Most Kindred cling to the familiar shores of sanity like drowning men, resisting the tug of dark, seductive waters. Though they know a constant, low-level madness from their slavery to the bloodlust, most Kindred usually resist it and fight it off all other derangements. Some are eaten alive from within by the Beast; most grip their sanity with a miser's clutch.
But some Kindred plunge in where the strongest elders fear to go, giving full vent to their demon desires and mad caprices. Some do it by choice, but the rest do it because they are forced to do it. The curse of Malkav has stolen their choice in the matter, and they can either agree to dive into madness, or be dragged under the murky waters of the chains of insanity.