Sanitarium, as befitting an adventure game with the theme of dementia and delirium, does not start with an expository introduction of any sort. After a cutscene of physical tragedy, the player character, a certain Max Laughton, wakes up in a place that bewilders him greatly - if not terrifying him outright.
So starts the premise of the game. The player character is placed into a level, with the current view transitioning as he moves around. The first level acts as a tutorial of sorts. Here, even without the use of a manual, the player is goaded into clicking on things like disturbingly animated sprites and subsequently learning about the controls scheme, along with an early taste of the sometimes gruesome puzzles that will come along.
The nature of the levels change quickly, and sometimes the player character warps from Max to another altogether. (The reason for this will have to held back for the purpose of preventing spoilers.) These other player characters, shortly after being introduced, will more-or-less proclaim their traits and characteristics during monologues and dialogues. These are important hints that the player should take note of as the new levels often have puzzles that can be overcome by utilizing these traits. The player would be wise to remember the solutions to these puzzles too, as the fantastic finale will throw plenty of deviously revised puzzles involving them at the player.
An odd checkpoint system of sorts helps in overcoming some of the seemingly lethal obstacles in the game. It is very handy, but considering that failure at achieving solutions to said deadly puzzles often involves deadly harm, it can be more than a bit awkward to watch, say, a recently drowned player character washing up onto a river bank, getting resuscitated without any help and going back into the shallow river again for another go at said puzzle. Still, it is much better than having to watch a "Game Over" screen (and subsequently a loading screen) and have the immersiveness of this game dashed.
A game with the theme of horror and delirium will not be complete without disturbing visuals and artwork; Sanitarium does not disappoint here. The game has plenty of dread-inducing map designs (though the forgiving gameplay mechanics do detract from this somewhat). One map can look very profoundly different from the previous one; the last few, this reviewer warns, can be nausea-inducing (but for very good story-oriented reasons, which cannot be disclosed here as well). There are also many characters whose looks would make anyone queasy (particularly in one of the earlier levels). Max himself is not really a looker too.
Dialogue between characters (& their monologue) is punctuated with faces and subtitles, the former of which have different sets of expressions according to the mood of the characters at the time. These sets are limited however, so the player can expect to see some oft-repeated facial expressions, especially Max's. As for the voice-acting of characters, they are voiced-over quite competently, though it takes a while to get used to Max's, for the man does not seem to be perturbed enough in some circumstances. He does have some moments where his lines are delivered with great empathy to his current situation, fortunately.
The music is spot-on whenever it is present, on the other hand. Ominous tracks play whenever the player character enters a region of the map that is dangerous, playful melodies permeate some of the more livelier sections of the game and of course, there is the bittersweet tune heard whenever Max reconciles with his remorse (which are tear-jerking moments, this reviewer warns).
The sound effects are a different matter, however. For a game that has a significant amount of dialogue and outstanding (for better or worse) visuals, they do feel a bit lacking. Scenes that otherwise should be filled with background noises are awkwardly silent, while some others (especially those of machines) can be very grating and unwelcome.
From a technical aspect, it is unfortunate that the retail version of the game comes with serious bugs that impede progress in the story; a particularly significant one involves the switching of CDs. The patch for this solution will have to be applied immediately after installation, as it affects the way saved games are loaded into memory as well. Restarting the game is no fun, as, unfortunately, the game is at its best when played the first time around.
Playing the game again only serves to have the player notice the shortcomings of the game that were overlooked the first time around, namely how slowly the player character moves, conversations that always play out the same way if no progress has been made, and, of course, incessantly looping animations and sounds (a bane of games at the time).
In conclusion, Sanitarium promises one heck of an otherworldly, eye-opening ride the first time, and the experience of which players may want to savour and not sully with another playthrough that would expose the game's setbacks.