The existence of a patch generally means that the non-patched version of the game was censored in order to avoid being removed from Patreon or some other site.
I always play with the patch enabled, even if I would not necessarily want every aspect of the additional content. The patch restores the game to how it was intended to be made by the creator. In my experience, the censored versions tend to be jumbled messes in comparison and don't really make much sense. The basic story in a censored version often won't significantly change from the original but critical details such as how the characters are related to each other, how they met, why they are living together, and so forth will change and the censorship often makes it confusing to understand the story.
When I first started playing games on here I didn't use patches either, but that just lead to confusion since I didn't understand why the characters in the games thought it was so weird that I was having romantic relationships with seemingly random women (neighbors, classmates, roommates, etc.). Once I enabled the patches I found that those women were actually supposed to be my character's sisters, mothers, cousins, aunts, etc. so those weird reactions (which themselves did not change between versions) suddenly made sense! It also had it make more sense why I was living with various people in the games, why landladies cared so much about their other tenants' grades (they were mothers and daughters), etc.
The idea of sexual relations with my mother is absolutely disgusting to me, so once the patch was enabled I knew which women to avoid so that I wouldn't have any nasty surprises later in the story!
Think of it this way, would you be able to understand Game of Thrones as well if Cersei and Jamie were always referred to as "roommates" or "neighbors" or that she was his "landlady" or something instead of acknowledging that they were brother and sister? Would the whole concept of their story and why their relationship is controversial make sense if it was missing that critical detail?
You should play with the patch enabled if you want a more cohesive and sensical game experience.
