Upon the sanity reaching 0, the screen cuts to black, accompanied by the sound of a gunshot. If the sanity reaches 20, Mickey becomes covered in blood, and dead bodies are scattered around the level. When the sanity reaches about 40, Mickey's face appears rotten and creepy, he starts moving faster, and the buildings in the background transform into creatures with multiple eyes and teeth. If the sanity decreases to about 50, Mickey's expression becomes a huge smile, and the background buildings wobble while static noises play. When the sanity decreases to around 80, Mickey becomes upset, moving slower with accompanying piano banging sounds. As the sanity bar decreases, Mickey's expression and movements change. The objective is to reach the goal and advance to the next level.
To prevent the sanity bar located at the top-left corner of the screen from decreasing, players must collect bowties while avoiding obstacles such as nooses and water that decrease sanity levels. The game features the player assuming the role of Mickey Mouse as he navigates through a town-like environment.
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