The Court of Madness, like the Shivering Isles itself, is divided into two halves. Dementia and Mania are represented by their own nobility. Lord Thadon is the current Duke of Mania and Lady Syl is the current Duchess of Dementia. Each house has control over their respective domains (at the discretion of Sheogorath) and each runs a section of New Sheoth. Bliss for Mania, and Crucible for Dementia. Their troops are distinct, Golden Saints are aligned with House Mania, and Dark Seducers are aligned with House Dementia.
- Tourist - Simply cross through the Door in Niben Bay.
- Aspirant - Awarded upon completion of Through the Fringe of Madness
- Citizen - Awarded upon completion of A Better Mousetrap
- Madman - Awarded upon completion of Understanding Madness
- Honored Madman - Awarded upon completion of The Cold Flame of Agnon
- Duke of Dementia or Duke of Mania - Awarded upon completion of Ritual of Accession
- Regent - Awarded upon completion of Retaking the Fringe/Rebuilding the Gatekeeper
- Defender of the Realm - Awarded upon completion of The Helpless Army
- Madgod - Awarded upon completion of The End of Order
Note: When choosing to be either the Duke/Duchess of Dementia or Mania consider your class above all else. If you are a magic type class such as a mage, you should go for Mania as they have many intelligence upgrading gear. The Raiment of Arden-Sul and Ring of Lordship are just a few examples of this. If you are a thief, you should go for Dementia as they have a ring of Lordship that makes you invisible to a certain degree. For warriors, there is no right or wrong choice, but Dementia is the most likely of choices.
- Note: If you want to unlock the full Achievement points in the Xbox 360 version, then it is best to make an extra save game before you make the decision to become either the Duke/Duchess of Dementia or Mania. You cannot become both with the same character. If you don't want to go through the game with another character, it's fastest to just reload the old save before you made the choice and quickly do the other option.