Quick hack based on the amazing Straits of Anian blog:
Sometimes you lose more than just your flesh and blood.
Any time you’d normally take a debility you instead choose one:
Language You can no longer speak language, nor can you read or write. You may still moan & holler unintelligibly if desired.
Civilization You can no longer use tools or weapons and must perform all actions directly, with your body.
Skill You lose a move of your choice.
Passion You become depressed and lethargic, unable to perform any significant actions not in response to a direct threat, immediate danger, or basic survival.
Humanity You becomes perceptibly but indescribably inhuman, reducing you Charisma score to 3 (Cha -3). Animals growl or otherwise act hostile in your presence, and hirelings will not follow them. Even old friends may turn against you.
Each can be marked only once. If you’d mark a debility but have none remaining, you are no longer alive. Your body may still move about, but there is no spirit in it.
Mark of Death
Nearing death always leaves you changed.
Whenever your total damage taken is greater than your Constitution score, you take a debility.
Note that this hack totally messes with the Paladin, because Bloody Aegis will be much less useful.