Where madness really causes a problem is with bosses. If you die repeatedly at a boss and your death spot is in the boss arena, the doppelganger won't show up, so you're kind of stuck with max madness unless you decide to go get killed somewhere else, take down the doppelganger and be back to zero madness.

Check out some of the best Wuchang Fallen Feathers mods to adjust the gameplay to make things easier, alongside some handy quality of life tweaks.