Solid gameplay, unstable code.
While the graphics are not top of the line anymore, they're very gritty and definitely do the job. Much of the gore is realistic, if not shocking at times. Seeing a flayed, young woman is unreal in this politically correct world. However, instead of a cheap thrill the terror of the sight affects even your character...
There will be times when his madness reminds you of the scene and the guild of what he (you) had done. The enemies are great, and impossible to fool. No Sam Fisher stealth here. If you're in line of sight, expect to get killed or make a nail-biting escape.
There are a few game-play problems. Should the voice actor be narrating, interacting with objects will cut off the narration and break the mood.
Technical issues abound, particularly with Vista. The game can be prone to crashing VERY often. Overall, the game is cheap to obtain nowadays and is definitely worth the price. Be sure to run on compatibility mode for best stability.