Sanitarium (1998, Windows) Review

 

PANIC IN THE BRAIN

Sanitarium is a completely unhinged adventure game in every sense of the word. From the story and dialogue to the perspective and sound design, everything revolves around a warped perception of reality, making the player question what is real.

When the freshly graduated art school students at DreamForge Intertainment sat down to plan the project, they couldn’t agree on which idea on the whiteboard to pursue, so they used all of them. The result pulls in every possible direction. It’s so fragmented and disjointed that the game really shouldn’t work, and yet somehow it does.

What you get is a hallucinatory odyssey through a damaged mind. The unusual isometric perspective brings to mind the RPG classic Planescape: Torment and its bewildering philosophical chaos, but Sanitarium instead sticks to traditional point-and-click mechanics. The interface is extremely simple: left-click to examine and interact, right-click to move.

The distant camera provides a strong overview of the environments, but it also turns pixel hunting and tiny puzzle details into a nightmare. Your eyesight practically gets a workout as you stare into the screen searching for scraps of interactable clutter.

The story begins with a violent car crash. You wake up in a gothic mental institution, your head wrapped in bandages from the injuries, with no memory of who you are. The rest of the game revolves around drifting from one dream state to another while piecing together your identity and backstory. You visit wildly different locations from the protagonist’s life, ranging from the comic-book worlds of his childhood to the circus he once visited with his deceased sister, to an Aztec jungle. In some worlds, you even take on different forms.

The game’s disjointed structure is tied together through recurring themes and symbolism. Almost everything — if not literally everything — seems to mean something. Children play a major role, as do corrupt authority figures, aliens, and angels. The nightmare-like mental hospital returns at regular intervals throughout the story.

Dream interpreters and psychoanalysts could probably have a field day with the game’s bizarre visual design.

Taken as a whole, it all sounds deeply psychotic and relentlessly bleak, but many episodes are laced with dark humor. The game skillfully balances despair with absurdity, and if I ever became frustrated, it was never because of the narrative. Sure, the ending leans a little into cliché, but the journey itself remained gripping throughout.

Adventure games often live or die by their puzzles, and here Sanitarium is relatively strong, though far from flawless. Some of the best examples are essentially mini-games within the game, not unlike the classic The 7th Guest, where you need to crack the idea behind a circuit board, control panel, or something weirder. Even though the game operates on dream logic, the puzzle solutions often fall into place naturally.

Unfortunately, there’s also far too much pixel hunting. Tiny, barely visible objects on the ground can be absolutely essential. A light gray wrench might be lying on a dark gray surface, so small it looks like a natural shade in the asphalt beside it.

What’s frustrating is that I sometimes knew exactly what the game expected me to do, which speaks to a kind of strength of the puzzle design itself. The problem lies in the execution. One example: I need the fishing rod to retrieve the object conducting electricity. I know who owns the rod. But how do I get it?

Early on, I was already on the right track and tried the correct solution, but my character refused to cooperate because I wasn’t standing in precisely the right spot. I experimented with other ideas for a long time. Much later, I tried the exact same thing again from a slightly different position — and suddenly it worked. The result was a strange mix of relief and even greater frustration.

The movement system is also clunky and sluggish, especially during the few segments that require precise movement or time pressure. Thankfully, these are very rare, and each chapter takes place in a relatively small area, so it never becomes unbearable.

There’s also plenty surrounding the gameplay that makes up for its shortcomings. The sound design is outstanding. The alarms, screams, and dripping water in the asylum levels create a constant sense of unease that perfectly complements the game’s mysterious visual style. The surreal blends seamlessly with the mundane. When the setting shifts to the circus or more alien environments, the tone takes on entirely new shades of madness, each governed by its own twisted internal logic.

A large portion of the game consists of clicking through dialogue trees. This is where the mystery gradually reveals itself, both between the lines and through more direct exposition. Certain encounters and events unlock pre-rendered scenes from the protagonist’s past.

Sanitarium features a huge cast of well-written characters — especially the children — brought to life through surprisingly solid voice acting, particularly by the standards of other games from the 1990s. The protagonist’s theatrical enthusiasm occasionally evokes Adam West’s iconic portrayal of Batman in the 1960s television series, which sounds like an insult but really isn’t.

Everything in Sanitarium is one giant puzzle. The dialogue, characters, environments, and even the puzzles themselves resist straightforward interpretation. Thematically, the game is deeply disturbing and surprisingly daring, especially in its depiction of child exploitation during the second chapter, which I consider the game’s strongest section.

Here, the game reaches a level of psychological darkness I rarely encounter in games, especially from that era. Today, moral outrage would probably explode across social media. But when the game was released in the late 1990s, the cultural climate was very different. Now Sanitarium survives quietly in the forgotten corners of the internet, preserved and waiting to be rediscovered.