Trepanning

Trepanning is among the oldest and most controversial surgical practices in Everwealth, an act of desperation passed off as cure, sacrifice, or spiritual ritual depending on who holds the drill. Practiced widely in borderlands, swamp settlements, and faith-warped towns, it is the crude drilling or carving of holes into the skull to "relieve pressure," cast out madness, or release spirits believed to be trapped inside. To some, it is medicine. To others, it is exorcism. In truth, it is both and neither, an act of trial and faith performed on the helpless.   Ritual or Remedy:
In places lacking clinics or sanctioned surgeons, trepanning is often the first and only answer to ailments of the mind, be it seizures, erratic behavior, grief-madness, or the long-term effects of magickal exposure. Some practitioners are herbalists with obsidian tools, others priests with chisels and saltwater. Among the Elfese-descended lowlanders, the act is often accompanied by candlelit chants and vinegar washings to "weaken the veil between breath and bone." In some Orcish clans, it is treated as a form of honorable scarification, reserved only for those deemed spiritually “full to bursting.” Trepanned survivors are both pitied and respected. Some are said to "hear clearer than others," while others die before they ever get the chance to speak again.   Tools of the Trade:
Common trepanning implements include sharpened bone awls, burnt iron rods, or old carpenter’s augers retrofitted for fleshwork. In regions near The Grandgleam or Ashwood, shamans sometimes use the jawbones of eels or beaked fish to perform the incision, claiming their curved bite "guides the soul's spiral path." One famed relic, the Whisperdrill of Flint Maw, is said to spin on its own when brought near someone possessed or dreaming too loud. No antiseptic is universal. Some boil willow-bark water, others rely on poppy resin or smoke from white sage. Almost all close the wound with cloth soaked in honey or magickal chalk. Almost none agree on what actually leaves the hole.   Madness, Spirits, and Soul Pressure:
Across Everwealth, there is a common but deeply misunderstood belief in “soul pressure”, the idea that the spirit, when too burdened by grief, trauma, or dark influence, swells within the skull. To many rural folk, this swelling causes the mind to fracture, and trepanning is the only way to “let the grief escape.” Some surgeons scoff at the idea, but still perform the act, if only to calm desperate families. In more ritualistic sects, particularly among breakaway cults of The Knights of All-Faith, trepanning is used in ceremonies of “redemptive piercing,” where sinners undergo skull-drilling to remove unclean thought. Many die. Some claim salvation. A few never speak again, but smile too often.