Very nice. I especially like the pacing of the story.
Crit:
Most definitely the lighting. The light from the lantern is overly harsh, it looked better when I turned up the gamma. I think if you only improved one thing lighting would be it.
Minor crit: the cut scenes are a little jerky but acceptable. The worst was the opening scene where the guy wakes up, his head makes a 90 degree direction change. But I liked the models for the cut scenes, they are better than some I have seen in big production adventure games.
Some advice... not crits:
have the text come on by default, it is hard to eat chips and hear what the girl is saying. An important part of adventure gaming is to be able to eat and play
Have a control menu easily accessible. took a bit to realize that tab brought up the inventory. Had to jam buttons for a while. Yes there is a menu under options but like a lot of people I do not like to hit escape unless I have to!
When you hit tab it brings up the inventory, hit tab it closes the inventory. click on the book the book opens click on the book again nothing happens... so I am mashing buttons again trying to close the book... then I notice the little button up in the corner to close the book. Maybe that button should be bigger. Of course I am playing on a wide screen so maybe it is just me.
Also remember that gritty is good but I do not know if adventure gamers are really into full on slasher type games! I really want to play this game when you are done but I would need to be convinced that wading through buckets of blood is something I want to do in an adventure game.
Last thing: where does the girl go? Ya free her from the cell and then she disappears. I spent some time spinning circles trying to see her. Wouldn't want to wander around an asylum followed by an inmate I can't see.

Nice game I hope to play it soon!