Ice Pick Lodge has surprised us all with the reveal of Pathologic 3 – an entirely new game launching in 2025, in place of what was originally planned as an update to its underappreciated folk-survival-horror predecessor. This gives us plenty of time to un-shelve an opinion I've needed to air for years: Pathologic 2 is the greatest game you always meant to play.
Aside from a smattering of superfans, the remake of Pathologic (confusingly titled with a "2", despite being the same game) never found the wider respect it deserved. Mention the name to an assembled group of horror or survival fans and you'd be able to put decent money on someone piping up with an, "Oh, I keep meaning to play that!" As an illustration, the infamous Hbomberguy video 'Pathologic is Genius, And Here's Why' has more than 11 million views, yet the monthly average player count for the game has only broken 100 eight times since its release.
No pain no gain
I first played Pathologic 2 for a review back in 2019, and it's no overstatement to say it was a transformative experience. I'd never encountered anything like it; never had a game made me feel the things that Pathologic 2 did.
On the surface, it's a survival horror and resource management game about a plague. Your character, Artemy Burakh, returns to his childhood home after a summons from his father, only to find his father dead and himself the chief suspect. While untangling from this web and trying to solve his father's murder, his problems are soon compounded by the emergence of a brutal plague – the Sand Pest. The Pest arrives seemingly overnight, spreading like wildfire, and Artemy is enlisted to care for the sick and find a cure.
The problem is threefold. One: it's been years since Artemy visited this strange, mystical Russian steppe town, and he has lost touch with the townsfolk – the Kin. They see him as an outsider, with his high ideas about university medicine, and require Artemy to prove himself through various rites and rituals. Two: he has absolutely no idea what this plague is, and no amount of medicine seems to keep it away. And three: supply lines have been cut off for weeks, the town's water supply is turning foul, the children of the town seem to have formed their own cultish society, and he's got just over a week to save the town before the authorities destroy it.
Additionally, no one in the town can give you a straight answer, secrets and riddles are all you'll get. The town seems to function more as a living being than a mere geographical location, a sinister spire of impossible proportions is distorting reality at the edges of the map, and everything has to be bartered or killed for. In short, you've got yourself some serious pressure. More, in fact, than Artemy can handle.
The sense of impending failure at every turn, the knowledge that survival was impossible – yet with enough desperation and luck you might save just one life first – may be what initially turns people off this game. The bleak, washed-out artstyle, the eerie character closeups where uncanny eyes roll around in deep sockets, and imposing plague doctors that seem to loom right out of the screen may be more than some can bear. Is it fun? Not always. But it is worth persevering with.
It was a shame at the time to see so many reviews default to dunking on the game for presenting something unexpected. Pathologic 2 is a deeply unusual and uncomfortable game. I'd hate to get so pretentious as to call it an 'experience', but that's exactly what it is. It eschews convention at almost every turn. You're deposited in a culture that feels so jarringly alien, yet you know it to be familiar. These are humans, certainly. They're speaking English, yes. The terrain and climate resemble Earth, sure. But a primal part of your brain keeps insisting that these assumptions are wrong.
The story relies on a relentless passage of time as its central conceit, but your fate is already sealed. Though your goal is to cure the Sand Pest and treat the patients, you can't possibly 'win'; you can't save everyone, you certainly can't save yourself. There are simply not enough resources, medicine, time, or prayers in the world that could make the horror end. In this way, Pathologic 2 is possibly the most life-like survival game I've ever played. Min-maxing won't serve you here. You're not a unique hero for whom the world rises up to make exceptions – you're just a guy with a bag of nuts and a scalpel. The world ends whether you're in it or not.
The knowledge that the best you can hope for is to carve out something, anything, positive in this ugly world excuses the game for being so punishingly difficult. It's easy to feel abandoned in its fog, tortured and taunted by its twisted characters… and to feel frustrated and exhausted. But Pathologic does something that games so rarely do: it treats you with respect.
This weird indie turns questioning your faith into a weirdly wonderful playable experience
It makes no excuses for you and won't coddle you, but it also doesn't mindlessly ramp up the difficulty just to see you squirm. Pathologic 2 is, at its heart, a deeply honest game. Artemy doesn't possess any special combat powers or superhuman abilities. He's a doctor, a folk healer, returning from the city to visit his father – only to find his hometown decimated by disease and the resulting religious fervor. He doesn't know how to use a gun, he's not a great fighter, and he gets tired, thirsty, and hungry like anyone else. He's fairly weak and flawed, despite his best efforts, and few people trust him without considerable cause.
You are not the main character of Pathologic 2, you merely live inside it. The events that take place and your minute-by-minute choices shape the direction of play, but you never forget that the town itself is alive. Will you use your time to scour the plague houses for abandoned babies, work tirelessly at the hospital to alleviate a dying man's pain, pursue your father's murderer, or choose only to protect the children who seem drawn to you? You don't have time for everything. You'll have to sacrifice someone. However hard you work, the town works twice as hard in the opposite direction. The unchecked greed of industry and the untethered ambition that led local architects to play god has – quite literally – driven a stake into the town's heart. Its rivers are polluted with blood, and the innocent pay the price. There is no hope here, why would there be?
But once you come to terms with your mission and its limits, you can let curiosity run rampant. The town is crammed with personalities, legacies, myths, superstition, and mysteries. You'll meet feral gangs of children with their own societal rules, Herb Brides who dance the blood right out of the trees, you'll negotiate with slimy businessmen, and break taboos by speaking with placid worm-creatures from deep underground.
You can't break into someone's house and loot their cupboards without consequence. Even performing your job as a surgeon could turn the town against you if you neglect their religious practices. Sometimes, when you die, you lose the ability to hug others. Occasionally, you'll find cotton wool instead of organs during an autopsy. You bend to the rules of this world – it will never bend to you.
All of this to say: don't miss the chance to play as Artemy in Pathologic 2. You'll soon get to play as The Bachelor – Daniil Dankovsky, a cockier, more self-assured physician – when Pathologic 3 releases, but Artemy's story carries a beautiful vulnerability that needs to be experienced first-hand to be appreciated. His self doubt mingles with a tentative arrogance; his cycles of despair and desire, his heartbreak and pity for those around him as the town grinds to a very final halt – it's equal parts tragic and transcendent.
Whether you love the wordy, lore-packed RPG style of games like Disco Elysium, or the bleak survival elements of games like This War of Mine, Pathologic 2 deserves your attention ahead of its long-awaited follow-up. Spend the winter in the Town on the Gorkhon River, live and die by its grassy, blood-stained banks, then emerge in the spring of 2025, ready to explore the town anew.
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