This was a really thoughtful review! And I really like how you explained executive dysfunction at the start. Thanks you so much for sharing it!
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It really is tough. I haven't dipped into anything first-person yet, though I have worked in 3D. I can already think of a few mechanics and scenarios that could be very interesting to experiment with though.
I feel like using "nightmare logic" will be a good place to start. Once I teach myself some first-person game design, anyway.