Acceptable Targets/Asshole Victims: Before the beginning of the game proper, the pair of drunken rednecks Tommy bludgeons (possibly to death) with his Stillson Wrench in bar fight after the two had been sexually harassing his girlfriend Jen.
Big Lipped Alligator Moment: After earning a spiritual power up in the afterlife, Tommy is suddenly and inexplicably attacked by aliens. How does he fight back? With guns. Alien guns. The alien guns he uses in the real world, despite entering a spiritual dimension. Whaaaaat?? Oh, and there's the whole "aliens invading The Afterlife! Physically!!" thing. The Land of the Ancients is treated as a physical, alternate dimension, where one can go through dying (as a Cherokee, perhaps) or by using a special kind of portal generator.
Complete Monster: The Mother deliberately captures and alters Jen to make you kill her, taunts and tortures you every step of the way while being fully capable of ejecting you into space at any point, and clearly enjoys it; she views this as a way to "harden" Tommy in order for him to take over the Sphere in her stead.
High Octane Nightmare Fuel: Where do we start? The Juicer machine? The cybernetically-altered human slaves with wires for eyes and exposed guts? The omnipresent protein pipes that you know are filled with ground human meat? The possessed ghosts of children doing acts of evil everywhere, including at least one little girl that kills her father on Earth? How about the ever-present screams of agony of said children and of other people? Or the ultimate fate of Tommy's girlfriend,Jen? Or how about that fucking nursery rhyme??
Scrappy Mechanic: Spirit Walking, wherein upon death you had to kill weak mooks in order to get back in the action. Chastised in this game because it effectively meant you were never punished for dying, although it has shown up in other games (such as Borderlands) with alterations or improvements.