Pathologic 3 dials into the psychological terror that makes this the most punishing survival horror franchise I've ever played

While Pathologic 2 de-centralized the player in its horror story, Pathologic 3 shines a blinding spotlight on them. As the Bachelor – otherwise known as Dr Daniil Danksovsky – finds himself in a remote eastern European town ridden with plague, he waxes poetical every chance he gets. Gone are the hunger, thirst, and exhaustion meters that made Pathologic 2 such a fundamentally miserable yet gripping experience. In their place sits a sanity meter.

The choices I make, items I study, and objects I interact with as the Bachelor influence his state of mind. The meter slides constantly toward apathy – a slower, more distanced view of the world around him – and I must combat that by introducing a little mania. An even keel between manic and apathetic is the goal most of the time, but as I soon discover in this harrowing enclave in the middle of the steppes, sometimes the only way to piece together a nonsensical world is to throw more of the same right back.

Take your pills

"Once she's close, she'll never stop chasing you." This is the warning uttered by a child named Clara – or is she a Changeling? She speaks of the Shabka, a spirit entity resembling a hulking bony mass, which haunts the streets of this plagued township. I'd initially shrugged off tales of her myth, dismissing them as nothing but smalltown folklore. But the Shabka is as real as the bodies lining the streets. Either that, or the Bachelor has truly gone mad.

I heard the rumors back on day one, when I first arrived at the town by train. Children stole my briefcase, filled with the doctor's tools and gadgets I'd need to perform my work, and my hunt to track them down led suitably strange findings. Women in rags lie weeping in the street, cradling a dead bull and pleading with an unseen force for forgiveness. Villagers gather together, gossiping in fearful, hushed tones of the monster who stalks the shadows.

No sooner have I come to grips with the basic gist of things – I'm a city doctor in a small, superstitious town where nothing makes sense and everyone speaks in ominous riddles – time seems to splinter. A flashforward tells me that the town will be destroyed on the sixth day of my visit, but the Bachelor insists he was operating there for twelve. That's certainly what the day calendar tells me when I navigate to it, noting the twelve days marked along the bottom of my screen. But there's one small problem: I started the game on day one, and seem to have completely skipped past everything since then and day five.

That means much of what is said to me by the townspeople makes very little sense. I've supposedly met these people before, and trying to admit that I have no recollection of them edges me further into apathetic territory. Respond to their queries in an odd way – with too many long and confusing words, perhaps, or with a little too much imagination behind them – swing my sanity meter into red manic territory.

With little understanding of what has happened or why, Pathologic 3 leaves me to piece together its fragmented storyline while keeping track of the time jumps. It's a familiar enough place to be; I recall feeling that Pathologic 2 didn't really care that I was supposedly the main character, clawing my way through each day on the barest amount of food and water and fearing the moment I'd succumb to exhaustion. Time moves forward when you sleep in Pathologic. I guess Pathologic 3's saving grace is that sanity is much easier to control than the ugly truth of physiological need.

Depersonalization

While pursuing various leads in my investigation into not only the disease, but the presumedly invincible man who runs this town, Daniil has to make his way through plagued districts on the hunt for specific people. Nothing here makes much sense, true enough, but certain interactable villagers hold clues to progress the story if you manage to catch them in specific places at a precise time on a given day.

But the path to reach them is rarely straightforward. Nor all that safe, for that matter. Daniil has a wealth of potions and tonics to cure almost every ail, physical or mental, inflicted upon him. A little morphine here and some tobacco there can always be administered through the quick toolbar or from the inventory, but the easiest way to balance out his mental state is to hit the concentrate button and focus on the world around me. Items with red auras can be interacted with or hovered on to pull my sanity meter closer to manic, while the same can be done with items of a blue aura to make him more apathetic.

It becomes harder to worry about sanity, however, when you're running through thick clouds of poisonous miasma. As I open the map, each district in the town has its own name and health diagnostic, and the latter changes depending on the day in question. Day one sees almost the whole town perfectly healthy, or "calm", according to the map, but once I reach day five, it's hard to find a non-infected corner. Miasma is cleared with another of Daniil's handy medical contraptions: the prototype. This portable air dispenser pushes a diffusion of toxin, medicine, and a purifying agent to cleanse the miasma from a specific location.

Each refill has only twenty charges, so I need to use them sparingly… which is harder than it sounds. Much of my time with Pathologic 3 so far has been spent running through foul black-tendriled air in diseased parts of the village, causing insanity to soar as mania sets in. Daniil hallucinates when this happens, but he also moves a hell of a lot faster, which is incredibly helpful since I must travel through all infected map regions on foot.

Calm or healthy neighborhoods can be passed through using fast travel, which opens when I reach a gate separating each district. Here, I can plot a course through the town as I hunt down useful leads. It's also the only way I can get back to my base, the Stillwater, to recharge the prototype so I can face the plague-addled streets with a little more confidence.

But even at basecamp, there's nowhere to hide from the absurd beauty of Pathologic 3. Madness and superstition are embedded in the heart of this place, seeping into conversations with strange cultists and seen in the masked entity who thinks I'm performing some piece of performance art with him. It's a medical sim wrapped up in a non-linear murder mystery, breaking the concept of time as I know it and forcing me to roll with each and every surprise punch as I try to atone for the sins of a past I don't remember.

I can already tell it will take me a long time to finish Pathologic 3. Unlike the good doctor, though, I'm not in any rush. A world this dense with storytelling and subterfuge deserves my full attention, even if I have to maneuver diseased alleyways to unravel it. It's Pathologic as I've never seen it before – yet no other game could make frustration so fascinating.

There's plenty more tension to be found among the best survival horror games ever