Down With The Sickness

HIGH God-tier writing and mechanics that inform the themes.

LOW The one frustrating sequence in which combat is mandatory.

WTF A frequent need to trade sharp objects to children.

It’s awfully weird that Pathologic 2 is called what it is, since it’s not a sequel to the original Pathologic, but a remake. Developer Ice-Pick Lodge insists that it’s enough of a re-imagining to warrant the distinction in name, but while the changes and upgrades are nothing to scoff at, this is still the same overall experience. So while newcomers can feel free to ignore the original and start here, the unwieldy mechanics, steep difficulty curve, and general air of foreboding and despair remain as present as ever. It’s an experience designed to make players feel miserable.

It’s all to a purpose, of course. I’m always interested in the idea of games attempting to evoke feelings other than stimulation, and Pathologic 2, set in a Russian village overcome with a deadly plague, is weighted from every angle to make us feel helpless against increasingly insurmountable odds. It’s entirely possible for players to dig themselves into holes they can’t climb out of, and given the tone, that almost feels like a canonical ending in and of itself – for a player to outright lose, to miss out on even an unsatisfying conclusion, to die trying.

As if to drive that point home, Pathologic 2 begins at the end of a failed playthrough. Dead bodies line the streets, soldiers are rounding up what few survivors remain, and the authorities seem ready to raze the town to prevent the spread of the pandemic. Our protagonist – Artemy Burakh, a surgeon – believes a cure can still be produced, but needs more time.

He gets that time, as Pathologic 2 then rewinds twelve days and grants us the opportunity to steer Artemy in the direction of (hopefully) saving the town. Those opening images continue to linger, however, as showing us how this story can potentially end lends the proceedings a sense of inevitable, impending doom.

If players hope to protect the town, they must first protect themselves. Pathologic 2 is a first-person survival game, and this manifests in the usual sense of having to monitor meters for hunger, thirst, energy, and so forth. But whereas most modern survival titles center on hunting and crafting, Pathologic 2 is set – at least initially – in a thriving community where the materials we need are bought or exchanged for work. As circumstances grow more desperate, the barriers of society begin to crumble, and players will likely need to begin stealing, looting, and even killing to obtain what they need.

Above all, the most valuable resource is time. Players have twelve days to solve the pandemic, and Pathologic 2’s in-game clock constantly eats away at their chances of success, enough so that even walking distance is something we need to be mindful of when planning out our daily activities. The town’s unintuitive layout and repetitive architecture feel like deliberate moves to slow the player’s progress.

Most of the missions revolve around helping townspeople either fight the outbreak or investigate a string of other occurrences, including the murder of Artemy’s father, which happens before we even arrive. But there isn’t enough time to complete every quest, or even most of them, and story events occur whether players are present or not. Time spent doing one task is time not spent doing another, and plot threads can end prematurely if players miss important deadlines. Pathologic 2 teaches us to make trade-offs early, so we’re more prepared when it’s people being sacrificed. It’s oppressively grim stuff.

The other thing that’ll likely drive many players away, especially fourteen years after the original release, is how gamey it all feels. Animations are stilted. NPC models are repeated ad nauseum. Hand-to-hand combat is a matter of spamming the same one attack over and over, and when guns are involved, aiming for the head makes no discernible difference. The plague itself manifests as cartoonish-looking black clouds that players need to physically circumvent. On the surface, nothing about this is remotely convincing.

Pathologic 2 plays into these would-be flaws by taking every possible opportunity to remind players that none of this is real. The entire plot is framed as an elaborate pantomime, and an enigmatic stage director frequently appears to address us, the “actor,” directly. The theater at the center of town is an important landmark, particularly when it’s turned into a makeshift hospital in lieu of a real one. When Artemy comments that he’ll have to work on the stage, an orderly responds: “Same as everyone, sir. Same as everyone.”

However, that old-fashioned design jank also underlines that Pathologic 2 isn’t meant to feel believable or real since it’s dictated by numbers and systems. There is, for example, a pattern to the way the plague grows and subsides. When a district is infected, its contents are up for grabs, but players who linger for too long risk catching the illness. The next day, the plague will have moved on, but the area will be overrun with crime. The day after that, the district will be inhabited again, and any items stolen come at the cost of the town’s trust (which, like everything else, has a meter of its own).

Does it make real-world sense for a pandemic to run on such a rigid schedule? Of course not, but as Pathologic 2 constantly hammers home, this isn’t the real world. We need to understand how the machine works so we can rig it in our favor when it throws us curve balls, either scripted (rising food prices) or random and emergent (important characters getting sick and possibly even dying).

Pathologic 2 brushes aside production values and just explores game design itself as the true artform. It’s ideal for a narrative-focused game to sell its themes through its mechanics, and Pathologic 2 does that expertly — enough so that it didn’t need to also sport some of the best writing in the history of the medium. Yet miraculously, it manages that as well.

The moment-to-moment dialogue perfectly balances wit and personality with the responsibility of communicating important information, including what feels like an encyclopedia’s worth of mythos. There’s an entire indigenous language, a fictional religion (with its own bizarre take on creation) and dozens of beautifully fleshed-out characters, not a single one of whom squarely fits into an archetype. Not all of these people are likeable, but they’re at least sympathetic in that their motivations are convincingly human. The plague is the only one-dimensionally evil entity here — and even then, perhaps there’s more complexity to it than there initially appears.

Pathologic 2 is a harsh, unwelcoming experience that took a lot out of me, but everything in it, no matter how odd or seemingly inconsequential, is setup for an eventual payoff. Players capable of embracing its dour atmosphere will be rewarded with one of gaming’s greatest narrative accomplishments — it’s an epic-length refutation of the idea that gratification can only come through success, that stories need to be about heroes, that “fun” is the only metric by which a game’s quality can be measured. Pathologic 2 is a masterpiece not in spite of its shortcomings, but because of them. There is truly nothing else like it.

Rating: 9.5 out of 10

Note: The original Pathologic featured three playable characters, each with separate campaigns offering vastly different perspectives on the same general events. All three will be eventually be released in Pathologic 2, but as of press time, the “Haruspex” playthrough is the only one available, and that’s what this review is based on.

Disclosures: This game is developed by Ice-Pick Lodge and published by tinyBuild. It is currently available on PC. This copy of the game was obtained via publisher and reviewed on the PC. Approximately 32 hours of play were devoted to the single-player mode, and the game was completed. There are no multiplayer modes.

Parents: As of press time, this game has not been rated by the ESRB but it would definitely be rated “Mature.” This is dark, sinister material, and often very gruesome given that performing autopsies is a central mechanic. Beyond that, there’s some scattered profanity, occasional nudity, and plenty of drug and alcohol use. It’s for adults only.


Deaf & Hard of Hearing Gamers: Most of the dialogue is text-based, but what’s spoken isn’t consistently subtitled. Uncaptioned sound plays a crucial role in helping players detect threats like plague clouds and hostile NPCs, so not being privy to those cues makes an already difficult game borderline unplayable. Sadly, Pathologic 2 is not accessible.

Remappable Controls: All of the controls are remappable save for the run, attack, and block functions (bound to left shift, left mouse and right mouse, respectively).

Mike Suskie

Mike Suskie



Mike Suskie

Latest posts by Mike Suskie (see all)

Notify of
Inline Feedbacks
View all comments
2 years ago

Awesome review. I feel like you’re one of the few reviewers who actually got what this game was trying to achieve and can appreciate just how thoughtfully constructed it is. I get that the experience isn’t going to be for everyone, but reviewing it badly because it’s not ‘your kind of game’ is pretty poor form. This game is a masterpiece and will go down as a cult classic, in my opinion. I hope they make more.

2 years ago

I truly want to give this a whirl but the hunger / thirst thing just seems way too frequent. I know it’s a surreal take on it and not meant to be “real” as you say, but still. It just seems so… Tiring?

2 years ago
Reply to  Mike Suskie

Ah, nice! All I need is to decrease the hunger etc speeds and I’m good.
Gotta say, I’m enjoying these mid-tier budget games lately; more polish than first-timer indies, but more creatively driven than the AAA objective-marker-hunter games that seemingly just want to get you addicted to feedback loops.