I'm pretty sure you still can't. The pause menu appears, but the game isn't actually paused and you aren't able to save or quit to menu. I honestly prefer this behavior over the old way because it lets people quickly access settings in case they need to adjust volume sliders or other settings.
Also, metaparanoia is easily one of the best atmosphere building features in this game. It makes it feel like the game itself is breaking under the anomalous crap in Dunkeltaler. The busted pause mechanic just adds to the feeling that whatever is messing with Kel can see you and screw with you too.