It takes place in a dystopian world where a mastermind artificial intelligence named "AM" has destroyed all of humanity except for five people, whom it has been keeping alive and torturing for the past 109 years by constructing metaphorical adventures based on each character's fatal flaws.

The player interacts with the game by making decisions through ethical dilemmas that deal with issues such as insanity, rape, paranoia, and genocide.

Producer David Mullich supervised The Dreamers Guild's work on the game's programming, art, and sound effects; he commissioned film composer John Ottman to make the soundtrack.

Examples of sentences the player might construct would be "Walk to the dark hallway," "Talk to Harry," or "Use the skeleton key on the door."

However, good acts are rewarded by increases in the character's spiritual barometer, which affect the chances of the player destroying AM in the final adventure.

Due to its immense hatred for humanity, stemming from the logistical limits set onto it by programmers, AM uses its abilities to kill off the population of the world.

With the aid of research carried out by one of the five remaining humans, AM is able to extend their lifespans indefinitely as well as alter their bodies and minds to its liking.

With the help of the Russian and Chinese supercomputers, one of the five humans (whom the player selects) is translated into binary and faces an as yet unexperienced cyberspace template, the world of AM's mind.

AM's mind is represented according to the Freudian trinity of the id, ego, and superego, which appear as three floating bodiless heads on three cracked glass structures on the brainscape.

If the human intruder disables all three brain components, and then invokes the Totem of Entropy at the Flame, which is the nexus of AM's thought patterns, all three supercomputers will be shut down, probably forever.

Should the human intruder fail to disable AM properly before facing it, however, AM will punish them by transforming the character into a "great, soft jelly thing" with no mouth that cannot harm itself or others and must spend eternity with AM in this form.

It is possible to prevent the physical bodies of the protagonists from being destroyed if Nimdok is the first to go face AM, but even so, some dialogue from the Chinese and Russian supercomputers suggests that they may have died when their digital counterparts were erased.

For example, in writing the script for Ellen's confrontation with her rapist, Mullich channeled the memory he had of his infant son going through chemotherapy, being with him at the hospital and sharing a room with other young cancer patients.

In discussing the characters changes made to Benny, Mullich said, "Looking back, I think it might have been a lost opportunity to write a story about someone struggling with the challenges of being homosexual."

Though a long-time fan of Ellison and his work, Sears was initially nervous and somewhat skeptical at his assignment: "… they said, 'No, it's I Have No Mouth, and I Must Scream, and I was like, 'What?'

Since the story takes place in the mind of a mad god who can make anything happen, the team chose a variety of art styles for each of the scenarios, ranging from the unsettling perspectives used in German Expressionist films to pure fantasy to stark reality.

Assistant art director Glenn Price and his team rendered more than 60 backgrounds utilizing a number of 2D and 3D tools, including Deluxe Paint and LightWave.

[citation needed] Mullich commissioned film composer John Ottman to write more than 25 pieces of original MIDI music for the game.

[8] Cyberdreams had developed a reputation, in the early 1990s, of selling video games with science fiction-cyberpunk storylines and adult violent, sexual, philosophical, and psychological content.

[10] The removal of the Nimdok chapter made achieving the "best" ending (with AM permanently disabled and the cryogenically frozen humans on Luna rescued) more complicated.

"[32] According to Computer Games Strategy Plus, "without appearing didactic, Ellison has the ability to hit us squarely in the face with a mirror reflecting the sorry lot that we humans have become.

"[33] T. Liam McDonald of PC Gamer US wrote "there are moments that challenge and disturb, and this gives the characters and setting much more psychological depth than we've seen in any computer game to date."

"[22] Ron Dulin of GameSpot was much more critical, stating: "There are numerous dead ends and illogical puzzles [and] many programming bugs."

Dulin commended the game for experimenting with interesting concepts and enjoyed its dark art work and resemblance to the original book, but criticized it for how "the so-called 'ethical decisions' these five imprisoned souls must face are no more than red herrings, providing only stopping blocks to progress or disturbing scenes with no tangible purpose.