The Insane is a title rewarded for completing the Feat of Strength Achievement Insane in the Membrane. The achievement requires gaining the following reputations: The title follows the character's name in the following format: the Insane This title has been confirmed to be acquire-able as of Cataclysm by a blue post: Yes, you can still earn the Insane In The Membrane achievement, which grants the title. Cataclysm made some aspects of it a bit easier, and some even more insane than before. Ravenholdt reputation in particular, if you didn't work on it prior to 4.0, is simply punishing.