Fair arguments! Yeah, I am certainly going to expand it to a 4 to 6 page version, thereby also allowing contested rolls. The way I envisioned this now is that players working against you counts as a form of unfavourable circumstances. Still, with more pages, it would certainly be possible to add a form of contested rolls.
The point on meds: I will be thinking about it. A part of the pervasiveness comes from the similarity between player and character, but in an expanded version I'll probably make that optional.
And about the "going mad": fair point. The creativeness of the players will give more diverse outcomes when keeping it to the vague "loss of all hope".