This is a seek-and-find puzzle game, based on the movie Shutter Island, in which players assume the role of U.S. marshals who investigate odd occurrences in the Ashercliffe Hospital for the Criminally Insane. Players search for clues/items among scenes of jumbled objects, and interview hospital personnel to uncover the whereabouts of a criminal. A handful of items contain blood on them (e.g., a blood-soaked cloth, a scalpel with light traces); other items include smoking pipes and cigarette packs (there is also occasional dialogue referencing smoking). During the course of the investigation, players can obtain patients' files that detail acts of murder: the drowning of a patient's three children; the arrangement of dead bodies around a dinner table; and the scalping of relatives for use as hats.