Gameplay is a nice blend between combat with all sorts of psionic-powered villains and puzzle-solving adventure. The balance is just about perfect for this style of game; those enjoying the story and the occasional enigma will never feel like they're being overwhelmed with bloodshed and those who just want to make things explode will never feel like they just blundered into a new King's Quest game. Around 20 levels are spread across six chapters in the solo campaign. Each chapter is unique in terms of both setting and foes. You'll investigate a psychic friends phone network scam artist set up in a mock-up ancient Egyptian temple, an illusionist who puts you through lifesize magic tricks and a deadly game show where your final answer often really is your final answer, a futuristic laboratory and factory staffed by killer robots, and even a spooky city of the dead populated by zombies.

The conundrums you'll have to solve in these chapters are always related to the surroundings, further immersing the gamer in each environment. Adrian Starr's theater is filled with giant sliding swords and a recurrent card trick theme, while Elijah Krebspawn's lair is noteworthy for its runic brain-teaser, and Dr. Aiken's lab is home to maze-like training facilities for her Children of Tomorrow. Psionic talents are also nicely varied and reflect the different milieus. You have an obvious leaning toward fire-based abilities such as Fireball and Inferno, though Priscilla Divine's Egyptian phone scam palace is home to Eyes of Ra cards, and Adrian Starr's theatre will see circus-like cards such as Rain of Swords arrive on the scene. These diverse locations, challenges, and talents do a lot to help prevent the action from growing stale or predictable.

There are pitfalls to watch out for, however. A fairly major problem throughout Sanity is the control system. You navigate Cain using solely the mouse for movement, and it isn't enough. The game frankly screams out for a keyboard and mouse interface that would make Cain more maneuverable during fighting.. As things stand, you must go toe-to-toe with almost every enemy you come up against, as you simply can't swivel and fire while dodging or retreating. Consider yourself a tank on the battlefield and don't bother moving around that much when you're under heavy fire from two or more baddies. Stand your ground, use those shielding talents, and let 'em have it with both barrels.

Poor camera angles also render some combat very awkward. The top-down view often depicts too narrow a field, leaving the player guessing where the enemies are. This even takes place in some boss levels. I defeated illusionist Adrian Starr in a battle where I never even got glimpse of my adversary. Moving the camera to more of a three-quarters angle would help immensely, but Monolith didn't include this as an option. Since the game uses the 3D LithTech engine, I'm surprised that the design doesn't allow more freeform camera settings. Judging by what I've seen of LithTech in the recent past (as in KISS Psycho Circus: The Nightmare Child, for example), it could certainly handle such a request.

Multiplayer options are pretty boring. While Monolith had high hopes of starting some kind of Internet sensation through the distribution of talent booster packs that could be sold and traded akin to collectable card games such as Magic: The Gathering, the only mode of actual online play offered is deathmatch. And that just doesn't cut it today when there's so much else out there. Nice idea for frills with the card packs, but someone should have remembered to take care of the basics first.

Finally, load times can be very long. I waited an average of 20–30 seconds to fire up a saved game. This annoyance is magnified further because boss battles that you'll typically have to replay a number of times before success often move quickly from the introductory cutscene (where you can't save) to heavy battle (where you can again). As it's easy to forget saving while you're under fire, this can often lead to a lot of repetition. I did this over and over again throughout Sanity.