In this game, each player tries to drive their opponent insane or have more sanity than their opponents when the deck runs out. If you are not insane, you may still have the chance to win, but if you lose all your sanity, you are out of the game.

Each player starts the game with a small deck, and five cards are drawn at random from that deck. These five cards are placed in the rows between each pair of players, in a special location, called the location area.

Each player is dealt five cards. You can play those cards in order to put locations into play, boost your own sanity, or reduce that of others, or use the power of your locations once each turn. At the end of your turn, you can discard any cards still in hand. Then, you must draw five cards from the deck. Then, you can place them in the location area. If you have more than two players, you can place three cards between each pair of players, or in the location area. Each location is one location.