Insight has a positive ring to it. We can destroy that.
The Wizard of Macke Town is a fantastic blog with a relevant blog post. Bloodborne apparently tracks 'frenzy' and this can, if accrued, cause horrible damage to the player. The wizard adapts this to games with Wisdom scores.
One gains Frenzy by encountering horrible things ('reading the grimoire deals 1d6 Frenzy damage and teaches you to speak to vermin'), gaining new knowledge of the world when speaking to some monsters. When your Frenzy score and Wisdom score are equal, you take double your Wisdom in HP damage.
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I would also posit that memorizing a spell should add to Frenzy - say, the spell's level determines how much Frenzy you gain when you memorize it. The spell will squat in your skull for as long as you want - you don't forget it when you sleep, you dream of it. Dream of it watching you. Anyone can memorize any spell they want - they just are in more and more danger of Frenzy making them burst blood vessels, have heart attacks, or have their head explode.
Now anyone can be a wizard - in plate mail or kevlar or just a comfy pair of joggers.
Another nice bonus is that this doesn't conflate horror with real-world psychological issues. You don't gain so much insight you get depression. You gain so much that your head explodes from the inside as the horrible living ideas try vainly(?) to flower and spore with your dying flesh. Rates of depression and anxiety here in the US have doubled in the last year, thanks to Trump's inability to lead in the face of a global pandemic. And even before this, mental health was considered a huge, yet systemically unaddressed problem. Given this, I prefer a system that doesn't tell you that you have PTSD or anxiety or depression during fun-relax-time.
I need something far more fantastical and strange.
To this end I have written a very simple character sheet and 'system' for this: CESR, Charlie's Eerie Simple Roleplaying. It owes a lot / steals from The Black Hack, Nate Treme's NOSR, Jared Sinclair's Anti-Sisyphus, and of course The Wizard of Macke Town. I am working through different Silent-Hill-4-esque scenarios of surreal mismatched interior places, dungeon crawls, where one must battle monsters and their own insight.
Soon there will be more.