The worst part about being alive is never truly being sure what is real and what isn’t. I feel like I can say that with a straight face because I’ve experienced serious hallucinations that affected my own interpretation of reality. Say what you will about COVID-19, but I’ve been sick plenty of times before, and none of those other illnesses made me argue, with all sincerity, that a duck had been walking in front of my apartment, quacking loudly enough to be heard on the sixth floor and woken me up. I live at least a kilometer from the nearest body of water, in which I have never seen a single duck. But, for a brief period of time, that duck was as real to me as playing through Horrific Xanatorium, which asks players to question their own eyes and ears as well.

Rui Genzaki is a young man who is currently infected with Spiria, an ongoing outbreak that, initially, makes people being to hallucinate many things. Rui has reached a point where he’s having trouble distinguishing what’s there and what isn’t, so, with the help of his little sister, Mone, he checks into the Kamikawa Sanitorium Hospital. Rui immediately runs into his former classmate/first love, Riza, who is also there and, well, about to jump off the roof. Successfully talking her down, Rui and Riza share days and nights talking about their lives, their conditions, and trying to help Rui battle his own demons (sometimes literally). Then, just when everything seems good, Rui’s life – and indeed the lives of everyone around him – takes a wild turn.

And later we go to the beach, but that’s not important for the story.

Horrific Xanatorium is an especially short visual novel, coming in at six endings and about three hours (probably less) to see everything in the main game. There are about eight choices, total, and the first three are inconsequential to the end game. Players looking for any long-form story will be sorely disappointed, as the game is broken into six neat chapters and one bonus, an If… segment that we’ll mention in a moment. Most, if not all, of the choices are fairly obvious, and one choice is even locked from your selection until after you finish the game. I don’t mean the choice is invisible: I mean it’s presented, but then you’re told off if you try and pick it. Which is quite the choice for the developer, Pageratta, to make.

Storywise, Horrific Xanatorium is a decent concept with middling execution and a rather poor landing. The setup goes well, though I found it weird for the protagonist to explain that other people told him his little sister was “an ideal little sister…out of an anime.” When you draw female characters cute, no problem, great, etc. When you then feel the need to point it out and point out their features, curves, and overly focus on their attire, then it begins to get into an uncomfortable territory. I only mention this because Rui and Riza are the only ones who have any kind of romantic connection within the game, so Rui’s encounters with Mone feel forced for a fanbase that maybe doesn’t need to be recognized.

Thank God, the cops are here. Yes, officer, that one over there in the Azumanga Daioh hoodie.

Anyways, we get into the hospital, we meet Riza, and then we spend more than half the game in the hospital, discussing life, hopes, goals, and Rui’s condition. This pacing felt great and was shot through with occasional moments of creepiness and foreboding that were appropriate. After all, Rui keeps hallucinating, some things feel real and not, and we even have a bit of fun with him in regards to how characters are dressed and appear. It’s a pretty solid section of the game with some good questions that don’t really need answers, but are still fun to explore. By the time you reach the endgame of our time in Kamikawa, it’s a really sweet and almost endearing breakoff point. Heck, there’s even an ending if you just want to pull off here.

But then we get into the second half of Horrific Xanatorium, which feels like the last fifth of the game instead. Things move so quickly, choices suddenly fly at you with real seriousness and you’re over and done with the game before you even know what’s happening. The best way I can describe it is if we took out acts three and four of Romeo and Juliet and just moved straight from the balcony scene to Juliet drinking poison and Romeo killing Paris (spoilers?). It’s certainly possible, but the tonal change and the shift in scenery would give most theater viewers whiplash. I felt the same way here, though I oddly felt Rui and Riza were still a better couple.

Seriously, it’s surprisingly wholesome and fewer people involved had to die.

That’s not to say that I didn’t have fun. The writing, though a bit muddled with grammatical errors and some spelling mistakes, gave me a clear view of these characters and their connections with each other. Rui didn’t come across as a brooding child nor as an irresistible pile of mediocrity, as most visual novels tend to do. The relationship he grew with Riza and Mone felt genuine and special, and I really enjoyed their banter during the calmer times. Anri, the seemingly insane director of the Sanitorium, was delightful and one of the few reasons I’d want to see this translated into an anime or short film. And some of the reveals, while a bit contrite, were still a bit unexpected, which gave way to delight.

My two major complaints for Horrific Xanatorium were the sound and the pacing. The sound, I felt, was really all over the place and, at times, wildly inappropriate. A majority of the game is underscored by this poppy, upbeat electronic track that seems to miss its cue to drop out during unsettling or upsetting moments. There are times where the tracks slowly distort and give way to something sinister, and those times work excellently. Then, there are other times (like when Mone reveals the fate of their parents) where we just keep cheerfully bopping along as Rui’s world is torn asunder. There are some great pieces of music in here (especially the chiptune credits track), but there needed to be more care given to the finale.

The whole thing left me very concerned.

Lastly, did we really need to have a Mone underwear moment? We went the whole game without needing to have the single most stereotypical anime trope present, and then, right at the finish line, Rui disappoints us all. I get that it’s essential to certain story beats (seriously), but it felt so forced and unnecessary. Especially since the If… chapter serves as fan service and has enough silliness as it is. I’m trying my hardest to not just spoil the moment, but it felt so out of left field and didn’t really sit well after the dust had cleared. Seriously, sometimes you can just have a little sister in an anime and she can go live her own life. 

I’m not using a screenshot of that, knock it off.

Having said all that, Horrific Xanatorium had its moments, regardless of how short they were. The art styling was good (though I LOVED the pixel art in the credits), the concept was mostly well-realized, and this is a really good first work from an up-and-coming designer and writer. The moments of hallucination, the fears, and the inability to distinguish fact from fiction all nestled into my brain quite nicely, and I’m thrilled to be sure that I’m really here. Fairly sure I am. Am I?

Horrific Xanatorium is available now on PC, Nintendo Switch, Xbox One, Xbox Series X|S, PS4, and PS5.

Reviewed on Nintendo Switch.

A copy of Horrific Xanatorium was provided by the publisher.