Violence & Scariness. There's little actual combat in the game, but no shortage of disturbing and graphic imagery. The opening cinematic depicts the chase and murder of a young girl. Some spirits Marianne encounters are dismembered or feature other graphic wounds.
It creates an unpredictability to The Medium that sees players constantly on edge from the fear of the unknown, rather than expecting a jump scare when it seems fitting to have one. The Medium only has one jump scare and, when it's used, it absolutely works because you never expected it in the first place.