It's real. You can die at the beginning of the game attempting to grab your tie. You're playing as a 40 something burnout cop who has recently done so much alcohol and drugs that you have complete and total amnesia and your heart can explode at any moment. At one point even sitting in a chair could kill you. lol

It's really worth playing. The voice acting is stellar, and it really is the best "role-playing" game, in the sense that you are fully immersed in role-playing a character. The mental gameplay mechanics are GOAT, and one-of-a-kind.