Played this game last week while I was ill. Fittingly, it felt like a fever dream.
The visuals really convincingly emulate the aesthetic of pixel art despite the entire game being 3D. It allows for a cleanness of style with the freedom for more expressive cameras and perspectives. I don't know that the animesque character drawings totally fit that setting, but it avoids Ross's Yuppie Psycho complaint of over-the-top expressions.
The game wears its Silent Hill 2 influence on its sleeve, in that you're looking for your dead wife and start the game staring in a bathroom mirror.
The story wears its Neon Genesis Evangelion influence on its sleeve, in that it doesn't make any fucking sense, but I cried anyway.
The puzzles aren't the hardest, but each one took me a fair amount of time and didn't feel too leading, without ever requiring a guide. I would say they respect the player's intellect more than they directly challenge it. The survival horror gameplay is also super-smooth, enough that I would recommend veterans of the genre play on harder difficulties, since I'm a novice and it was still pretty comfortable for me on normal. I kinda wanted to feel the squeeze, a little bit more than I got.
Just make sure to use the "extended inventory" option. Some people might think futzing around with too few item slots is rewarding. I don't.
The psychological/cosmic horror aspect gave me a headache. This story would be confusing and non-linear even if it didn't feature the breakdown of reality making both the player and protagonist unaware of what's real. This is the classy style of Lovecraft, where the influence of something sinister is felt more than the presence of the thing itself. If there even is a something. It might all be one thing that's a different thing. It also might not be real. Interpretive art!
All in all, you have to be willing to accept that the story is more emotionally honest than literal (you also have to like lesbians) but it was one of the most arresting experiences I've had with a game in a long time. Highly recommended if you enjoy good survival horror mechanics and having all hope crushed from your psyche.