This could also be important for broken legs, social standing with the Pope, or resistance to an addiction. Anything that slides downward with use or time or continued stress.
Rough ideas
Have an ongoing extended challenge, with only one resolution per sanity
event, that runs parallel to the entire story.
At moments of "ickiness", use a Pass/Fail determined challenge with minor failure causing a lasting setback and major failure adding a new flaw.
Just add a Sanity trait and attack it now and then, with the score dropping with failure (The simulationist answer to this question)
If you have any other ideas or sources I could turn to, I would be interested. The idea of playing the old CoC modules as narrativist games instead of simulationist makes so much more sense to me than determining how many feet away from a monster you are standing and how much damage a shotgun does to a deep one.
Thanks,
--Todd
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