The enemies and environments were kind of a let-down, and at times would actively interfere with the interesting story going on. The environments were puzzling, because unlike in Dear Esther, (DE and Karsakovia spoilers to follow) where the environments were both physical and places in the mind of the narrator, Karsakovia's environment's felt like neither: too bizarre and too copy-pasted to feel like a real place, too mundane and not imaginative enough to feel like a place in the mind. In some cases, I would be attacked by the wind monsters while a monologue was playing, and that made it difficult to catch some story bits.
I liked the later chapters more than the previous ones, which suffered from some really monotonous level design. The building slowly unravelling into a cloud of debris as you progressed was kind of cool, but only really shines when you see it all exploded like that. In a way, the building is a metaphor for Christopher's mind, he deteriorates and slides further and further into his post-apocalyptic fantasy, dragging his fictionalized version of the doctor with him.
Smashing the TVs was an interesting mechanic, especially because it was mainly suggested to the player through the monologues. Christopher smashed his own personal TV, his hands wrapped in (copper?) wire, thus burning himself. IIRC, that was when the Karsakoff's Syndrome set in, and he forgot about his previous life.
