Pathologic is a classic, Russian-made game that concerns a series of characters all wandering into a mysterious town where a strange illness has taken hold. At first glance, the art style of Pathologic is absolutely phenomenal -- somewhere between Lovecraftian meeting Junji Ito in an industrial, dreary world. That is a large part of what contributes to the feeling of dread. It is a semi-open world filled with NPCs and creatures who may very well be hostile. At times, they can run right at you or from the mists, and the reaction time involved can be between life or death.It's very System Shock II like in that manner: you find an item, it goes somewhere (hopefully) or you can turn it into something you can use to make the game a bit easier on your frayed nerves. It's honestly almost mesmerzing how Pathologic pulls you into its story, it's atmosphere, and then bum rushes you with some demented creature. It definitely kept me on edge.
Unfortunately, that's also something of its downfall. You can't run in the game, and for such an open world, that really killed me. Not being able to run also makes the combat more difficult and frustrating, because enemies really can be ruthless the further in you get.
Something I must compliment is the sound design. It is of System Shock II quality, feeling eerie and omnipresent. There were moments where the music and sound actually got to me so badly that I dreaded turning a corner. Kudos to the developers on that. The ensemble of creepy NPCs, whether they are "normal" people or assholes that resemble Spirited Away's No Face sprinting at you all have this air of inexplicable dread. The plague doctor masks also don't help, nor does the ever-evolving art style that gets creepier the longer you are in.
In short, you go around, talk to weirdos and try to dig down to the bottom of the mystery. It feels very Silent Hill like, to be honest, which isn't a bad thing. If it weren't for the inability to run, the off combat system and the generally unintuitive tutorials or key mapping, I could honestly feel myself getting deeply invested in this game. There's such an interesting and dark story at work, and it feels like something truly different to the vast majority of horror games. You really have to piece together dialogue, bits you find and think critically to survive.Again, I felt it captured the spirit of System Shock II in a special sort of manner. You're alone in a hostile, alien sort of environment, with no one to trust except forces and people who may very well be sociopaths or people sadistically watching you run for their amusement (if you could run). Always being watched, but by what? Who knows. All you know is that it wants to hurt you and it could strike at any moment while you are pouring all of your wit into solving the horrors around you.
For fans of RPGs and horror, I'd say definitely give it a shot.