It’s a great way to play a low Intelligence, melee-focused run. Just assume the bullet did a lot of damage to your brain, and murder hobo your way to a New Rome.
I did exactly this in my Legion run. I didn’t have a problem with the Legion story itself but the run showed a disappointing lack of low Intelligence options/paths (I think there was maybe three unique conversation options all game) and really poked holes in the Karma system. I did everything I could to tank my Karma as a murderous cannibal sociopath and it had no obvious effect on game play at all.
Slightly different perk choices, IIRC, and yes, nowhere near the dialogue choices in a FO or FO2 idiot run.
Seemed appropriate for working with the Legion though.
It is amazing seeing what other things particular voice actors have gotten up to. I think the guy who voiced Joshua Graham could credibly do a Richard Burton impersonation, if he got tired of doing video game voice actor work.