The Suffering plays as a traditional first or third-person shooter, employing the controls of the former but allowing players to switch between the two camera angles. The weapons provided to the player are reminiscent of those found in prisons: shivs, revolvers, Molotov tails, and a wide array of less *** weapons.
In the game, the player is presented several opportunities to test their morality, usually in the form of a person who is trying to survive the horrors of the island. In most cases, the player is presented with three options: help the person (good), kill them (evil), or remain indifferent to their plight (neutral). A hallucination of Torque's wife will attempt to convince him to take the good path in the obvious cases, while demonic voices attempt to coerce Torque into being evil. Good or evil, if done correctly, are indicated by the reaction of Torque's wife, while being indifferent has no response, as it is accomplished by getting someone killed without direct responsibility. Not every moral choice has all three outcomes, nor are they always so clear cut; for example, in the asylum, Torque comes across a correctional officer who has lost his limbs and is slowly dying. Torque can kill the man to relieve him of his misery, which will constitute a good action, or leave him be, which constitutes a neutral one, but in no way can he perform an evil act in this instance. The decisions made in regards to these opportunities will affect the ending of the game. Torque's "morality level" is indicated by the picture of his family in the inventory, which gets cleaner with good acts and dirtier with evil ones.