This is a survival-horror game in which players assume the role of an inmate inside a psychiatric hospital. Players will lapse into an alternate reality (called 'hell mode'), where the environment becomes twisted, covered in blood, and populated by ghoulish creatures that attack. Players use revolvers, shotguns, daggers, sledgehammers, and bone saws to kill the ghosts, ghouls, and witches. Prison guards will attack players in an attempt to get them back to their cells; players must defend themselves with a weapon and kill the guards to remove the threat. Some rooms contain mutilated corpses, splattered guts, and severed limbs; a few creatures have giant incisions or open cavities that reveal their inner organs. In one cutscene, players witness a creature being ripped from a hanging chain by a larger creature—the smaller creature's bloody, severed arm dangles from the chain.