Posted by Davide Tomei.
First posted on 20 October 2006. Last updated on 15 May 2014.
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Even the menu arouses an anguish feel, where the eyes follow the cursor on screen.
Nice kid! Good place to play too!
The asylum is where you wake up in this nightmare.
The circus is in town. It is just too bad that all the people are dead and floating around!
The mighty Grimwall, your alter ego, walks into an insect hive.

How do you survive inside a gothic styled insane asylum, surrounded only by screaming and self mutilating inmates? Now imagine what if you do not know, or worse yet, do not remember why you are trapped in this nightmare. Though aware of your predicament, you are not even sure of your own identity. All that remain are strange flashbacks haunting you and the memory of your face completely wrapped up in bandages after a freakish car accident. Who are you? What have you done to deserve to be locked up? Have you gone mad?

In this creepy and ambiguous, yet captivating and immersing adventure, you play a man who must fight his own demons who are trying to pull him away from reality and into madness, all the while exploring his own journey of redemption. While the story may not begin in the most original fashion, how the story eventually unfolds is light years away from being a cliché such that it is anything but predictable.

Our hero, whose name is revealed only later in the game, finds himself in a mental hospital with complete amnesia about his past. The asylum resembles almost an infernal circle of hell. It is dirty, with blood stains on the walls and holes on the floor. It is a macabre hollow tower extended by small balconies. You are on your own, trapped in an endless nightmare. Your effort must be focused on uncovering your lost memories, and with them, the truth about what has happened to you.

Unless you seek to become the freakish denizens around you, the first task you must undertake is to find a way out of the asylum. You reach for a towel in the middle of the cell, only to trigger unexpectedly the first piece of your missing memories. In the flashback, you recall your encounter with Dr. Morgan, the director of the asylum who later becomes your nemesis. Eventually, you manage to escape from the building, after a mystic interaction with an angle statue that envelops you with her wings and takes you to the next chapter of your bizarre voyage. There you find yourself in a decayed ghost town, with no adults and only a group of children, all of whom are all horribly disfigured.

By now, you may have guessed that your journey is going to be neither easy nor pleasant, and the road ahead of you is only getting rougher than the path you have already crossed. Soon, you realize that it is not about a journey in the physical world. Rather, it is about a journey deep inside your mind through the depths of consciousness that is full of madness, anguish, and demons. In this journey, even your own self image is altered when you are transformed into a Cyclops or an Aztec God. Shocked by such transformation, you begin to question yourself about what is real and who is dreaming. Fortunately, with a bit of intuition, you quickly learn to discriminate between reality and fantasy to survive into this web of nightmares. Every character, real or imaginary, uncovers parts of your past that helps you to understand what has happened to you. While it is admittedly difficult to explain on a deeper level without revealing more of the stories (and there are more than a single story) in this game, even the smell of conspiracy alone makes it a most intriguing adventure. It is up to you to slowly discover the awful truth that lies behind your own horrific past.

Sanitarium is played from a third-person isometric perspective in non-tiled 2D world. Even though the graphics are a bit dated, they serve well enough to portray the great variety of locations within the game and the gruesome details of the environments. The characters are drawn well, but all have a pixelated appearance and are not very detailed. None of the flaws, however, overshadow the fact that Sanitarium has some of the most suggestive sceneries ever drawn in adventure games. The game plays over 9 chapters. Load times between levels and chapters can be quite long. When you enter a building, the roofs and walls disappear to let you see from above and explore the inside. Pixel hunting can be an issue if the inner area is too small. The navigation system used in this game is unusual. Movement is not done by using the classic point and click combination with the left mouse button but by holding the right mouse button and then directing your character to walk (there is no option for running) in the desired direction. The left mouse button is used to summon the inventory or interact with objects and people by clicking on the character, though often you need to first observe the objects or people before you can interact with them.

The sound effects and music in Sanitarium fit perfectly to the mood of the different locations in the game, giving an added emotional push to the player. Even the sound of your footstep changes depending on what kind of ground on which you are walking. On the other hand, the written dialogs and voice acting (all speeches are subtitled) are quite poor. For most conversations, the options given to you are often few and repetitive. The cinematic sequences in Sanitarium also deserve a special mention. They are functional to the story and are drawn in sepia color that helps to capture your attention to the story. Sometimes the imageries are obsessive, sometimes they are frightening, but they are always important in helping to convey the vital elements of the story.

Even though Sanitarium is a psychological horror adventure, the puzzles in it are not of the same kind. They are rarely just "plain" puzzles. Some are inventory based (where you have to use items that you have collected) while others are logic related (where you have to figure out how to operate a device such as a complex door or a pipeline system). None of the puzzles are too difficult. In fact, some of them can even have been made more challenging just to extend the life of this game. As these puzzles are unlikely to leave you in frustration and anger, solving them is going to give you instead with a sense of satisfaction and gratification.

In conclusion, Sanitarium is a must have game for all the adventure games fans, particularly those with a strong stomach for the bizarre. This game does not belong to typical survivor horror genre. There is no explicit violence and the gameplay is not merely a "splatter", except for a few disturbing imageries such as a circus on an island surrounded by floating corpses or an experiment chamber with walls covered in blood and eviscerated bodies. The horror that comes from this game as envisioned by designer Mike Nicholson is more shifty. It is psychological horror that reaches into your inner mind and twists it with its powerful storytelling. Sanitarium may have been the perfect masterpiece if not for its outdated graphics, long load times, and awkward interface. Nonetheless, it is an amazing and unforgettable adventure that guarantees you at least 20 hours of addictive gaming.

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