Sanitarium isn't a very good game. Largely this is the fault of its narrative, which appropriates certain aesthetic tropes from Lovecraft but employs them in the service of a very bland psychological horror, which undermines their materialist basis and instead positions them as dull, overdetermined psychologistic moves. This might, for all I know, be an effective way of evoking horror/terror/dread; as affects, these are pretty foreign to me, despite my appreciation for the genre that takes its name from one. Given that the question of “how scary might you find it?” is beyond my remit, then, let's continue.
Quickly; when I say “overdetermined,” what I mean is that the structural components that give rise to a particular aesthetic object within a text employ the object in such a way as to overwhelm any valence that it itself might possess. Generally these are also certain cultural signifiers that come prepackaged with strong significations; the clown being the most obvious that comes to mind. Because of the strength of meaning that is culturally impressed on clowns, often in paradoxical ways, their appearance within a text is thus always already marked by an excess of meaning; for a text to then overdetermine them would mean that it forces, through the application of pressures created by everything from the narrative's movement to the mechanical logic to the methods of characterization, them to become the receptacles of the various and often contradictory “meanings” of all of these various components, pinning them down as the explicative metaphor or keystone of the text. I'm probably using it wrong.
Roughly, Sanitarium is the story of Max, who wakes up in an asylum that is mostly abandoned, unaware of his name and swathed in bandages. He travels through a town of deformed children, various iterations of the asylum (and distinct spaces within it), and, as his (dead) sister, a comic book character, and an avatar of an Aztec God, through a circus, a Hive of intelligent insectoid creatures, and an Aztec village.
These are all fecund environments, of course, fully capable of being engaged with in interesting and complicated ways to create deep play-experiences. Unfortunately, they are all hokily telegraphed or retroactively justified by reference to the unfolding narrative; Max, it turns out, was traumatized as a child by the death of his sister, and his inability to comply with her last wish (bring her a doll that her father had won her at the circus the year before); as an adult, he is a head researcher working on a cure for a virus called DNAV which exclusively kills children. He works under Dr. Morgan, who he met at med school, and whose drug, HOPE, prolongs the life of DNAV patients without actually curing them. By the end of the game, you learn that the visions you've been playing through represent a drugged and delirious Max who, having barely survived a car wreck after Morgan cut his brakes, is fighting off the effects of a drug Morgan injected into his IV to silence him before the DNAV cure comes to light.
The idealism here runs deep, and the cribbing of Lovecraft is incoherent; not only are we made to believe that everything material here is nothing but a psychological projection, but that, deeply confusingly, the way to resist being poisoned while in a coma is to symbolically confront and overcome childhood traumas. That this overcoming is done by the successful completion of a series of puzzles is, of course, simply a feature of the genre; at the same time, though, it becomes a metonymic replication of the specific mode of reasoning of the game. Reductive, instrumentalized, over-reliant on the epiphanic and masterful, but at the same time rife with the mundane, patient drudgery of trial and error.
This is the universe of the conspiracy theorist, whose analysis of power is locked into the same reductive mindset of the puzzle-solver; that the main narrative tension of the game – why you want Max to wake up, why he wants to wake up, sooner rather than later – is an enactment of prominent conspiracies related to HIV research is much less coincidence than it is symptom. When the logic that undergirds everything from the genre to the mechanics is conspiracist, an attempt to tell a story with a more nuanced analysis of power is bound to be dissonant, at least. But then, this is already a game which tries desperately to allegorize Lovecraft, so perhaps dissonance is the order of the day.
Probably my favorite aspect of Sanitarium was that you were unable to run. The fact that your character is slow as shit was a constant source of simultaneous frustration and amusement for me; on the one hand, this nod to realism is utterly weird in a game which is very uninterested in being realistic outside its own logic. On the other hand, the tight allegorization actually allows for this to make sense in terms of level design, by allowing the architecture of an area or its layout to collapse a variety of (cultural, outward-looking) meanings and (narrative, inward-looking) significances into very few spaces. This means that the levels can be sufficient to both their internal logic and the requirements of the narrative progression without being particularly large; and, on top of that, the use of exposition through space-triggered cinematics moves the weight of the overarching narrative even further outside of the mechanical. And the level design is very good; even the annoying multi-layered maze in the Aztec portion is handled as well as that sort of thing can be, meaning that the frustration with the slowness of the character's movement is exclusively a symptom of familiarity with other games. You aren't actually wasting any time by moving so slowly; you just expect that because you are playing a video game means you are going to be running all the time. And because of the frustration of that expectation, you (or at least I) end up actually spending more time taking in the level design of the game than you naturally would while simply playing, which ultimately is easily the richest aspect of the game.
Generally, I think, this sort of totalizing integration of disparate parts is held up as the triumph of a text, and I understand how that could be appealing to a potential player. The problem with this game, as I see it, is that this totalizing is done in the service of a specific, and ultimately uninteresting, mode of valorization; it is less an integration of disparate things into a compelling system, and more a collapse into equivalencies, in an allegorical and metaphorical register, toward the didactic reveal, resulting in a monovalent text with a symptomatically underdeveloped analysis of its components, specifically institutional power, meaning, in the end, it is more involved in closing off possibilities than opening them up.
This is where a certain reading of Lovecraft's employment of “madness” actually makes the misappropriation of his aesthetics into an harmonic, rather than dissonant engagement; I claimed here (comment #5) that the consistent use of “madness” in Lovecraft actually undermines his apparently amoral universe by reintegrating it into an implicitly moralistic framework. Rather than being a simple expression of the absolute indifference of the universe, madness is a moral category which is diagnosed by power that Lovecraft fails to engage with; this is symptomatic of his complicity with the economic power which informs his racism. That the biographical Lovecraft was not privileged with the material benefits such complicity promises is beside the point; his enactment of them is tied inextricably to material structures whose indifference to the individual is much more profound than the universe's indifference, at least in terms of lived existence, and it is only by reading his stories through this lens that they offer anything of interest. This is Lovecraft against himself, of course, but the way that his stories avoid the reproduction of a conspiracist analysis of power makes this reading much more compelling; there might be cults and cabals and hidden knowledge in Lovecraft, but it is not the product of machinations. It is the conflation of accidents and fears and ambitions and stuff, in a purely materialist sense; Sanitarium, no matter how totalizing it is as a text, appropriates the results without understanding the importance of the method, and ends up being very slight because of it.