I read a book recently, that brought to life the mental effects that 4 years of brutal war could have on people. And the whole time I was thinking, man, Eberron has had a hundred years of war that only became more and more brutal. What would their mental hospitals be like?


I decided that the most likely place for such a hospital would be Aundair. No offense to the other nations, but I think Aundair probably had officers that were more valuable than the others. It takes years to make a mage. Maybe Karrnath had some generals, but I think they may have been more accustomed to war and less likely to be put in situations where their sanity was strained.

There’s not a lot of places in Aundair that’s far from a front of some kind, but nestled in between the Eldritch Groves and Lake Galifar, around half way between Passage and Arcanix, lies Dragonvale Mental Hospital. (You can, of course, move this to wherever the heck you want it. A psych ward in other countries is going to be different in details, but in general, a lot of it will be the same.)

Dragonvale is a hospital funded by Aundair, but is run by House Jorasco as a special project. While the patients filling the wards are mostly Aundairn war heroes, there are occasionally others, Aundair nobles, Arcanix students, and heirs of House Orien who are in need of psychiatric and long-term care. Passage and Arcanix are close enough that the healing house there sometimes call on the expertise and the hands at Dragonvale, and vis versa. Arcanix being fairly close is useful when some of the patients episodes get… exotic, and patients are brought in on medical wagons that make the rounds from Passage where the lightning rail.

Since the last war, one or two cases from other nations have been brought to Dragonvale, but House Jorasco is very cautious on who to suggest. It would not be good for business if their inconsiderate actions sparked a new conflict.

Healing the Wounds of War

“I cast Restoration to cure his PTSD…” is probably the most trivializing sentence I’ve ever thought up, but I think, RAW, that’s what it might be. Sanity and madness is not handled well in base D&D. I mean, I don’t play those sorts of games enough, but I know that randomly adding a flaw to your character when you fail certain isn’t a great way of doing it. Call of Cthulhu is a big name in that type of game, and there, Sanity is treated something like Hit points. It gradually decreases as you see things that strain your mind. Spycraft had an interesting system, where you would take stress damage from tense situations, which threatened debuffs unless you used your interests to relax, explaining James Bond’s proclivities.

I was going to roll things for the patients on the Madness tables, but I’ve decided against it. Trying to do that would make me want to rebuild that structure and I don’t have the time, inclination, or the qualifications to do that at this point in time. (I’ll probably have to tackle it eventually, though. There’s too many times a sanity or fear mechanic has come up at my tables and I didn’t have good answers for them.)

So how do you cure madness? There are two spells. First is Lesser Restoration. This is used as an immediate treatment of symptoms. If you’re having a psychotic episode or something, a quick LR causes that to fade away and you can go back to living a mostly normal life. It’s not a fix, it’s a patch. A Greater Restoration is a more serious fix, but it’s better for curses. When you’ve lost your sanity, a GR can give you a chance to recover, but it’s not a guarantee. It still costs 100 gp to try, though, which means that House Jorasco’s chirgeons are going to do whatever they can to try and heal you the cheaper way, and try to maximize the chances of GR working by understanding your malady, finding the root causes, and treating those.

How do we use this in game?

There’s a few angles that Dragonvale could be used. First, It could be an interesting game start, with the different characters being patients and staff at Dragonvale. Then Something Bad happens, and what is reality becomes a less philosophical question, and the PCs have to band together to survive. Second, there may be something interesting in the party being one side or the other. The doctors of the place, or the patients.

If the party is the doctors, spend act 1 establishing the PCs as awesome medical people, the patients as looneys and lean into the improv of the interactions. Let what the party says go, except when it would go directly counter to your plot. The plot can be many things, but having a patient’s psychosis turn out to be real could be interesting.

If the party are patients, they might have fun playing into their psychosis, before the incident. It’s probably the aforementioned Something Bad, leaving the inmates and their issues running the asylum, but it can be almost anything.

Part of the reason Aundair is paying for this facility is that the officers within are magic users and psionists. Their Psychosis sometimes can develop a physical form. Also in Eberron, there is always a chance of a region becoming coterminous with one of the planes, or even Dragonvale being pulled fully into one of the planes.

The Cult of the Dragon Below could have intentions, someone in the asylum could have a part to play in the Draconic Prophecy, or some group wants to break out a patient for something they know or who they are.


Ravis d’Jorasco

The Halfling head of Dragonvale, he takes good care of his patients. An Heir of House Jorasco, his Mark allows him to cast Lesser Restoration, and small healing magic. He tries to find the reasons behind their issues and relentlessly asks details about the

Nurse Scalpel

A Warforged built for medical duties, Nurse Scalpel is careful which patients she interacts with. Some of the residents had experiences with warforged on the front, and Nurse Scalpel is careful not to cause additional distress.


There’s an Alchemist on the grounds, who makes medicines and other Concoctions. There are bunch of Orderlies, apprentice nurses who are selected for their brawn more than their brains, but they are learning the trade. There is also a Chaplain on the grounds, who sees to spiritual needs and helps as he can.

Locations at Dragonvale

Airship Tower

Located a short distance from the main house, so as not to scare the residents, this is a fairly simple airship tower. House Orien is not happy about it’s installation, but they begrudgingly acknowledge its utility.

Herbal Beds

A greenhouse covering a large variety of vegetables, flowers, herbs and reagents. Gardening is good for relaxation and the feeling of accomplishment and the flowers can brighten anyone’s day. In addition to the vegetables that feed the residents, there are also ingredients for potions, both of Healing and other potions commonly used at Dragonvale. The surplus is distributed to other House Jorasco locations. Gardening is not relaxing for those who were traumatized in encounters with the druidic magic of the Eldeen Reaches.

Isolation Ward

Located a short distance away from the main building, the Isolation Ward is for residents who are unstable to the point that they can’t control their magic.

Magic Items

Poison of Complacency

Even when diluted with water, this potion is good at calming creatures down. A creature who consumes one dose makes a DC 11 Constitution saving throw or be under the effects of a Calm Emotion. A more concentrated dose has a higher DC.

Arcane Sapper

Use on creature w/n 5 ft, Randomly eats one of the targets unused spell slots. Has X charges, use a number equal to the slot consumed. If the target is concentrating on a spell, make a concentration check with disadvantage.

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  1. So…. Would PTSD always be a debuff in combat? It’s usually talked about as a failure to adjust to civilian life, though extreme cases do involve a total shutdown. Really much of PTSD is the brain optimizing itself for a combat environment, like heightened alertness that comes with a side of stress. So something like, PSTD is a buff to initiative but a debuff to social skills? That’s still oversimplifying, but all of D&D is oversimplified.

    1. I can see a trade-off between combat readiness and social interactions, but I hesitate to provide a mechanical label. I don’t know enough about PTSD to say what its effects would be.

      >That’s still oversimplifying, but all of D&D is oversimplified.

      I’m not sure how much I agree with this statement. D&D is abstracted, sure, but I don’t think that’s the same as over-simplifying.

      In terms of “Madness,” there are several factors at play. I think primarily when people in gaming and fiction think about mental issues, the label “Madness” comes to the fore, which leads people to Lovecraftian Horror, and therefore, extreme reactions. I don’t have my shelves on me, but I’m sure a solid percentage of what we use now days is descended from D&D’s first edition. What did they know about mental illness in 1974? Or rather, what would an insurance adjuster who played a lot war games know about various forms of madness?

      I think a thing like PTSD should be held in the player’s hands, instead of 3 layers up the chain where the game designer sits. There is no way I can craft a mechanic that perfectly covers something like this. It being in the player’s hands lets them customize their reactions, and allowing their lack of control to remain in their control, which sounds paradoxical but its much better than the alternative (which is, incidentally, the system we have atm)

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