- The game and short story both start with some of the most horrific imagery to ever grace an artistic medium, and it only gets worse from there. The entire human race has been wiped out, and the surface of the planet has been made completely uninhabitable. The only five survivors of the apocalypse are trapped in a living hell by an insane, rage-filled supercomputer that can alter reality at will. Said supercomputer has kept these five alive for 109 years, torturing them continuously and making horrific alterations to their minds and bodies while ensuring they can never put themselves out of their misery.
- While they doesn't have as much depth as the game, the characters in the original story still have some rather .. unnerving personalities.
Gorrister: Why doesn't it just do us in and get it over with? Christ, I don't know how much longer I can go on like this!
- Gorrister was once a compassionate and forward-thinking conscientious objector, AM has tortured and demoralized Gorrister into an apathetic shadow of his former self to the point of which he angrily beats the crap out of Ellen for attempting to do something when Benny makes a stupid decision. Despite this, he does still have the capacity for sadness, as when AM shows them a fake projection of Gorrister's dead body, the real Gorrister has to walk out.
- Benny was once a proud, handsome college professor who was secretly homosexual . However, after AM got through with him, he had been physically transformed into an ape-like Psychopathic Manchild with an enormous "member" who is forced to suffer as AM's favourite punching bag. Also, he was now conditioned to have sex with Ellen in spite of his original sexual orientation.
- Ellen was (allegedly) chaste and pure prior to capture, but after a hundred and nine years under AM's "tender ministrations", she's been reduced to nothing more than a Hysterical Woman who is forced into the role of the group's prostitute.
- Nimdok is The Spook, with next to nothing revealed about him - in fact, AM forced him to use the name Nimdok because it thought it sounded funny. At points in the story, he's spirited away by AM, and returns looking pale and shell-shocked, but what was done to him is never explained.
- Ted, the Unreliable Narrator, doesn't elaborate on who he was before AM captured him, but does state that he is the youngest and the "one AM affected least". He's wrong, of course, and is extremely paranoid of the other survivors. And to make matters worse, at the end his ultimate fate far outclasses them all, becoming the Trope Namer for And I Must Scream.
- In the game, Benny was a murderous military commander who murdered anyone who had the misfortune of showing compassion, helping his fellow man, or learning about his cruel ways and trying to report him.
- In the video game, Benny is given enough intellect to understand his scenario and recall some of his life prior to his life under AM. However, AM also cripples his legs and removes his ability to speak because it makes Benny suffer more.
- When AM sacrifices of one of the tribe, he shines a huge light, speaks in a booming voice, and vaporizes the person on the altar, leaving behind only a few "bones". When investigated later, it turns out that all that's left is in actuality robotic junk.
- The deleted scene of Benny eating a baby.
- Ellen was raped by a man wearing a yellow maintenance outfit in an elevator. As a result, she has extreme claustrophobia, panic attacks and an aversion to the color yellow. So, of course, her entire scenario takes place in an Egyptian tomb that's almost entirely filled with yellow objects.
- If she doesn't fight back against the yellow-clothed apparition created by AM, you can see her being forced to endure a re-enactment of her rape.
- Also there's the Fridge Horror of being the only woman in a group with four other men for 109 years, in a place with no other outlet for release. Yeah. Despite what you might expect, however, everyone involved acknowledges how Sick and Wrong it is.
- Normally, you would think AM would intervene to stop the group from having any sort of respite, no matter how temporary. However, according to the short story, AM lets them have sex because he finds the idea of sex amusing, and particularly thinks their discomfort about AM observing their sexual interludes is hilarious.
- Gorrister is constantly wracked with guilt over having to institutionalize his wife... so of course, Gorrister encounters a copy of her in his scenario hanging from a meat hook.
- Gorrister's heart was physically removed from his chest by AM a long time ago, but he remains alive thanks to AM's influence. The spot in his chest where it was removed has never healed.
- He always hated his in-laws, but if Gorrister investigates properly in his scenario, he will discover that it was actually his mother-in-law, not him, who drove his wife insane, although she tried to pin the blame for it on Gorrister.
- If Gorrister wishes, he can offer up the hearts of Edna, Harry or Glynis to the jackal in his scenario so he can get his heart back, potentially resulting in him becoming the cold-blooded murderer he always feared he was.
- The entirety of Nimdok's chapter, which is set in a Nazi concentration camp.
Nimdok: It is difficult to see what purpose the surgery has than to mutilate the patient.
- The game is fairly graphic in its depictions of the atrocities in the concentration camps, at least insofar as the limitations of the game engine allows. Particularly bad is the "recovery" room of Mengele's hospital, where we see the bloody and mutilated (but still living) bodies of those who were experimented on by Nimdok and his associates.
- Nimdok is horrified to learn that he was an assistant to Doctor Mengele in the Nazi camps, particularly once he remembered that he was Jewish, and sold out his own parents to get a position on Mengele's staff.
- In probably the worst What the Hell, Hero? moment in the game, and a significant contender for one of the worst such moments of all time, Nimdok can obey AM and continue his experiments from the war, which is particularly brutal when considering the above.
- In the video game, Ted, no matter what moral decision he makes will discover that Earth has become a barren, uninhabitable wasteland thanks to AM, so even if he could escape, he wouldn't survive. If he sells Ellen's soul to the devil, it gets worse: he will see Ellen on that uninhabitable wasteland, meaning he will have damned not only himself, but Ellen.
- Several pieces of the game's soundtrack is frightening beyond words. For some highlights:
- The Main Menu's theme, which really does sound like something you'd hear when looking at a pillar of hate while surrounded by hot coals.
- The Zepplin theme starts out with just a bunch of random noises before these sounds are bound together by a mournful base string. It really helps seal the atmosphere of isolation and despair that plagues Gorrister's scenario.
- The daunting, ominous Jungle theme.
- The Pyramid theme just sounds off.
- The Concentration Camp theme, appropriately enough, is rather freaky.
- The Castle theme really helps nail the Paranoia Fuel that embodies Ted's scenario.
- The terminally depressing Demo theme, which also counts as a Tear Jerker due to just how lifeless it is.
Nightmare Fuel / I Have No Mouth and I Must Scream
Trope Namer for one of the most horrific tropes in fiction, it's obvious that Nightmare Fuel runs rampant here.