You have to draw your own conclusions about a lot of the game. Do all the endings coexist canonically? For example, in one ending, your character escapes. In another, you realize you are a serial killer. Are both "true" within the game world? Is there a main character who escapes without ever realizing they are "the Surgeon" referenced in the newspaper clippings? Or, if you escape, are you not that person?
The medium is also "painted" in some cases. For example, at one point, the player is presented with a false option to leave a room -- the text looks like a link, but does not function as one. In another case, the text "HE LIES" appears briefly when a new character is introduced.