Installed the game, then installed the downloader just to re-install the game.

Nothing seems to be working.

The "start.exe." file appears on my bottom toolbar next to my clock and anti-virus, but it disappears within a second or two, and nothing start up.

Not sure what I'm missing here.

Running Windows XP, more than exceed all the requirements...

What happens if you try to run the game with 'sntrm.exe' (located in the game directory (i.e. C:\Program Files\GOG.com\Sanitarium\sntrm.exe)) instead of 'start.exe'? I'm running the game with Wine on Linux, and I can't run the game with 'start.exe' either, but 'sntrm.exe' works. Since we're on different systems, this mightn't help, but it's worth a shot.

Nope, nothing happens.

If I click "start.exe," the computer at least pretends like it's gonna start the game, the mouse arrow playing busy animation, the start.exe orange square icon appearing in the toolbar next to my clock.

Clicking on "sntrm.exe" or cntrl-clicking and selecting open does nothing. There's no response what so ever.

Got an e-mail back from GOG's support staff. Turns out I needed to left-click on the shortcut to the game, and adjust the compatibility settings. For me, it has to be on Windows NT to play.

Thanks GOG, and to Auguste for answering.

No problem. Glad you can play the game now.

I just downloaded the GOG Linux version of this game and installed it through Lutris and am having a similar problem as the OP.

It's not loading at all.

The Sanitarium directory has a uninstall-Sanitarium.sh and a start.sh file in it.
The Sanitarium/game directory contains no .exe or .sh files.
I am trying to run it via the start.sh and nothing happens.

Compatibility issue?
Anyone have a solution?