Interview: Sanatorium Devs Discuss Their 1920s Mental Asylum Simulator

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Job simulator games have run the gamut from the most basic of subject matter to the most extreme. Sanatorium — A Mental Asylum Simulator is taking a unique approach to the genre and will place players into the role of a journalist from the 1920s masquerading as a mental health doctor in order to uncover the mystery of a local institution.

This is also more than a simple simulator/adventure game title, however, as Sanatorium also uses a unique and creative card-based system in order to diagnose patients and come up with the best (or worst) treatment plans based on the resources of the time, and the money you have in your pocket.

I got to go hands-on with this title myself, and the whole thing becomes a balancing act between your own personal humanity and the need to keep up appearances as best you can in order to stay within the asylum walls long enough to figure out just what’s really going on here.

I also got the opportunity to have some of my lingering questions about the title answered by the game’s two main developers, Sebastian Riedi (Lead Design, Programming, and Writing) and Fabian Hunziker (Art and Sound Design) of Swiss studio Zeitglas.

If you’re finding yourself just as curious about this upcoming indie job simulator with a unique and potentially nefarious twist, read on below to learn even more about this game as the impending launch date of November 6th rolls r.

Interview With Sebastian Riedi And Fabian Hunziker Of Zeitglas

Interview: Sanatorium Devs Discuss Their 1920s Mental Asylum Simulator0

Q: Can you share a bit about your background in the Psychology field and what initially inspired you to make a game about this subject?

Sebastian: The initial inspiration was to explore “professional mimicry” (a fancy name for Job Simulator games) and decision-making as core game mechanics for an academic bachelor thesis: The setting of a 1920s asylum was ideal because its historical context—with its ethical gray areas and outdated psychological understanding of the time—offered a challenging environment for these themes. We have no professional background in this field and therefore had to rely on thorough research and consultation.

Q: What lengths did you go through for the research process to ensure you’re covering everything within the game appropriately/accurately?

Sebastian: To guarantee the accuracy of our content, we performed thorough research and consulted with various experts. This included the curator of the Museum of the Psychiatric Clinic of the University of Berne here in Switzerland, who is also a professor of psychiatry. This gave us a strong historical foundation for our fictional narrative.

Fabian: Most importantly, to cover these topics appropriately, we pay attention to the way patients are represented in the game. Some games with similar themes make fun of patients, comically exaggerating their symptoms and dialogues.

Q: Are any of the patient cases in the game based around real-life stories or events?

Fabian: Yes, some patients are based on real people and some background stories were inspired by true events, but they are never 100% accurate and never completely obvious. If players are familiar with certain events or historical figures, they will discover a clue or two. We deeply love Easter eggs.

Interview: Sanatorium Devs Discuss Their 1920s Mental Asylum Simulator1

Q: Did you consider any other time periods to be the setting for this game, or did the 1920s always make the most sense?

Fabian: While the 1960s, the era of One Flew Over the Cuckoo’s Nest, was certainly an option, we were ultimately won over by the Roaring Twenties. This flourishing, extravagant era provides a dramatic contrast to the institution’s gloomy and oppressive atmosphere, which we felt made the setting far more powerful.

Sebastian: It was also an era of dramatic contrasts: frivolous nightclubs alongside prohibition, and an economic boom overshadowed by deep-seated corruption and the rise of organized crime.

Fabian: A big factor was also the aesthetics. Art Deco is a fascinating combination of streamlined forms and subtle decorative elements.

Sebastian: For creative and narrative purposes, we drew from a broader historical period for the game’s content. This allowed us to include diagnoses and treatment methods that were considered outdated by the 1920s, as well as some that were not yet in common use, such as the lobotomy, which began to be used in the 1930s.

Q: I think there’s a connection between old mental asylums and the horror genre in lots of media. Is this something you lean into with Sanatorium at all?

Fabian: Not directly, as our goal wasn’t to create a horror game. But we deliberately sought to evoke a dark and oppressive atmosphere. To achieve this, we designed the building to feel both old and timeless, creating a sense of dread and unease.

In a sense, very similarly to the horror trope of the mental asylum in other media, but with many subtle differences.

Q: In terms of multiple branching paths and endings for this title, can you speak to just how much potential for different playthroughs will exist? Do you expect players will be able to replay the title and get a unique experience repeatedly?

Sebastian: There are a few key decisions that lead to different endings for you as the player character, the patients, and the clinic. There are a few patients with a fixed storyline, but also some randomly generated ones. You’ll also be able to unlock an Endless-Mode with rising difficulty.

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Q: I’m curious about the players’ ability to choose more humane or more archaic treatment options. Are there penalties based on what you choose?

Sebastian: Not directly. The penalty system is tied to the institution’s own warped logic. You are penalized for inefficiency, for making mistakes, or for using incorrect treatment methods according to the directions from the institution and the systemic incentives of the era, not for acting more or less humanely. This design creates a core conflict in the game: humane treatment is often less efficient than treatment that has a greater impact on patients’ health. When players experience the conflict between “kind” behavior and “malicious” efficiency, they hit at the core of what Sanatorium is about.

Q: Obviously mental health treatment and outlook has evolved a lot over the last hundred years. Where do you think there still may be some shortcomings in the field in modern day?

Sebastian: We’re neither mental health professionals nor have any of us worked in a medical or clinical field, so we would rather not make any statements in that regard.

Fabian: But we were consistently surprised by feedback from professionals in the field who noted a surprising degree of similarities after playing the demo. They weren’t referring to the diagnoses or treatment methods, but rather to the bureaucracy of the institutions and their fundamental approach to patient care, which they said, in some ways, still feels eerily similar today.

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Q: From what I can gather, this looks to be the first full game for the team. What have been some challenges you didn’t anticipate going into the dev process?

Fabian: Since this is a part-time job with limited funding, juggling development, resources, and work between the two of us took a toll on some days.

Sebastian: In a sense, this game about mental well-being sometimes challenged our own, but it also helped us grow as game designers and personally. Ultimately, thanks to our loved ones, the Swiss cultural promotion organization Pro Helvetia, the Swiss Game Hub co-working space, additional contractors, and our great publisher, we always found a solution.

Q: Do you have any sort of message you’re hoping comes across in the game?

Fabian: The game is, first and foremost, a work of entertainment and not a teaching tool.

Sebastian: We want to encourage players to reflect on their actions, how the Sanatorium views people, how we see mental health today versus 100 years ago, and to question what we view as normal compared to a century ago.

Sanatorium Is Coming Soon

Interview: Sanatorium Devs Discuss Their 1920s Mental Asylum Simulator4

If you’d like to learn more about my personal experience with Sanatorium — A Mental Asylum Simulator, take a look at the thoughts I had after spending a few hours with the preview build recently.

Like what you’ve heard so far? You’re in luck! Sanatorium is coming soon on November 6th for Steam, macOS, and Steam Deck. If you want to stay as looped in as possible from now until then, consider wishlisting the game on its Steam page now.

To get a r look at the game in action, check out the new trailer below as well:

Валентин Павлов/ автор статьи
Страсть Влентина к играм началась с Resident Evil, и с тех пор он не переставал играть в хоррор-игры. Пишет экспертные руководства для самых сложных игр и обзоры для самых громких релизов. Является магистром журналистики и имеет степень бакалавра лингвистики. Любимые игры: GTA 5, Silent Hill 2, Call of Duty: Modern Warfare 2, Heavy Rain, Metro 2033 и другие.
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