Welcome back to the Sanatorium Blog! Today, we wanted to talk about the era this game is set in and the narrative behind the game.
The 1920s
The original idea was to investigate professional mimicry and decision-making as central game mechanics for an academic bachelor’s thesis. The guiding question was: How can psychiatry be represented in a game through impactful choices and card-based mechanics? A 1920s asylum provided an ideal setting, as its historical backdrop—marked by ethical ambiguities and the limited psychological knowledge of the era—created a compelling and challenging environment for exploring these themes.
We struck a balance between historical accuracy and creative interpretation to keep the game engaging. While it’s not a fully accurate historical simulation, it’s set in a world rooted in real history. This approach resonates with modern players, allowing them to explore controversial and intriguing historical practices within a stylized noir setting—complete with humorous clichés and exaggerated portrayals of overconfident, misguided physicians.
Although the 1960s was a consideration, we were ultimately drawn to the allure of the Roaring Twenties. The era’s vibrancy and extravagance create a striking contrast with the institution’s dark, oppressive environment—an interplay we felt gave the setting much greater impact. It was also a time marked by stark contrasts—glamorous nightclubs thriving under the shadow of prohibition, and a booming economy existing alongside widespread corruption and the growing influence of organized crime.
Atmosphere
A major influence was also the era’s aesthetic. Art Deco offers a captivating blend of sleek geometry and refined ornamentation. For both creative and narrative flexibility, we drew from a wider historical timeframe when developing the game’s content. This gave us room to include diagnoses and treatments that were already outdated by the 1920s, as well as others—like the lobotomy—that wouldn’t become widespread until the 1930s.
Our intention wasn’t to make a horror game, but we deliberately aimed to evoke a dark, oppressive atmosphere. To do this, we designed the building to feel both aged and timeless, cultivating a sense of dread and discomfort. In that way, it echoes the classic horror trope of the mental asylum found in other media—though with many subtle distinctions that set it apart.
The Story
Your aunt Patty has been committed to Castle Woods by her scheming sons. To rescue her, you’ll need to infiltrate the sanatorium—by forging a medical diploma. Now posing as a newly appointed doctor, you must diagnose and treat patients convincingly, all while avoiding exposure as an imposter. Only by earning enough prestige can you hope to secure her release.
Every character you encounter has a unique backstory and reason for being in the Sanatorium. As you work toward freeing your aunt, you’ll also uncover the institution’s darker underbelly—including shady dealings among the staff and connections to organized crime.
But there may be more at stake than just your aunt’s freedom. An undercover journalist has checked in, determined to expose Castle Woods and its questionable "treatments." Perhaps there's a chance not only to save Aunt Patty—but to bring down the entire Sanatorium.
Sanatorium, first and foremost, is a work of entertainment and not a teaching tool.
We aim to prompt players to reflect on their choices, the Sanatorium’s treatment of individuals, and how perceptions of mental health have evolved over the past century. By contrasting today’s more open and nuanced conversations with the harsh and often misguided approaches of the past, the game immerses players in a much darker chapter of mental health history.
Sanatorium isn’t meant to be a documentary—it's a stylized commentary on how mental health was understood and addressed a hundred years ago.
