A thoughtful 1920s card-based psych sim where moral dilemmas, desk-work drama, and outdated medicine combine into a smart – if imperfect – indie experience.
Concept & Setting
Sanatorium – A Mental Asylum Simulator is set in 1923, inside the imposing Castle Woods Sanatorium. You play a journalist posing as a doctor, sneaking into the institution under false credentials to investigate a missing person case and uncover what’s really happening behind closed doors.
It’s not a power fantasy about “fixing” mental health with modern knowledge. Instead, you’re working with the messy, often harmful tools of the 1920s: dubious diagnoses, experimental treatments, and a hierarchy that cares at least as much about funding and reputation as it does about patients.
As a concept, it’s excellent:
- The asylum is treated less like a horror trope and more like a historical system to critique.
- Your impostor status keeps you constantly off-balance: you’re simultaneously trying to help people, protect yourself, and dig into the mystery.
- The game leans into the moral grey areas of early psychiatry, which fits perfectly with the indie space’s appetite for risky, unusual themes.
It’s a strong narrative setup that gives the “desk job” core of the game real stakes, without needing big-budget spectacle.
Gameplay & Mechanics
Despite the “Simulator” label, Sanatorium plays more like a card-driven narrative work sim / puzzle game than a deep management sandbox.
Each in-game day unfolds at your desk:
- Patients arrive as files containing basic info and a short introduction.
- You play cards representing questions, tests, and treatments, each costing action points.
- Cards reveal new symptoms, traits, and story snippets, gradually building a picture of the patient.
- At the end, you decide on a diagnosis and treatment plan and sign off the paperwork.
Beneath that, several layers overlap:
- Card-based diagnosis: You’re essentially playing a deduction puzzle, combining symptoms and tests to narrow down conditions.
- Light resource management: Your time, supplies, and money are limited, forcing you to make uncomfortable triage decisions.
- Narrative choices: Conversations and file notes hint at the missing-person plot and the wider rot inside Castle Woods.
Patients can reappear over multiple days; how you treat them can affect their outcomes and your perception of the institution. Sometimes they become key narrative anchors, sometimes they’re reminders of cases you didn’t quite get right.
It’s worth noting:
- This is not Theme Hospital with base-building; you’re not placing rooms or hiring staff.
- The heart of the game is the loop of “read → play cards → diagnose → sign”, repeated across many days.
- The systems intentionally feel constrained, which fits the historical setting but can also make the experience feel more “puzzly” than some management sim fans might expect.
For players who enjoy Papers, Please–style desk work and slow-burn narrative tension, the core loop can be very satisfying. For those seeking a broad, sandbox-style sim, it may feel narrower than the title suggests.
Atmosphere & Presentation
Sanatorium is built around a striking “dark deco” visual identity:
- Paper files, faded photos, and rigid forms dominate the interface, reinforcing the bureaucratic nature of your work.
- Character portraits and environmental art use slightly exaggerated, cartoon-ish designs to soften the subject matter without trivialising it.
- The overall tone is somber but not joyless — there’s a thread of dark humour running through staff banter and some patient encounters.
The music supports the mood well: a subdued, period-tinged soundtrack that leans into tension rather than jump scares. It fits the indie scope nicely, giving the game personality without overpowering the quiet, text-heavy focus.
In terms of writing, the game generally shines:
- Patients tend to feel human and specific rather than generic archetypes.
- The line between institutional cruelty and genuine care is drawn through dialogue and case notes, not just exposition dumps.
- The script respects the subject of mental illness more than many “asylum” games do, especially for such a small production.
The presentation won’t blow anyone away technically, but it’s cohesive and thematically thoughtful — exactly what you want from a small, stylised indie.
Progression, Difficulty & Replayability
Sanatorium can be surprisingly dense for a relatively compact title:
- The learning curve is steep. There’s a lot of terminology and a web of symptoms to parse, and the initial onboarding doesn’t always explain that complexity smoothly.
- Difficulty stems from limi