In this week’s Classic Mondays feature, we take a look at the 1998 PC adventure classic Sanitarium.

By the time Sanitarium was released, I had already played through a ton of mentally disturbing games, but nothing could prepare me for this one. After a horrific car crash, Max (the main character) awakens to find himself suffering from long-term amnesia. To make matters worse, he’s stuck in a decaying sanitarium filled with monstrous noises and terrifying scenes of brutality. Trapped in a world that may or may not be all in his head, he sets out to not only regain his memories, but also to unravel the mystery of what happened to his family after the accident.

What makes Sanitarium such a disturbing game isn’t necessarily the story (although that certainly helps), but rather the deformed landscapes and NPCs. C’mon, look at this insanity:

And take a look at this kid:

Disturbing NPCs and locales aren’t anything new for the world of PC games, but there’s something extremely unsettling about the way Sanitarium displays both, despite an underlying sense of black humor that persists throughout the storyline. Visually, the game looks fantastic for its age…the hand-drawn environments up the creep factor considerably, and allow for far more detail than other games from the same time period. As for NPCs, they don’t just populate the world in a static way…the majority of them are engaged in some form of off-putting activity. Whether it’s constantly ramming their head against a wall, digging up graves, or poking and prodding the sores on each other’s bodies, they all actively engage in things that help anchor them to the game world. The fact that so many of them are pleasant to actually speak with only emphasizes their physical, mental, and spiritual deformities even more.

The game is split up into chapters, with each one taking place in a wildly different environment. Before Sanitarium is over, you’ll have traveled from the eponymous sanitarium, to a haunted pumpkin patch, to an abandoned town populated only by horribly disfigured children, to a nightmarish carnival, and more. Each of these environments has their own distinct music, visual style, and role in the story. They also provide different gameplay styles: while the 2D isometric view is constant throughout the game, one chapter might be a “find these objects” type of mystery, while the other might involve talking to (and subsequently trying to persuade) various NPCs. Since each chapter shifts so completely (gameplay style, visuals, and music) the game feels fresh throughout its roughly eight hours of gameplay.

In addition to the landscapes and NPCs, the understated soundtrack adds to the sense of dread that permeates the experience. The music ranges from droney atmospherics like this one:

To dread-filled understated pieces like this one:

To more powerful tracks like this one:

The soundtrack itself isn’t all that creepy, but when combined with the visuals and the situations present in the game, the music really ups overall atmosphere. The voicework is mostly forgettable, although it does help lend some additional personality to the NPCs you encounter. Unlike the voicework, the script is beautifully done; there’s an occasional cliche line here or there, but the things some of the NPCs say puts a strong emphasis on their own nightmares and wishes.

Sanitarium won’t challenge your reflexes or your puzzle solving abilities (what puzzles are here are fairly easy to decipher), but it will definitely creep you out. Turn out the lights and throw on the headphones…you’re guaranteed to get shivers in your spine.