Alternate Aesop Interpretation: Arguably, one of the main Aesops of the game is that running away from or ignoring problems doesn't make them go away or hurt you any less. You have to face your problems head on and acknowledge them before you can be free of them. Case in point: if Miki chooses to believe the monster isn't real she winds up dead, apparently killed by the monster. Whereas if Miki chooses to continue believing the monster is real she discovers the monster is actually her aunt and finally comes to terms with her death, she is diagnosed with schizophrenia - meaning she can get the psychological help she needs to live a normal, happy life - and the monster disappears.
Did Minako (Miki's mother) really tell Saeki to kill herself? Given Saeki's mental illness, which included extreme paranoia and delusions, she may be an Unreliable Narrator. In the remake, Miki actually states that as awful as Minako could be to Saeki, she doesnt think she ever told her to kill herself. In turn, this could also cast doubt on whether or not Minako really tells Miki to hang herself like her aunt in the good ending.
Saeki's ex husband. Is he is a jerk who cruelly abandoned his grieving wife after their baby died, or a more tragic figure who simply couldn't cope with his wife's deteriorating mental state while also grieving for a child he lost? Or maybe a mix of both?
In the original game, Shinji has a habit of just barging into Miki's house uninvited, although his intentions are benevolent. In the remake, he always has a valid reason to come over and only breaks into her house once (when Miki is trapped down the well in the remake, he had been coming over to ask her out to dinner and hears her calling for help; the only time he comes in without permission is in the ending, as he was concerned for Miki's mental state and/or was supposed to be taking her to hospital, depending on the choice the player made). Word of God explains that she decided to give Shinji more characterization, after realizing most players misinterpreted his concern for Miki in a more sinister light (when he simply has a crush on her).
Base-Breaking Character: Miki's mother. Some people see her from a more sympathetic angle as despite being a massive Jerkass, she has had a difficult life and suffers from an untreated mental illness, causing her to act out. Other players view her a lot more harshly and can't forgive her for the horrible way she treats her sister and daughter, especially considering it may have contributed to Saeki's suicide and her daughter's depression (and possible suicide as well).
Enjoy the Story, Skip the Game: While the gameplay isn't terrible, it's rather barebones with some frustrating elements (such as the chase sequences and the vagueness of some puzzles). Most players agree the best part of the game is the story, which is a heartfelt tale about grief and mental illness.
Fan-Preferred Couple: Miki and Shinji are shipped by many players; they have a fair bit of Ship Tease, Shinji is one of the few characters who is genuinely supportive of Miki and tries to help her, and a lot of players think Miki deserves some happiness in her life after all the crap she's gone through.
Insane Troll Logic: Uri's games have a general trend of forcing you to choose the LEAST realistic option during a choice scene in order to get the best ending. In Paranoiac, insisting that the monster isn't real, despite your family's history of mental illness and schizophrenia, is actually the bad end.
Jerkass Woobie: Miki's mother. Yes, she's an emotionally abusive and self-absorbed bitch, but it turns out she suffers from hysteria and possibly other mental health conditions, her parents died when she was young forcing her to become the primary carer of Saeki, until she couldn't cope anymore and Saeki was taken into care. Note that Saeki is mentioned as having been placed with a foster family, but her sister apparently wasn't. Also, Miki's father isn't around, suggesting he either died or took off. A lot of Ms Takamura's comments towards Saeki also seem to imply she's jealous of her, suggesting she herself is emotionally insecure and deeply unhappy. In the remake, Miki says outright that her mother uses harsh words to cover up her own weaknesses.
Miki, who suffers from depression has a very uncaring and cruel mother, and gets constantly attacked by a monster at night and her kindly neighbor doesn't believe her. She greatly misses her late aunt, who was more caring towards her than her mother. It's later revealed that Miki was the one who found her aunt's body after she committed suicide and that she blames herself for Saeki's death. She has been carrying this guilt and trauma for three years with no one to help her.
Saeki. Lost her baby to miscarriage and subsequently lost all emotional support from everyone, eventually leading to her going mad and committing suicide. And becoming the monster haunting the house...and in the good ending we learn that even though she'd been frustrating the player so long by all the nightly chases, all she wanted was to make up with her niece. Her parents also died when she was a kid and she was raised by her older sister, who grew increasingly resentful of her due to her disorder. Despite her sister's poor treatment of her, Saeki makes it clear she still loves her and even thinks of her as a mother-figure.
Shinji in the bad ending, especially in the remake. He spent days supporting and trying to help his troubled new neighbour, who he obviously cares a great deal for, only for her to end up dying, possibly by suicide. In the remake, Shinji clearly blames himself for what happened to Miki, feeling he should've done more to help her and he even starts seeing the monster, implying that he may end up being slowly consumed with guilt over Miki's death, just as she was over her aunt's death.