The Medium is developed by Bloober Team, Bloober meant to enhance the immersion by changing their traditional perspective from first- to third-person and taking advantage of Xbox Series X’s background streaming. They modelled the spirit world after Zdzisław Beksiński’s dystopian surrealist artwork. Lead designer Wojciech Piejko said The Medium imparts the message that “there is no universal truth”. Composers Arkadiusz Reikowski and Akira Yamaoka were tasked with scoring the physical and spiritual plane, respectively. Yamaoka worked on the Silent Hill franchise, which inspired the game, including its fixed camera angles. He was persuaded to take on the music when Piejko approached him with a gameplay demonstration.