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The more directly you come in contact with the Slender Man, the faster your sanity drains.

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Sanity effects

The game's standout concept, patented by Nintendo, is the "sanity meter", a green bar on screen which is depleted under various conditions, generally when the character is seen by an enemy. It can be restored under various conditions, such as performing a "finishing move" on an enemy. As the bar becomes low, various effects occur, reflecting the character's slackening grip on reality. If the bar remains empty, further damage to sanity decreases the player character's health.

One effect which is consistently used is a skewed camera angle accompanied by whispers, cries, and unsettling noises. The lower the sanity meter, the more skewed the camera angle and the louder the sound effects. Fourth wall breaking effects include simulated errors and anomalies of the TV or GameCube; this does not affect gameplay unless the player misconstrues them as actual technical malfunctions.

There are many different sanity effects, the length they last depends on each effect. Not all effects will necessarily be encountered during a given run through the game. A few more commonplace examples include:

Sounds, such as footsteps, women and children screaming, doors slamming, the rattling of chains and the sound of a blade being sharpened.
The player character finds him/herself walking upon the ceiling after entering a new room.
Walls and ceilings bleeding. Attacking them causes more effusion.
The volume is lowered, accompanied by a fake television volume indicator on the screen.
Appearance of large numbers of monsters that are not really there, and disappear when attacked.

Some sanity effects are character-specific and reflect the individual's personal fears or experiences. When the sanity effect is finished, everything goes back to normal and the character often utters a panicked statement to the effect of, "This can't be happening!"