Imma just say I don't much like the headcanons that try to wave away OFF's weirdness by saying the game is just symbolic of this real life thing, i.e. it's all just happening inside a dying Hugo's head.
It gives me the same ick as 'Ash Ketchum is in a coma' or 'the magic went away' type explanations. I feel like this is just running from what was presented in the game since OFF wasn't deliberately made with dreamlike interpretations in mind, like it's not a psychological thriller and there's no character waking up at the end.
However, when I do engage with the idea of it being symbolic of real events, I think there's an interpretation that fans have overlooked.
What if the game is actually from the point of view of Hugo's father?
After all, if The Batter is sorta supposed to be based on Hugo's dad and you play as him, it stands to reason we are looking at events through his eyes. But what events are they?
That Hugo is already dead and his father is coming to terms with his grief.
Perhaps it's all the artistic venting of a man who lost his son as he works through everything that happened, how he acted and participated in events.
The Guardians are stages of grief he experienced but also represent who he was at the time.
Dedan is the anger that he couldn't stop the disease that took his child. But he is also the man who threw himself into work to the point of exhaustion and took it out on everyone around him until he became withdrawn and reclusive.
Japhet is an anger mixed with denial. How dare the world keep on spinning when his son is gone? How dare everyone just move on like it never happened?
Enoch is bargaining and substance abuse. He tried to bargain away the pain with drugs.
Zacharie and Sucre, having a connection to sugar, represent some part of that drug rabbit hole. Zacharie perhaps as the gateway, over the counter sleeping pills and such, or maybe he is the pharmacist or dealer. He could even be the rehab therapist given his role is a positive one in-game, but it is implied he supplied Sucre with her stash in Zone 0.
Sucre is the point in the father's life when the addiction had firmly gripped him.
The Queen represents a few things. Depression, the lowest point, as well as his marriage falling completely apart. But she also represents his struggles with God on account of what her name purportedly means: Vader Eloha, Father God.
Hugo is acceptance, killing him puts him to rest at last in his father's mind.
So when you play as The Batter, who are you really playing as? You're playing as the grieving father who went to rehab and church, got himself clean and right with God, and then worked on confronting who he used to be, the consequences of his actions, and finally coming to terms with everything. Which is why Batter is accompanied by The Father, The Son, and The Holy Spirit, they are helping him settle his past so he can move forward.
This just leaves The Judge. The Judge is guilt. Guilt acts like an old friend but puts you down. The Judge acts friendly but he often insults The Batter, calls his mission noble but can't accept that things were so bad that everything needed to end. Like guilt, he comes back in the last moments to try and drag you down with him, to tell you that you don’t deserve to move on but deserve to keep suffering. But how are you at any more fault for what happened? Neither you nor The Batter are really, events were in the end out of both of your control. So the Judge is the father's guilt.
Which makes the game's question to you at the end all the more important. Continue to feel guilty and see yourself as a monster? Or move on and find that Somewhere Over the Rainbow or peace in the idea that rainbows come with rain?
As an aside; Stay in Your Coma becomes quite a bit more sad with this interpretation, since it would mean Hugo's dad never got better.