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    \$\begingroup\$ Are you asking if the players know their character has gone mad, or if the characters know they have gone mad? You seem to be using "player character" and "player" interchangeably in your question. \$\endgroup\$ – Christopher Jun 8 '16 at 17:10
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Yes, tell them

Several of the madness effects alter the PC's behavior, such as with paranoia, delusions, or a desire to kill people. In order for the player to correctly play a PC with madness, they need to be aware of this so they put themself in the PC's shoes.

The alternative is to tell a PC with madness (paranoia, for example) that they can't open a door but don't know why. This would get old quickly.

Of course, you don't need to tell them all of the mechanics or that you might be rolling on a table. In a previous campaign where unworthy characters were punished for touching the McGuffin, I did something like the following example:

Ever since you touched that strange artifact, you've had a gradually climbing feeling of dread. As you reach to open the door, you find that your hand hesitates. Make a Wisdom save.

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    \$\begingroup\$ @KaZie101 As a general rule, it's a recommended to wait a few hours before accepting an answer so you don't discourage others from answering. \$\endgroup\$ – aebabis Jun 8 '16 at 16:27
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Reading your question, it appears that you want to know whether a Player Character is aware of their own madness, not whether the player themself is aware of their character's madness. If that is the intent of your question, then the answer is:

Maybe

Madness, as outlined in the DMG, p:258-260, encompasses a wide range of mental disorders, many of which can occur without the knowledge of the sufferer.

Disorders explicitly or implicitly listed in the madness tables include, but are not limited to:

  • Obsessive compulsive disorder
  • Severe anxiety
  • Irrational fears/phobias
  • Various states of psychosis
  • Various personality disorders
  • Major depression

The gold standard for classification of mental disorders is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) produced by the American Psychiatric Association. While there are numerous issues one may raise with this text, that does not preclude its usefulness.

Many mental disorders, particularly the ones that cause disturbances in personality (e.g. borderline disorder or schizophrenia) are found in the "Blind Area, Section II" of a JOHARI window - others are quite aware of the sufferer's malady but they, themselves, are not.

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As an example:
One of my player's characters (lvl 13) was struck by a powerful delusion in which they truly believe they underwent a period of training in a Monk monastery and, therefore, have monk abilities. The players know of the Madness, but none of the PCs have figured it out yet. They just don't understand why the fat bard keeps trying to run across water and corner jump up walls. Hijinks!

Conclusion

It is very possible that a Player Character who is suffering from one or more Madness effects has no idea that they are mad.

As Acbabis notes, you should absolutely inform your players that their character is suffering from one or more Madness effects. However, for a more realistic treatment of Madness, encourage your players to RP the disorder their PC is suffering from appropriately. This may require a few minutes of research but can provide deeper and more entertaining gameplay.

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    \$\begingroup\$ +1 for reference to medical text that I've never heard of! \$\endgroup\$ – Ladifas Jun 8 '16 at 18:07
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    \$\begingroup\$ For the sake of more specific examples, obsessive compulsive disorder is one where sufferers typically know exactly how irrational they're being, but can't help it. There's also a weird middle ground, like depression, where folks frequently know they have it but are unable to estimate how far gone they are or which areas of their perception are affected. \$\endgroup\$ – Blue Footed Booby Jun 8 '16 at 19:15
  • \$\begingroup\$ @BlueFootedBooby I avoided adding a list of specific disorders that a sufferer may be unaware of out of concern for brevity and due to the spectrum nature of many disorders. If readers would find more detail or specifics helpful I can add to my answer. \$\endgroup\$ – Ruthaford Jun 8 '16 at 19:40
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The way that I always do this is to relate the symptoms, not the cause. If they're insane, they may have delusions (so they may see things that other PCs don't despite being less perceptive, and those things will turn out not to exist). They may feel worried all the time but not be able to describe why. They may believe themselves able to understand creatures that speak no languages, such as drakes, with varying results for correctness (if a drake is obviously happy, they may hear it saying that it's happy, but if it's ambiguous, they're just as likely to be wrong). That way, the player can deduce the symptoms through the experiences of the character.

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  • \$\begingroup\$ You mean "deduce the affliction through the experiences of the character"? \$\endgroup\$ – aebabis Jun 9 '16 at 16:05
  • \$\begingroup\$ Well, deduce the affliction through the symptoms, which are in turn inferred from the experiences of the character. Paranoid people often do not believe that they're paranoid, for example. \$\endgroup\$ – Kenny Jun 17 '16 at 17:57

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