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Basically you roll SAN as an ability check when you do things like decipher forbidden lore, understand the ravings of a madman, overcome your own madness, understand truly weird magic, etc. - you'd presumably be rolling it alone or with a skill (replacing the normal stat).
Are you talking about how to generate your San score? If so, from the DMG:

"Here’s how to incorporate these optional abilities at character creation:
  • If your players use the standard array of ability scores, add one 11 to the array for each optional ability you add.
  • If your players use the optional point-buy system, add 3 points to the number of points for each optional ability you add.
  • If your players roll their ability scores, have them roll for the added ability scores."
EDIT: I quoted the wrong portion of your post. You said:

"The DMG has suggestions. Basically SAN operates as a 7th stat (like good old Comeliness), though they are vague about how you obtain a value for it (I believe just suggesting "rolling" - like so much in the 5E DMG it is profoundly half-arsed)."
 
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Again don't agree...understanding something is based on rationalism... not insanity.
So you're proving my point here.

You don't understand how cosmic horror works. On a really basic level. A constant theme in Lovecraft is essentially "What if the madmen were right?" or "Maybe the madmen see the truth of the universe?" or "Understand the truth of the universe drives you insane".

This isn't really debatable. Have you actually read any actual Lovecraft? Because this is just a bizarre thing for you to claim. It's like saying that in A Song of Ice and Fire, being honest and decent and sticking to your morals will see you through anything (RIP most of the Starks).
 

Er, that's exactly how it works in the source material, so "doesn't seem right" seems to suggest unfamiliarity with Lovecraft. Crazy or at least part-crazy people are better at casting spells in that, yes. And the theme that you have to go a bit mad to understand the Mythos is absolutely ever-present.

Understanding the mythos drives you mad not... you have to go mad to understand it... otherwise you'd have to be mad in the beginning or no understanding would be possible. Crazy and partially crazy people are better at casting spells because the exposure to it has caused more madness to take root... the madness doesn't make them better spellcasters, becoming a spellcaster makes them mad.

You're wrong, and it's hard to see why you'd think you were right, because it's pretty clear.

Uhm... Ok. I feel the same way.
 


So you're proving my point here.

You don't understand how cosmic horror works. On a really basic level. A constant theme in Lovecraft is essentially "What if the madmen were right?" or "Maybe the madmen see the truth of the universe?" or "Understand the truth of the universe drives you insane".

This isn't really debatable.

Understanding the truths of the universe... drives you mad. is the theme
 


Yes, exactly. Is this news to you? It shouldn't be news to you if you're discussing cosmic horror.

SO madness doesn't impart understanding... it's a result of understanding. In other words a lower san score doesn't allow for a better understanding it occurs due to exposure to the truths.

EDIT: And there's a point where you become a gibbering heap who can't comprehend anything and can't cast any spells. That's what more and more madness does to you.
 

SO madness doesn't impart understanding... it's a result of understanding.
Sure, in a sense. But they're intertwined. You can't retain your sanity and understand, not as a human being in the Cthulhu Mythos. As you understand more, you slide into madness. You can't have the deep understanding without being "crazy".

But there are also hints of the opposite direction too - i.e. people who seem like they've always been mad, but who seem to understand the Mythos. Some shuffling tramp might never have been an Arkham professor or whatever, might always have been "off", but he recognises the signs of the impending apocalypse or the like. And frequently "primitive" or "feral" people, who have no training, no deep intellectual understanding of the universe, just some kind of implicit one, or instinctive one, and whose minds are already "mad" or "bestial" (and yeah there's a ton of racism in there, but let's skip lightly over that), also understand the Mythos.

In other words a lower san score doesn't allow for a better understanding it occurs due to exposure to the truths.
No. See my second paragraph (you edited this in after my first).
EDIT: And there's a point where you become a gibbering heap who can't comprehend anything and can't cast any spells. That's what more and more madness does to you.
Civilized men of the type that are the heroes of his stories become gibbering heaps, sure, yeah. Sometimes they literally become a non-human being of some kind. But we see characters who are not such men, who are crazed, but not totally ineffective (just usually totally devoted to an Old God or the like).
 


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