07. Oct, 2025
Written by Maddie Fisher, Dual Shockers
It’s quite often said that if you want true innovation and imaginative game concepts, you need look no further than the indie scene.
Indeed, indie games are responsible for some of the most oddball, entertaining video game experiences every year. It’s safe to say that this year has been no different, as titles like Strange Antiquities and Deltarune have proven.
Enter Sanatorium: A Mental Asylum Simulator.
Set in the 1920s, feeling like it’s one beat away from a video game version of The Great Gatsby, Sanatorium casts you undercover at an asylum looking for the truth about your long-lost Aunt Patty.
Described as a card-based workplace adventure, which in itself is a delightful concept for a game, it is a title that challenges you both from a gameplay perspective and a moral one.
Ethical dilemmas clash with an ongoing mystery about the true nature of the asylum, which becomes a major focus of the game.
In between that ongoing story, in the moments that make up the bulk of the game, you’ll find yourself connecting with patients that have their own stories to tell.
The core game loop, excellent period setting, and unique card-based progression system make up a large part of what makes Sanatorium: A Mental Asylum Simulator so engrossing.
Dark Deco
Taking place during the 1920s in Castle Woods Sanatorium, it evokes an art deco style that relies on sharp, angular lines and classical architecture. It’s not a style I’ve seen explored in games too often, which really makes it stand out.
In many ways, it’s reminiscent of classic point-and-click adventure games, where you shuffle between 2D environments with a click of your mouse.
Castle Woods Sanatorium hides many secrets and sinister passageways. As you explore its dank halls during the night, attempting to avoid arousing suspicions, the asylum opens up to reveal even more of its darker side.
Castle Woods Sanatorium hides many secrets and sinister passageways.
It’s made up of four wards, and progressing to each one relies on being good at your job. A job that you have no experience in, no less, as you’re just an outsider attempting to find out what happened to your Aunt Patty.
I felt like a patient in Castle Woods myself sometimes, as the walls often feel like they’re closing in on you. This dark, encroaching aura of doom plays out in its music and the characters.
Backed by what I can best describe as Doom Jazz, the soundscape of Sanatorium is one that creates a mix of playfulness and imminent dread.
In what feels like scenes ripped straight out of One Flew Over The Cuckoo’s Nest, you’ll meet a wide assortment of unusual characters.
Ranging from a seemingly untrustworthy head doctor all the way to a disgruntled orderly and a curious gatekeeper, the cast all have their own little funny quirks. This is strengthened even more by the sharp writing, which brings each one to life in their own kooky, funny ways.
A Good Bedside Manner
Making your way through Sanatorium: A Mental Asylum Simulator revolves around you understanding what your patients need, as well as being clever enough to avoid detection.
Doing so relies on you diagnosing patients correctly, using an unusual form of medicinal pseudoscience known as phrenology. After all, if you don’t know what’s wrong, you can’t treat them.
Worse yet, if you can’t treat them, you’ll wind up in the asylum yourself.
As you talk to each patient, you’ll find that their personalities are remarkably varied. Some of them are socialites, veterans dealing with the trauma of war, and everything else in between.
No patient ever really feels the same, as the large number of symptoms and illnesses are excellent.
One thing that the game does brilliantly is its examination of how stigmatized mental health both was at the time, and how that even persists today.
No patient ever really feels the same, as the large number of symptoms and illnesses are excellent.
In order to diagnose a patient’s issue, you first need to find out what each symptom needs. This is done by talking to them, then assigning their symptoms to a particular area of the phrenology chart.
You can also use tests that come in the form of cards, which can be used to uncover more symptoms. Once they are in treatment, you can use the appropriate cards to combat their illness.
I especially like the way the game handles these moments. You have to actually sign off on their treatment, writing with your mouse to do so. You also need to stamp them out if you want to release them.
Both of these activities are incredibly satisfying. Once you’re in a groove with the game, the simple act of doing this day-to-day just feels so fun.
It’s a neat little system, but it does lead to some frustrating design choices.
If you get it wrong, your ability to treat the patient decreases. This leads to suspicion from the staff, which could end your game.
All that on its own is fine, except it almost feels like a Dark Souls-style runback to try again. You have to go through a lot to reach where you were again, which just doesn’t feel great.
It’s also worth noting that there are also times when the game itself works against you during these sections.
Menus have a tendency to act a bit strange, sometimes resulting in a soft-lock or simply not responding during your patient result summary. It doesn’t matter how many times you click, you’ll have to restart the game.
The game can also get stuck during patient discharge, leaving you unable to let one of them go home even though you’ve satisfied all their health conditions. It’s a frustrating element of a game that runs perfectly otherwise.
Doctor Bertham, I Presume?
Sanatorium: A Mental Asylum Simulator focuses most of its efforts on the health and well-being of your patients, but there’s also a fun little mystery to uncover just underneath the surface.
Between treating patients, you’ll be able to explore the facility. This all happens at night, with a bit of spooky music to accompany each trip.
As you explore the asylum, you’ll find evidence and bits of lore that add to the mystery of Castle Woods. It’s a place that hides a lot of secrets, and paying attention to all of it is important to where you end up when the credits roll.
You’ll find yourself scrounging for scribbled notes, broken bottles and more. Some of them even come via hints from patients themselves, as the game does an excellent job at making sure each patient has a unique story to tell.
While the asylum is fun to explore, it does create a sense of fatigue the further you get in. Going back and forth from patients to exploration is fairly engaging, but it does start to feel a little stale after a while.
I suppose you could argue that is exactly what the developers were aiming for in their critique of the health care system, but that may be a bit of posturing on my part.
The story does take some neat turns, however, and the final stretch of the game is actually quite good. And as each ward introduces new symptoms and new phrenology charts, the game itself doesn’t suffer too much.
I just found myself feeling a bit deflated by the end, as the core concept is definitely unique, but the game just doesn’t quite have the horses to finish in the most spectacular way.
Closing Comments:
Sanatorium: A Mental Asylum Simulator is a unique, compelling little indie title that examines the dark, sometimes stigmatized world of mental health. It does so in a lovely way that is clearly made by a team with tons of respect and sensitivity. The oddball staff members at the asylum are full of charm, and the patients are just as endearing. It struggles with some unfortunate design choices and some unusual bugs in the menus, but is overall worth a bit of your time.
To read the full story, click the link below:
https://www.dualshockers.com/sanatorium-a-mental-asylum-simulator-review
