I know it physically hurt these developers to add in difficulty tweaks, but thank god they did, because more people should experience what this game has to offer, and frankly I wouldn't have made it as far as I did if I'd kept dying immediately on the first day. There are big long video essay reviews you should go watch, but my main thing is that it's the best execution of Pathologic, and if it looks enticing in any way to you, you should absolutely dip your toes in.