There's been a lot of debate over whether the game is ableist against the mentally ill? For some, it's the latest example of media portraying the mentally ill as violent and dangerous, using them and the abuse heaped against them for cheap scares.And then the DLC came out and retconned Miles' death, or at least revealed it was a Disney Death, if his survival was intended all along. The same people also liked that the Walrider wasn't stopped, since it could lead to a possible sequel. Others enjoyed the fact that Miles didn't make it out alive because they expected it, and it fit the tone of the game. Some were disappointed with it because Miles suffered through so much and players put so much effort into escaping the asylum, only to get anticlimactically shot to death, thus rendering everything pointless. Preceded by the Male Ward, a non-stop adrenaline stress test where Trager poses a serious threat, and followed by the Female Ward, a very long level with multiple pitfalls and several hostiles and difficult traversal challenges, the Courtyard sticks out as being a very short, easy level with no hostiles at all up until (and except) Walker, who's very easy to avoid the one time he shows up near the end.
It was considered one of the scariest games ever made, which prompted multiple people to be too scared to play it, but love to watch people getting scared by it.