In fact, the game comes with some pretty serious content warnings, including intense violence, blood and gore, partial nudity, sexual themes, and strong language. These aren’t just ratings included for the sake of formality, either. Fire and Ashes gets exceptionally graphic, and anyone sensitive to disturbing imagery should probably watch some gameplay footage before deciding to jump in. I also chose to play the game offline rather than stream it on my Twitch channel, simply to avoid potential issues with the content being shown during a broadcast.
Set in 1977, the story follows Henry Gray, who awakens inside the Paul Staderbeiger Psychiatric Hospital surrounded by blood and seemingly caught in the middle of a nightmare. Haunted by events from his past, Henry must find a way through the hospital and the terrifying places beyond it. What initially appears to be an escape from a psychiatric facility gradually develops into something much more psychological, with reality and hallucination becoming increasingly difficult to separate.
The developers clearly invested considerable time and effort into the game’s environments, and this is one of the first things that stands out. The locations are deliberately creepy, uncomfortable, and downright disgusting in places. I’m talking REALLY gross. The hospital corridors, disturbing rooms, blood-covered surroundings, and grotesque imagery all contribute to an atmosphere that makes exploration feel uncomfortable in the best possible way for a horror game. There is a deliberate effort to make the player feel like they’re somewhere they absolutely do not belong.
What also helps is that the horror doesn’t remain confined to the psychiatric hospital. As Henry’s journey progresses, the environments change, taking players into other disturbing locations connected to his past. The uncertainty surrounding what is actually happening gives the experience an additional psychological element. You’re not simply trying to escape dangerous surroundings; you’re also trying to understand what happened to Henry and why he’s experiencing these increasingly disturbing events.
Gameplay combines exploration, puzzle-solving, survival, and close-quarters combat. Players need to investigate their surroundings, collect clues, uncover pieces of Henry’s history, and find the resources necessary to survive. You’re also going to encounter plenty of enemies, ranging from deranged patients and guards to cannibals, experimental creations, and supernatural threats. Not every encounter is something you can simply run through, so knowing when to fight and when to avoid attracting attention becomes an important part of the experience.
Weapons are another part of the survival equation. Henry isn’t exactly walking around with an impressive military arsenal, and much of the combat revolves around improvised weapons and whatever resources can be found along the way. The game also incorporates different tools and mechanics that become important when dealing with the threats lurking throughout its environments.
One of the more interesting ideas in Fire and Ashes is its approach to sound. Using voice recognition technology, the game can react to sounds picked up through your microphone, including breathing, whispering, shouting, and screaming. Staying quiet can help prevent enemies from detecting you, while making noise can sometimes be used to distract opponents or create opportunities to escape.
I played the game on PlayStation 5 and used the built-in microphone on my DualSense Edge Wireless Controller to take advantage of this feature. This meant I didn’t need a separate headset microphone or additional equipment to experiment with the voice mechanics. Your voice can even become part of the combat system, with shouting and taunting enemies creating openings during certain encounters. The Electric Voice tool can also be used to pacify dangerous patients and other threats. It’s an unusual mechanic that gives sound a much more active role than simply providing background atmosphere.
The game can also be played without a microphone, although using one is recommended for the full experience. I do think your experience may vary depending on what platform you’re on. I had a few issues with the game, for example, where at times I wasn’t able to pick up objects to add to my inventory. Also I can’t say that the same attention to detail was put into the animation and physics of the enemies and other animations. The game doesn’t seem to have a Quick Resume feature, so I found myself restarting sections I had already completed when coming back to the game or even dying during the game.
Ultimately, Fire and Ashes is clearly aiming for a particular type of horror experience. It combines disturbing environments, graphic imagery, psychological storytelling, survival mechanics, and an unconventional approach to sound. Its willingness to push the boundaries of what players might find uncomfortable is certainly going to make it a difficult recommendation for some audiences, but horror fans who appreciate darker and more graphic experiences will find plenty here to explore.
Fire and Ashes is available now on PC through Steam and the Epic Games Store, as well as PlayStation 5 and Xbox Series X|S. The PC version launched October 14, 2026, with the console versions following on October 23.
If you’re looking for a horror game that isn’t afraid to get grotesque, unsettling, and downright disturbing, Fire and Ashes certainly makes its intentions known from the very beginning. Just be prepared for what you’re getting yourself into.
Rating: 4.5/10