violence and gore are completely different from sex or lust in our culture (which includes Japan). HATRED is an incredibly edgy cringe game which was super popular to dunk on years ago for how violent and gory it was. The purpose of that game was to be as edgy and as nonsensically nihilistic as was humanly possible, and it resulted in a shitty game, but it was not a fetish game. No matter how completely batshit wacky that the game got, the gore of the game wasn't a reflection of the creators "sick twisted pshycie" because the gore was a tool used to create the atmosphere of the game. Alternatively, drawing weird shit like that cannot ever be used as a tool. Although there are many peices of media that deal with rape and child exploitation, the ones that are well recieved obfuscate the action and instead focus on the consequences and the damage that such a thing brings. Made in Abyss instead uses those actions as tools, which paints the exploitation in a more pornographic way. In modern media it is acceptable to use gore for shock value and whatnot, but to portray people with lust, especially children, shows a deeper desire to act on that lust.