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Basically, interact with the shrine, either in the lobby when you enter the mod OR when you reach the ending area before the rush starts in Act 1, both works.
Then select "Casual Mode", it will transform to a Void Diamond (the same collectible) and the music for all levels are replaced.
In the DeathWish contract the difficulty selector regardless of choice will always be set to DW, for obvious reasons.
Hope this helps!
Level 2-4 have power ups around that can be used or timed to exploit, some of them are intentionally hidden for exploration purposes.
Hardmode was reworked into a DeathWish, its named "All-Zones Run" where you have the beat the 3 levels in one run with multiple bonuses.