Pathologic 2 Review

Published: June 8, 2019 12:00 PM /


pathologic 2 review header

Pathologic 2 drops you in at the deep end. It throws you into its overpowering atmosphere of misery and oppression with very little setup. The first few hours of Ice-Pick Lodge’s latest are some of the strangest and most confusing you’ll find in any game. Slowly putting together the pieces of its bizarre lore and decrypting people’s riddles makes for a head-scratching first impression. It’s a hellish way to start, but Pathologic 2 is truly a hellish game.

You assume the role of Artyem, a surgeon returning home after receiving an urgent letter from his father. Upon arrival in his hometown, it’s immediately clear that something is very wrong. The trains that deliver biweekly food shipments haven’t come in, there’s intense paranoia in the air, and a giant bull god derails your train. Everyone’s on edge, talking about bad things approaching and dark times ahead. And then the plague occurs.

A brutal, unforgiving plague of biblical proportions. The kind with frogs and locusts and stuff. After a couple of days of exploring the town and uncovering the mystery of your father’s sudden death, the town flips on its head. This is effectively where the game really begins. In an instant, your responsibilities as a doctor become clear. You quickly become the only thing keeping the town’s citizens from death’s door.

Surviving The Wonderfully Weird World of Pathologic 2

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Issuing treatment to folks is a big part of your role as the town's only doctor

To ensure this odd little town keeps ticking, you’ll have to gather herbs, mix remedies, and issue them to the ailing. But, first, you’ll have to keep yourself alive. Pathologic 2 is a survival simulation at its core, so staying alive is your primary concern. In order to keep breathing, you’ll need to manage a myriad of meters: hunger, thirst, exhaustion, immunity, and health. Each of these requires constant attention, leaving you munching food and guzzling water at least a dozen times a day, provided you can find it.

Things really are dire in Pathologic 2, and staying healthy isn’t easy. The only safe water comes from barrels and fountains (which also need maintenance), and you'll have to scavenge and trade to find food. You’ll also want to be sure to keep the plague off you, equipping yourself with protection and consuming medicine to keep it at bay. On paper, these ideas make sense. You’re in a brutal situation and death is just around every corner. But they’re just so overbearing.

They’re engaging to manage for a few hours, but quickly become a tedious impediment of progression. They’re so invasive that they can’t simply be ignored. When you’re not talking to people (the part of the game that’s great), you’re staring at your various meters and ensuring you can make it to the next conversation. You’ll be pumping the vast majority of your resources into keeping the meters at bay. It’s a real chore.

Breaking The Law in Pathologic 2

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Here's me about to stab a fool and take his stuff.

Although reputation is everything in Pathologic 2 - people won’t trade with you if you’re disliked, and they’ll even attack you in the street if you cause too much trouble - you begin to realize that living clean won’t do in a diseased town. It’s alright, though, the law dictates you can rob and murder as long as you’re only harming your fellow bandits. At night, the town becomes a terrifying free-for-all. You and every other hopeless survivor, hopped up on fear and duking it out for the supplies needed to survive.

Unfortunately, scavenging for materials and supplies only highlights Pathologic 2’s mechanical shortcomings. The flimsy combat and wonky stealth make sneaking around broken and diseased houses more frustrating than exciting. The riveting tension that comes with narrowly trying to sustain yourself while also ensuring the survival of the entire town is great, but the minute-to-minute is a real cumbersome slog.

Death isn’t final, though. Each time your health falls too low, you’ll revert back to your last save with a slight penalty to your meters. You’ll die a lot, and each death only makes it more difficult. It’s easy to find yourself in a sticky situation that you can’t get out off. The game contextualizes your resurrections in a fun way, suggesting you’re simply an actor in a play being replaced each time you die. It just stops being cute when you’ve died 10 times in 20 minutes.

Pathologic 2’s Brilliant Writing

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When all else fails, the writing is just great and wholly unique

When it’s punitive systems become too restricting and the combat too frustrating, the writing keeps Pathologic 2 from falling apart. It’s important to note that you do spend a lot of time talking to people, and that stuff is consistently compelling. The game recieved a fresh localization and it shows. The writing is sharp, unique, and fantastically consistent, offering a plethora of eccentric and memorable characters inside a seriously bizarre world. If you can look past its issues, it’s a world worth losing yourself in.

There’s an engaging devotion to the sheer weirdness of the world and its population that’s enrapturing. It’s a surreal blend of 19th Century London and the Black Death combined together in a dreamlike world of mythical bull deities, clay demons, and creepy masked dudes. Getting a grasp on this odd universe isn't easy thanks to extremely cryptic dialogue. Still, it’s extremely rewarding to uncover, providing one of the most unique worlds in all of gaming.

Pathologic 2 Review | Final Thoughts

pathologic 2 weird
Pathologic 2 is a deeply weird game.

Solid production values are there to support everything. The game looks surprisingly sharp, considering its modest budget, and the character models look pretty good. As an iterative update of the original, it’s a resounding success. It is a shame that the frame rate can be quite inconsistent, especially indoors, where it can drop dramatically for no clear reason. Meanwhile, the ominous, industrial soundtrack provides a tense and off-kilter backdrop to your weary explorations and slow descent into madness.

I really want to like Pathologic 2. For the most part, I do. Its overly-cryptic writing can be initially off-putting, but I quickly became fascinated by its weird ways and quirky inhabitants. The world is worth uncovering, it’s just far too much of a slog to play. Consider letting someone else play it for you on Twitch or YouTube. It’s a world everyone should experience, at least for a short while, but being the driver is absolutely the worst part of this otherwise thrilling ride.

TechRaptor reviewed Pathologic 2 on PC via Steam with a copy provided by the publisher.

Review Summary

Pathologic 2 presents a weird, engaging, and wholly unique world to uncover and explore, but makes the act of playing it a clunky and laborious chore. (Review Policy)


  • Weird and Wonderful World
  • Fun, Eccentric Characters
  • Nails Its Oppressive Misery


  • Frustrating, Overwhelming Survival Mechanics
  • Dreadful Combat
  • Wonky, Unreliable Stealth
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