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Sanitarium is a Weird and Spooky Adventure Game That Doesn't Have Much to Say

Released in 1998 for the PC, Sanitarium is an isometric point-’n’-click adventure game filled with big ideas, imaginative worlds, and creepy monsters. There’s no doubt that the game was ambitious for its time, but does it hit the mark?

As part of our Halloween season podcast, The Eerie Arcade, my wife and I played through this horror-themed adventure game. While there were certainly many aspects we enjoyed, the game presents mediocre elements in equal measure. Let me explain.

Horror rarely treats mental illness with respect, and Sanitarium is no exception
Screenshot: Alternative Magazine Online

The premise of the game is that Max, a man without any memory and a bandaged face, wakes up in a mental hospital engulfed in flames. I was quite put off by this initial segment, which presents mental illness in exactly the archaic and problematic ways I was worried the game might. Characters bash their heads against walls, babble incoherently, etc. and it’s all played for laughs. The game isn’t interested in saying anything poignant about mental illness, it just uses it as a backdrop to be weird and have a cast of wacky characters.

Fortunately, this segment concludes quickly and we get to the bulk of the game in which Max transitions between different worlds and bodies. This essentially allows the game to act as an anthology that explores many different stories and settings and uses the titular Sanitarium as a device to connect these strange dreamscapes. While this worked well as a structure to keep the game fresh and always moving on to something new, it suffers from the same problem that most anthologies do. Namely, some segments are much stronger than others. I enjoyed exploring a town of mutated children whose parents had all been killed by a sentient plant monster that grew out of a comet and found the warped and sepia-toned exploration of Max’s childhood home as his deceased sister to be effective and moving. However, the circus segment is a boring slog that tries its hardest to be weird and just comes across as annoying and doing fetch quests for people as an ancient Aztec spirit warrior just feels underwhelming.

Screenshot: The Let’s Play Archive

The game’s prerendered art style does a pretty good job of realizing these strange worlds but the artists clearly had a difficult time animating characters. Everyone in the game moves stiffly and awkwardly. Occasionally animations were so inhuman that we couldn’t help but to burst out laughing at the absurdity of them. Not ideal if you are aiming to draw in your players.

Sound design is a similarly mixed bag. Music and atmospheric sounds, such as children playing, insects skittering, and water bubbling, help to give a deeper impression of these settings than the graphics alone are capable of. Then there is the voice acting. While there is some genuinely good voice acting on display here, most of what you will be hearing is Max talk and, boy, did someone phone their performance home. Listen to how stilted this conversation is. It’s clear no one was coaching the actors on how they should sound, leading to bizarre readings and unusual reactions to what is happening in any given scene. This is a real problem for a game that is primarily walking around and talking to people.

Screenshot: YouTube

Thankfully, the actual gameplay in Sanitarium is solid, at least if you like classic point-’n’-click adventures. The puzzles make more sense than a lot of games of this era and the few cases of bad “adventure game logic” actually kind of make sense within the dream-like atmosphere of the game. Especially fun were the “puzzle box”-esque segments where the game zooms in to a first-person perspective and tasks you with solving some sort of mechanical contraption.


Unfortunately, the game’s narrative just fell flat for me in the end. The way it was presented, with you and Max being unclear of reality throughout and more and more memories being revealed as the game progresses, is an excellent narrative structure but the game’s ending squanders what it had built. (Spoilers ahead for anyone who cares): In the final chapter we find out that Max, who had come up with a cure to the DNAV virus plaguing the world, was poisoned by Dr. Morgan, who wished to continue selling his treatment that only prolonged the life of patients instead. The entire game, as it turns out, was just Max’s mind and body battling the poison in the hospital. There was never a Sanitarium, Max was never mentally ill, none of the other patients even exist, and it was all just a bad dream.

This ending leaves the game, which was ostensibly trying for a heavy story, with very little of substance to say. There’s no commentary on mental illness or how we treat the mentally ill, no real growth for Max, and essentially no time spent in the real world. I guess the overall message was just that sometimes pharmaceutical companies are bad and that poison can make you hallucinate strange things?


Overall, Sanitarium very much feels like the video game equivalent of a B movie. It may suffer from bad acting and a contrived script, but it’s fun if you just don’t get that invested or expect it to leave you thinking very much.

You can listen to our full discussion on the game below or by subscribing to The Eerie Arcade on Google Podcasts, Apple Podcasts, Spotify, or wherever else you like to listen.


Join us next time to talk about the horror gaming classic Silent Hill 2!

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