You didn't find Carol! She's our secret weapon. She's the best there is at this game. She's been hidin' a looooooong time..
That was an 'Oh Shi-!' moment – but not at the level of the 'Oh shi-!' you experience when a demon just pops out of a locker you open expecting to find ammo (something which later changed to 'oh, not that shi- again'), or when your flashlight runs out of steam just as the motion tracker picks up a signal (and the music changes accordingly just so you know you're really screwed). It was simply the moment when you understood the meaning behind the boy's words and felt an unsettling feeling sweeping over you as the next step of the puzzle flashed before your eyes. Sanitarium was a game about not knowing if what you saw was real or imagined or a perverse mixture of both. It didn't scare you; it creeped you out, it put ideas in your head, it made you question what you saw and brought new questions once you've found the answer. It was a game that kept you guessing and made you uneasy that you might have guessed right.
Sanitarium came out in an interesting time, just when groundbreaking games like Half-Life and Unreal were appearing on the market, at a time when 3D accelerators and never before seen graphics showed how technologically capable games have become. It was a time when simply seeing the flyby of the Unreal castle and marveling at the exquisite reflections on the stone bridge or witnessing a police chase taking place during rainy weather in Need for Speed 3 was enough to completely grab your attention and immerse you into these worlds.
A decade later and times have changed when even a game like Crysis can no longer make a strong enough visual impression to lessen the amount of nit-picking from players who are not distracted by the pretty images rendered on their screens. The audio/visual punch to the face has become weaker and weaker and we are no longer left dizzy with amazement and are more capable to scrutinize the other elements making up a game. Sanitarium grabbed your attention for reasons many would say have gradually disappeared since graphic acceleration became the norm – simple things like originality and creativity.
In order to present the chaotic mind of an injured mental asylum patient the game went in an unusual direction with levels completely unique in atmosphere, presentation, and even gameplay. Instead of keeping a consistent feel throughout its duration, the game kept breaking up the design and throwing you in environments that seemed like they were taken from entirely different games (Limbo of the Lost took that concept a little too literally, however). Only recurring themes such as the mutilated children or the general weirdness accompanying each new environment made regular appearances, but it was up to the player to discover them. You were never thrown in a horror situation right from the get go; it was revealed to you piece by piece after each conversation you had, the puzzles you solved and the world you uncovered, and while levels seemed peaceful and ordinary at the start, by the end you would have surely come across a mutilated body lying about somewhere, at the very least.
The biggest scares came from not just seeing a big pile of bodies but figuring out why there was a big pile of bodies in the first place. Scary monsters, gore, and violence are usually great for giving you thrills, but Sanitarium excelled at giving you chills. You have amnesia, you wake up in an asylum, you don't know what's going on. Lost memory has always been a good starting point for creating an interesting storyline, but the team behind Sanitarium went a few steps further and used not just their own imagination, but also that of the main character himself. Yet even if it was clear that a certain chapter of the game was an illusion sprung up from the fragmented memories of a confused mind, there were enough connections with the real world that created doubts. Yes, being some kind of a futuristic insect might be just a hallucinatory fabrication, but does it have roots in the real world, and is it an interpretation, albeit a traumatized one, of actual events? The suspense and horror in the game came from finding answers to such questions.
Another unusual decision was that of the perspective. Isometric top down view was common and still is in strategy and role playing games, and starting up Sanitarium for the first time one could have easily confused the game with an RPG, as opposed to an adventure game. However, the choice complemented well the game's premise of self-discovery, since the normal pre-rendered shots from various angles and locations that make up the slides of a standard adventure game gave the feeling of linearity and constraint. It is a set up that has been chosen for the player unlike the freedom of exploration that walking freely around a map might allows. Some recent releases like Dreamfall have even been referred to as interactive movies where one is little more than a trigger moving the action forward. Sanitarium's perspective really allowed players to be part of a more complete world and gave them that sense of adventure for which role playing games were famous.
From a pure design standpoint the game did a great job of putting players in an unfamiliar and sometimes uncomfortable territory and by just the right amount. It still felt and worked like a good old-fashioned adventure game, with cool puzzles and interesting characters, as well as the odd joke here and there, only with some tweaks that got along well with the subject matter at hand. Add a solid base in terms of gameplay to back up the imagination of the development team, and you get a package that can be sent to retail this very day, and no one would complain. Or at least no one would complain if one were to first add pixel shaders, multiplayer, controller support, and as a bonus one of those pleasant forms DRM that promote violence (not to mention all the screaming and hair pulling that would add to the immersion and really help you get into your role as a mental patient). Actually, there's an even better idea, get it now and cheap from GoG.