Alternative Character Interpretation: Johnny's mom is subject to this with her limited appearance. What we know is after Joey died, she underwent Sanity Slippage and deliberately gave Johnny the Beta Blockers to block the trauma of his death. From there two interpretations arise. The first is that she is abusive, forcibly editing her surviving son's memory, and tricking herself into believing he was Joey, her preferred son, in a twisted case of Parental Favoritism. The other is that she gave Johnny the blockers to save him from the trauma of losing a twin, and her confusing him for Joey down the line is just her own fragile mental state.
Angst Aversion: This is widely known as one of the saddest games ever made, so some people feel uneasy about playing it, since to the situations the characters go through are depicted painfully realistically.
Base-Breaking Character: Neil. Plenty of critics thought his Mood Whiplash inducing antics were distracting and frustrating, others think of him as comic relief for game that really needs it. Chapter 6 showcasing that he doesgenuinely care about the patients and The Stinger implying he has Hidden Depths helped saving him in most eyes.
Epileptic Trees: A handful of Freeze Frame Bonuses in the first game gave rise to a number of theories as to the "real" nature of the game, with one of the most pervasive being that the entire story is actually one of the player characters dying and going back through their memories, the same way they did for their patients. The evidence for these theories was pretty circumstantial... until the second minisode was released, which has given some legs to a few fan theories and kicked the speculation into overdrive.
Esoteric Happy Ending: Johnny fulfills his wish. But... because they're only changing memories, not the past, the real Johnny dies never knowing what his wife was trying to tell him, and the real River dies knowing Johnny never understood/remembered what she kept trying to hint at. Well, assuming any of it was ever real to begin with. Somewhat dulled by the final sequence prior to the credits rolling and after Johnny flatlines. We see him approach River against a plain white background, both as children, and hand her the platypus before sitting down next to her, strongly implying that they're at least Together in Death. But still...
The agency is called Sigmund Corp. As in Sigmund Freud, the famous psychologist.
Izzy describes Johnny as "neurotypical," which is not a word that's thrown around much outside of the neurodivergent community.
Tony Attwood is mentioned. If you already know who he is, note a British psychologist notable for his work on autistic people, notably Asperger's Syndrome then you know what's going on with River.
Part of the code in the background when you prepare a memento says, "Step twice into the river of life." This is based on a quote from Greek philosopher Heraclitus: "No man ever steps in the same river twice, for it is not the same river and he is not the same man."
Glurge: Even if the story aims to be an uplifting tale, there are still the issues of the real pain and suffering undergone by the real people, and the fact that the happy ending was experienced by only three people.
Viewer Gender Confusion: Some players are apparently confused whether John's medical doctor is a man or a woman due to somewhat gender-neutral sprite and clothing. It doesn't help that the doctor is a minor character that the other characters don't usually talk about and when the doctor did get mentioned by other characters, they usually refer to the doctor without using any pronoun.
Johnny, obviously. He's dying while outliving his beloved wife, without ever getting the chance of being the head of a family, but he really takes the cake when it's revealed that he saw his twin brother, Joey, die right in front of him and his mother fed him beta blockers to forget about the trauma, while calling him by his brother's name as a sort of Replacement Goldfish. That also had the unfortunate side-effect of him forgetting his first meeting with River, where he made a promise that they'll meet on the moon if they ever lose each other. So not only does he not understand why his wife made paper rabbits or why he wishes to go to the moon, but he also never had the chance of being himself, as he played the shade of his dead brother.
River. Being autistic, she was an outcast in school. The only person who ever liked her for who she is doesn't remember their first meeting, no matter how hard she tries not to tell him. She ended up dying, knowing that all of her efforts to remind him were in vain.
Joey. The kid loved his family and dreamed of becoming a writer, but all of that ends up down the drain when he was hit by his mother's car in a complete accident. At least Johnny ends up remembering him as the author that he always wanted to be, but the real Joey never got that far.
