The Stone of Madness is described as a hardcore tactic set in a Spanish lunatic asylum in the late 18th century. According to the plot, there is an insane asylum and an inquisitorial prison in an old Jesuit monastery located in the Pyrenees. Five mysterious characters have been imprisoned within their walls under various pretexts. Suffering from cruel punishment, madness, and despair, they soon begin to develop a plan to escape from this place.

You will control the characters one by one. Depending on your playstyle, their sanity will deteriorate, gradually causing negative effects such as paranoia, dementia, and bouts of violence, in addition to the strengths and weaknesses of each hero already present. Sims will also be able to unlock positive skills or reverse negative effects on their sanity. Interestingly, the game has a division into actions during the day and night phases.