Most of Otomo's work are realist depictions of people or still-life objects. Although she uses both real-life models as well as people and structures from her imagination as the objects for her portraits, the departure for some of her work includes characters from books such as Kobo Abe's "Box Man" and Camus' "The Myth of Sisyphus," as well as the writings of philosophers such as Kierkegaard and Sartre. The characters she depicts are sometimes sobbing, drooping their head or standing still in a trance. Food is often depicted within her still-life objects, with bananas or beef making frequent appearances. However, the way these objects are depicted in her work almost make you forget that they are food.

Her work, which is heavily influenced by existentialism, reflects a fascination, against the background of this philosophy, with how vitality can exist from within even a maelstrom of despair brought about by struggle or anguish. Her focus is on a consciousness that reaches an incomplete "state of despair accompanied by hope," in other words, a state which never quite completely reaches "absolute despair."

"While it does not lead to death, a state of despair accompanied by hope is like an incurable illness that one doesn't recover from throughout all of our life. There is also no hope within absolute despair. That said, absolute despair changes into hope and gives one a thirst for life that pursues questions such as who am I? Or what is truth? In my view, as its fundamental essence, absolute despair allows us to arrive at the possibility of choosing and affirming one's self. There are things that only appear beyond the point that all hope has been reduced to despair." (Kumiko Otomo)

The Paper-Knife was made. That is, it is for a purpose that was previously decided. How about us, as people? Perhaps there is something we can touch or reach by feeling beyond the point where Otomo's work ends.