Pathologic 2 is one of the most unique experiences you’ll ever have.

Steam: Released
Type: Single-Player
Genre: RPG, Adventure, Horror
Developer: Ice-Pick Lodge
Publisher: tinyBuild
Release Date: 23 May, 2019


I’ll be honest right from the get-go, Pathologic 2 is one of the hardest games I’ve had to review or even talk about. It’s such a surreal and different experience that I can’t even say everything about the game as I usually like to. There are too many little secrets, mechanics, and choices that I haven’t tested because of how big of an experience this can be. It also means that this review basically will be based on my playthrough, of which I haven’t fully completed nearly as much as I wanted to. The game is absolutely huge, and content and quests can be missed entirely based on a time-limit system and multiple playthroughs are encouraged. Seriously, Pathologic 2 is easily a game players can sink dozens of hours into and still miss quite a lot of content. I have to say, though, that my time and enjoyment obtained from playing it are more than enough to give this a full recommendation beyond a reasonable doubt of the quality in the game’s final acts, even if my progress wasn’t as deep as I wanted to for the review.

While it has its problems such as mediocre performance (at least for me, this is a case by case situation, of course), the lack of an accessible save functionality, and a lack of direction, it can be extremely off-putting to most people even if I found it fine for myself. If you think micro-managing 1-2 stats is annoying, like in Amnesia for example, then you’re going to be disappointed. I encourage folks to stick around, though, as this game does quite a lot right.

It’s also a game worth playing going pretty much “blind” going into it, so I won’t expand on too much detail as I usually like by giving examples, etc.


You are Artemy Burakh, a surgeon who receives an odd letter from his father asking him to return to his hometown for help with his duty, as he’s one of the last doctors in town (this letter is read out loud once you reach the town itself and it becomes clear it is more than just a family reunion).

Right from the start, you’ll have multiple surreal experiences, some visions, and even dreams (or not). You’re greeted by various characters, all speaking with a heavy tone of mystery and existentialism. Your whole train ride back home is mind-bending in itself, let alone the stuff going down as you progress through the days.

The actual first scene of the game where you get to play is interesting as the game reverses the plot and puts you in the 12th day of the game, the final one, as it is ending. Streets are dark, military and common folk are fighting each other, and dead bodies line the streets (and it’s not from the fights). The game then kicks you back to the start and there you are, in your hometown, with no idea of what to do or why some men tried to kill you…

Wait, what?

Yeah… and that’s how Pathologic 2 makes you realize it won’t be a cakewalk of a journey. Masked people witness you fending off three aggressive men and you enter this pseudo-tutorial when talking to them. You are warned of the death of someone important… somewhere, as well as to visit your dad in the for your first quest. You are advised to tread lightly in the town: folks are neutral but not receptive to strangers such as yourself. You need to keep a reputation or you’ll be pretty much screwed and receive something I don’t recall many games giving you of late (probably only the recent XCOM games): a Game Over (you may not progress further due to health, for example)

That’s all I’m going to say about the story, honestly. There is only one character to play as and I actually finished the original and the HD uplifted version as there were more characters, each with a rather different playthrough. Replayability in this game will be completely through the roof if the extra characters are added, and there are plans for that in the works. There’s no reason to not grab this right now, though, it is everything players of the original could ask for in my opinion.

This network is developed as you explore and engage in events/conversations regarding the lore and plot. Each day has its own “mindmap” of your thoughts, very much like a journal.

Pathologic 2 is a game so focused on its narrative that even days or screenshots can cause minor spoilers because the environment changes drastically as days go by. People who love a good story will feel right at home here if you can withstand the difficulty.


The other core aspect of Pathologic 2, aside from the story, is its gameplay. You play in the first person and have a detailed town as your open world to explore. You can enter pretty much anywhere provided your reputation isn’t negative. You will need to manage your health in various ways, not just an arbitrary “health meter”: diseases, stamina, hunger, thirst, sleep. These metrics are very punishing as you will go through hell to get your stats in a decent state, especially by mid-game. You will be pushed to commit harsh and morally questionable decisions to ensure your survival, to the detriment of somebody else’s life and/or your reputation.

If you can’t pick locks or trade with vendors because of the negative reputation, you can kiss your playthrough goodbye and might as well start a new one. These are depressive conditions at their finest and Pathologic 2 couldn’t nail the atmosphere for this any better. The town is bleak and somewhat empty, without sacrificing immersion. Its characters are creepy and suspicious of you at first, to the point where you almost feel vilified by the community and not as a “simple stranger”. The fact that several nasty events are happening in the town doesn’t help and those three men you killed in self-defense will be the lesser of the consequences you’ll suffer in the game’s choices. Choices are portrayed by actions, mostly. Dialogue is the standard “pick a line” type of choice and it also works well here.

Don’t worry. At first, you’ll be confused at the lines Burakh can deliver but soon stuff will click and you’ll just want to dive back and suck all the story out of this atmospheric gem of a game.

The game can look pretty surreal at times, and completely nails what it sets out to do.

The game also has combat, this isn’t a walking simulator. There’s a melee system, which isn’t very good. It is clunky in the responsiveness and lacks depth. For example, you can block to either avoid most attacks (some are unblockable and there’s no dodging) or regain stamina faster, which is drained when jumping, sprinting or attacking (power attacking also exists, which breaks blocks and/or stuns the opponent). The feel of the melee is lacking severely and that’s what sort of kills it to the point you want to shoot your guns (when/if you get them), but you shouldn’t as saving ammo is more precious than Jesus himself, who apparently forgot to bless this chaotic nightmare of a town.

I should now talk about time, one of the core attributes of the whole Pathologic franchise gameplay. The game lasts twelve in-game days, during which you walk, talk, shoot, punch, steal (or not), trade, buy, get scared, get mindblown and much more. You depend on time to manage your health and game progression. Setting up a route and personal tasks for each day is not a bad idea, though you’ll surely lose yourself in the world midway. Events and quests are triggered per-day and after that day is over, those quests are erased if you haven’t finished them. It’s harsh, but also logical.

This is why I feel the game gives the player a great sense of replayability, besides being brutal (which can be absolutely and understandably off-putting for some), it has some pretty great characters, good dialogue, an interesting story and an atmospheric beautiful world filled with content you can easily miss out on in each playthrough. It begs replayability, especially when the other two characters release.

Speaking of how off-putting Pathologic 2 can be… auto-saving isn’t present, and neither is manual saving (to a degree). Saving is location-based and this is something that goes fundamentally against player accessibility, in my opinion. Losing hours of progress because of a real-life emergency or because the game is unstable and crashed (there’s no such thing as bug-free software) is nothing short of insulting and terrible design. It’s a frustration I can understand the intention behind, but I can’t agree with it as it is, at the core, a mechanic of frustration more than an immersion factor; pairing this with a lot of status/meters you need to take care of, the game really suffers from this design choice.


Made on the Unity engine, it’d be more of a shock if Pathologic 2 ran well… but it doesn’t. Though unrelated to this review, I’ve been playing Steep (the Ubisoft sports game), which is absolutely drop-dead gorgeous, and the fact that Steep runs at 60FPS on Ultra 1080p settings while Pathologic 2 looks worse in comparison and struggles to even hand me 40FPS on Low 720p is just terrible. The performance of this game is abysmal in the current state though I’m pretty sure it’ll improve in the upcoming weeks with patches as the devs have been very active with hotfixes and discussing community feedback.

The comparison above isn’t to say that Pathologic 2 looks bad, it absolutely does not. In fact, it even looks pretty solid, but there are some noticeable shortcomings along with shining moments. For example, the characters look quite dated during conversations and some movements/animations can look oddly robotic and amateurish, but the lighting system is brilliant. Fire and light feel dynamic and the reflections just add a lot to the atmosphere. Thankfully, quite a few options are available for configuration so it’s possible to get better framerates. I got from 30 to 40FPS when going from High to Low graphics, but each PC is their own thing so you may get 60FPS on a worse PC than mine, it’s just how Unity hates us all.

The game has a very impressive and unique artstyle in its architectures and characters

And also worth mentioning, a FOV slider up to 100 is present, thank goodness.


I found the background music minimalistic but perfectly placed. While there isn’t much music, the tracks that exist (such as the one seen in the 12th day presented at the start) is frankly brilliant. The dialogue is, sadly, mostly text-based as not many characters talk more than one sentence, let alone have voiced dialogue to begin with. The atmosphere is helped by a lot of sound queues: ambient noise/music and the sound cues for events, exploration, combat in the dark where audio is the main means of understanding your surroundings, and bleak experiences. The game is very proud to portray the player with audio.


Pathologic 2 is a surprisingly good breath of fresh air thanks to the sheer variety of gameplay situations if utilizes in comparison to the usual modern game mechanics of grinding or cutscenes (I’m being pretty broad here, of course). Here, it’s all a story told and shown “for you” and not “to you”: you only see what you manage to see, the rest just goes… poof, you missed it, maybe you’ll find it on the next playthrough… or maybe you won’t.
It is a seriously good game with an unbelievable amount of content, difficulty and unusual themes and mechanics to make it worth at least a shot. At the current price of 29,99€, I can seriously recommend it for anyone into survival/RPG hybrid games with bleak, depressive, downright horror-like atmosphere. I’m even considering it a horror-lite as the surreal themes and the existentialism/depressing atmosphere it portrays are very creepy, but well made.

This is, in the end, a unique little gem of a game, even putting the original to shame on many departments (not even counting the graphics), without sacrificing the core structure for the sake of the demands of the modern gaming market. tinyBuild and Ice-Pick hit the right buttons with this one, I just hope other people notice this game as it totally deserves it.


I wanted to state that recently a post was made by the developers mentioning that the difficulty is getting patched with a slider to adjust it: source.

This may help in case you’re afraid the difficulty may hurt your enjoyment of the game. Now is definitely the time to get it if the game interests you and you’re looking for a very narrative focused game with interesting and different mechanics than your usual open-world survival game or RPG.

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