The character of Dropsy, a merciful and viceless clown with a seemingly terrifying appearance, was originally envisioned as a villain in a circus level for an unmade "zombie platformer" game. Creator Jay Tholen would eventually use the character in a "Choose Your Own Adventure" forum game on the Something Awful forums in 2008, where he would build a story out of responses to his art, leading to Dropsy's starring role in a point-and-click game, which began development in 2011. Tholen stated that he was not bothered by initial reactions to the grotesque character design and assumptions that the game was a "stoner-horror-comedy", stating that he liked "hiding a powerfully loving, gentle being inside an unattractive wrapper" and that it mirrored how Dropsy is perceived by other characters in-game. However, he hoped this would not "keep people away from a game that they may actually enjoy."