Sanatorium: A Mental Asylum Simulator gives players the authority to make compassionate decisions

Class of 2025 Ambassador Nico Vergara looks back on a dark history of mental health care in Sanatorium: A Mental Asylum Simulator.

We gave our ambassadors some keys to the new game Sanatorium: A Mental Asylum Simulator which transports players back to the roaring 20s, as you take on the role of a doctor in Castle Woods Sanatorium. Read on to hear what Nico thought about the game and how it reflects a dark history of mental healthcare and treatment in the early 20th century.

Mental health is about care and attention, understanding and intention. It’s a continually evolving spectrum of sensitivity and empathy, where each person’s needs and concerns call for different diagnoses and treatments. Today, that goes without saying. After all, therapy, medicine, and care are so much more accessible and comprehensive than they were before.

But as serious a topic as it is, mental health has often been treated carelessly in the past, not taken as seriously as other, more conventional ailments. The roaring 20s, in particular, were a prime example of carelessness and arrogance in the field. Most doctors used it as a study, with patients being treated like guinea pigs; experimented on with highly questionable treatments masquerading as cures – lobotomies and electroshock therapy were frequently used as the answer to depression and anxiety.

This is what Zeitglas and Shoreline Games’ Sanatorium – A Mental Asylum Simulator portrays throughout its story…

Now, Sanatorium doesn’t exactly explore the conventional path of a mental health professional in the roaring 20s. Instead, it goes in a completely different and ethically dubious direction.

You, the player, take control of a down-on-their-luck journalist with very questionable morals: to uncover the shady business going on within the Castle Woods Sanatorium, you pose as a ‘qualified’ physician to get a first-hand look at the controversial treatments, abusive orderlies, and illegal business practices happening inside.

Obviously, forged medical degrees and credentials likely wouldn’t fly even in the technologically challenged era of the 1900s. But what its far-fetched plot does at least hammer home is how much of a dart throw the entire mental health field was back then.

During that time, a lot of treatments and diagnoses were guesswork since most of the issues doctors faced weren’t readily apparent: catatonic World War I veterans, patients suffering from melancholia, or seeing hallucinations and hearing disembodied voices each night, and the list goes on.

What’s even worse is that a person could easily be misdiagnosed, given the wrong treatment, and no one would bat an eye. What might be considered a life-threatening mistake by most people would be treated as a minor mishap by those in charge. In an age of significant technological and economic progress, mental health was largely a sideshow, an insignificant afterthought.

Treatment, instead of being a lasting solution, became a recurring nightmare; it was not about care but control – containing the problem instead of fully addressing it. It was the medical equivalent of placing duct tape over a leaky pipe; sure, it temporarily stemmed the incessant dripping, but eventually, the pressure would build and start spewing again tenfold.

Much to my relief, Sanatorium gave me the authority to change that. I cannot tell you how many times I have been frustrated after hearing of doctors abusing their position of power, or patients not being properly cared for or listened to, simply because their physician was careless, cynical, arrogant, or a combination of all three.

Instead, as Castle Woods Sanatorium’s resident physician, I was able to provide some semblance of relief and kindness to the people I oversaw. Rather than forcing borderline torture in the form of electroshock treatments and straitjacket therapies, I was able to administer more humane routines, like fructal diets and guided catharsis. Of course, I also had the option to provide the complete opposite. But the last thing I wanted was to live with the lasting guilt of performing a virtual lobotomy on an innocent, pixelated person.

Of course, questionable methods and their healthier alternatives only paint a small portion of the controversial mental health portrait of the 1900s. After all, you’ve probably seen what these institutions looked like back then in the media. Think Shutter Island with fewer jump scares or, if you like banned books, read about the abuse that goes on behind dilapidated doors and security-screened windows in One Flew Over the Cuckoo’s Nest.

For most people who entered an asylum, it served as the proverbial end of the line; once inside, any agency over their life was practically forfeit, placed instead in the hands of potentially power-tripping doctors and orderlies.

It’s a scary thought, living then and struggling with a mental illness because the only options were the extremes: either permanently live with a debilitating ailment and suffer silently, or seek assistance and risk facing a perpetual future in an asylum. Asking for help from friends and family was a frightening prospect; sure, on the surface, they might listen to what you’re going through, but they’d also just as likely have you sent to a mental institution as soon as your back was turned.

Going to a professional was even more out of the question because the odds of getting an opioid prescription and being put under an insulin coma were essentially equal. Yes, in the past, these were just two of the many life-altering ‘cures’ asylums and their staff used to treat their patients.

Naturally, these were some of the exact scenarios I encountered throughout Sanatorium. ‘Well-meaning’ relatives admitting their children into Castle Woods because they imbibed a little alcohol, schizophrenic patients permanently dwelling within after being labelled and certified insane, and typically docile residents unfairly transferred to high-security wards after fighting back due to abuse.

In short, people who aren’t allowed to defend themselves and aren’t given chances to live normal lives, for no other reason than the people in charge deeming it so, despite all signs pointing to the contrary.

Now, the horrid conditions didn’t only affect those within the asylums; it also maintained its malevolent influence on people who managed to make it outside. Since most of these buildings were overcrowded and underfunded, patients were likely to be discharged before receiving the proper care; life after treatment would change for the worse, purely because they didn’t receive the appropriate amount or the right treatment.

On the other hand, some could spend their entire life inside, because doctors deem them “unfit for society.” Either that, or the friends and family who were simply ‘looking out for their well-being’ no longer want anything to do with them.

Can you imagine being subjected to these forms of physical and psychological torture day in and day out? It’s terrifying to even think about because if I grew up in the 1900s, I might’ve had to stare at white walls, shuffle across grimy tiles, and been subjected to a lobotomy, all because I have anxiety.

The care we have readily available at our fingertips today is so often taken for granted that it’s easy to forget the sacrifices it took to get to this point. Thankfully, Sanatorium: A Mental Asylum Simulator puts it all into a pleasantly designed perspective. Ordering and re-ordering prescriptions at the tap of a button, therapists, psychiatrists, and social workers ready to listen at a moment’s notice, both online and in-person, and friends and family more open-minded when it comes to mental health topics are all things people in the roaring 20s could only have imagined.

Unfortunately, there are still instances where mental illnesses aren’t taken as seriously as typically apparent ailments. But the leaps we’ve had from then until now make me hopeful that we’ll only continue to see more progress and acceptance in the future.

Nico Vergara
Ambassador Nico is a freelance writer in games and tech from the Philippines where mental health topics are heavily stigmatised. He’s a fierce advocate for Safe In Our World, using his writing skills to raise awareness and encourage people to seek support.