The game focuses on an unnamed but slightly customizable protagonist (meaning you can choose their gender and skin color) who finds themselves at the Blackwood Pines Sanitarium in the 1950's, with a case of amnesia during the wendigo massacre of the Sanitarium as described in the previous game. Meeting their roommate Anna/Gordon, depending on which gender you choose in the beginning of the game, the player must uncover the truth behind their missing memories as they try to survive the massacre and meet up with the other survivor as they try to escape the madness.
Much like Until Dawn there are a number of choices and dialogue options given to the player to effect the story, with the Butterfly Effect still being at play, given the game Multiple Endings.
The Inpatient contains examples of the following tropes:
- Alone with the Psycho: For a bulk of the game, the player spends their time locked up in their room with fellow patient Anna/Gordon as wendigos are rampaging throughout the sanitarium for a unspecified amount of time. Downplayed as they seem to get along pretty well and the players wasn't in any danger with them, and subverted on account of Anna/Gordon not being a patient but a doctor trying to observe their process, and not being psycho's so much as potentially being slowly possessed by the Makkapitew. If not them then the player will become possessed.
- Amnesiac Hero: The player at the start of the game has no memory of who they are or how they got to Blackwood. According to some flashbacks, they got it as part of shock therapy experiments when they where caught snooping around as part of their investigations.
- And Then John Was a Zombie: In one possible ending, the player can become possessed by the Makkapitew.
- The Atoner: Jefferson Bragg feels this way about what his experiments ended up setting loose. In Until Dawn we see he committed suicide over it.
- The Bad Guy Wins:
- The Police Captain is successful in covering up his men's actions, either by sending the player back to the sanitarium or bribing them to silence.
- Whether it's Anna/Gordon or the player, the Makkapitew finds a new host.
- Big Bad: Subverted with Jefferson Bragg, despite running the hospital and experiments he conducted; he has next to nothing to do with the supernatural creatures existing beyond their inevitable breakout and he is shown to be The Atoner when we meet him. Played a little more straight with the Alpha Wendigo Makkapitew, who has been behind Anna's/Gordon's or the players slow Sanity Slippage as it gradually possesses one of them.
- The Cameo:
- Billy is one of the named miners from Until Dawn who has transformed into a wendigo. We see him prior to his transformation here.
- In one of the endings we see Hannah and Beth from Until Dawn make an appearance when we see their disappearance from the Makkapitew's POV.
- Deadpan Snarker: The dialogue options can make the player this.
- Defiant to the End: The player can be this to the police captain, which gets them institutionalized again.
- Demonic Possession: Over the course of the story, Anna/Gordon slowly becomes possessed by the Makkapitew's spirit. Although this can also happen to the player.
- Dirty Cop: One of the cops accidentally kills a nurse in a panic when they discover the wendigos. It's unclear if their attempts to kill the other survivors is an attempt to kill witnesses or kill anyone else who is infected, but either way, they are trying to cover up what's happening by executing anyone in the area who's not a cop.
- "Everybody Dies" Ending: It's perfectly possible to end the adventure like this. You need to get possessed by the Makkapitew, then arrange yourself to reach the end of the adventure with Ted as the only other survivor. You'll then have the option of killing him instead of pulling the Heroic Sacrifice.
- I see it now. It was so easy. So simple.
- Foregone Conclusion: Anyone who's played Until Dawn knows that the wendigo are what's wrecking havoc in the sanitarium and on the mountain. It is also an obvious conclusion that the truth of what happened isn't gonna be exposed to the public no matter what the player does.
- From Nobody to Nightmare: Either the player or Anna/Gordon (both of whom are relatively unimportant people; either a journalist or a doctor), will inevitably become the Makkapitew, a deadly Wendigo that proves almost impossible to capture or kill even for seasoned hunters.
- Hate Sink: The Police and their smug Captain are shown to be a corrupt squad trying to cover up the presence of the Wendigo as well as their murder of a nurse during a breakout. They spend the game hunting survivors and trying to kill them to prevent the truth from spreading. In the ending where the survivors escape, the Captain blackmails them into keeping quiet of the incident, threatening to send them back to the Sanitarium when exposure is threatened.
- Hearing Voices: Something Anna/Gordon goes through. It's the voice of the Makkapitew.
- Heroic Sacrifice: Anna/Gordon cannot be allowed to leave the mountain due to being possessed, but stays behind and makes sure everyone makes it to safety on the cable car. The player will do the same if they end up possessed.
- Hijacked by Jesus: Averted. Despite being a priest and the game's Exposition Fairy on the wendigo, Father Ted makes no attempt to connect the wendgio myth to Christian dogma, keeping it strictly within the Cree myths of the beast.
- Intrepid Reporter: It's revealed that the player lost their memories, they were an investigative reporter seeking a story and got caught up in the happenings of Blackwood Sanitarium.
- Karma Houdini: The police receive no comeuppance beyond a few of them being killed by the wendigo. Threatening to expose them gets the player institutionalized.
- Leave No Witnesses: The cops doing this are either trying to cover up the wendigo outbreak or silence witnesses who saw them kill a nurse.
- Mad Scientist: Jefferson Bragg, the head administrator, has been trying to conduct psychological experiments on the survivors from the mines. Subverted as he's seen as regretful about it when it gets out of hand. As a result of these experiments, either Anna/Gordon or the player end up possessed by the Makkapitew.
- Mountaintop Healthcare: Set in the last days of the Blackwood Pines Sanatorium before the wendigo outbreak.
- Multiple Endings: With two of them being of the Downer Ending variety and the Golden Ending being the Bittersweet Ending.
- Anna/Gordon stays behind before s/he succumbs to possession, allowing the player and the other survivors to leave. The player is successfully bribed by the police to keep their silence.
- Same as above, but should the player not accept the police's terms, they get institutionalized again.
- Should the player be the one possessed, they are the ones who let the survivors go before they succumb to the Makkapitew's transformation in Anna's/Gordon's place (unless Ted is the only other survivor, in which case you can kill him). We are given a flashback to the night of Hannah and Beth Washington's encounter with the Makkapetiew from its viewpoint.
- Police Are Useless: The cops here are both unable to stand against the rampaging wendigo, and more interested in making sure there aren't any surviving witnesses. At the end of the game, they end up having to bribe the survivors to silence.
- Pragmatic Hero: Getting the Golden Ending means you are pretty much forced to accept the police captain's bribe, as opposed to threatening to expose the truth and getting sent back to the sanitarium. Once they actually leave the mountain, their hands are pretty much tied.
- Pragmatic Villainy: Once the survivors actually escape Blackwood Pines, the police cease trying to kill them in favor of trying to blackmail them to silence.
- Pyrrhic Victory: In the Golden Ending, the player manages to escape the sanatarium and rescue the other survivors, however they are forced to leave Anna/Gordon behind to succumb to the Wendigo transformation, and further forced to accept the blackmail from the police to cover everything up.
- Sanity Slippage: Anna/Gordon seems to be going through this, claiming to be hearing voices and getting more and more agitated, although it becomes increasingly obvious they are being possessed. And as the ending reveals, by the Makkapitew itself.
- Tomato in the Mirror: It's revealed that Anna/Gordon isn't a patient; They're actually a doctor/nurse who worked for the institution and Bragg's experiments. Likewise as the player uncovers their memories, we learn they are actually a reporter trying to investigate what was happening before the shit hits the fan. On top of that, either one of them ends up possessed by the Makkapitew.
- Wham Shot:
- If you get possessed by a Wendigo, after the credits, you see the calendar start flipping through its pages. Slowly at first, but it goes faster and faster, eating through years at all speed... And brutally stops on one day. February 2, 2014. The day Hannah and Beth Washington fell from that cliff, launching the events of Until Dawn. And then you see the event through the Makkapitew's eyes.
- The main game mentions a reporter having their camera taken after they were found snooping. That person? The player!
