The game features motiveless violence against multiple innocents and violence against defenceless persons. During gameplay, players can kill bystanders by throwing knives at them or running them down with a horse and carriage. Players may also shoot restrained characters in certain parts of the game. One cut scene shows a vulnerable patient being ‘operated’ on in a large medical theatre: he is awake, twitching and groaning, as a metal instrument is inserted into his skull. The game features infrequent use of the word ‘fuck’.