ReviewsReview: Pathologic 2

Review: Pathologic 2


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Picture the scene; the world you live in is a dank cesspool of; oppression, fear, and death. Hatred burns deep among the neighbouring people, and everything you do is constantly judged. A plague runs riot, and the town where your father lived is poisoned by this curse. This is the brutal existence of the characters in Pathologic 2. A survival game where you must; form bonds, save lives, and battle infection to stay alive for 12 days.

Developed by Ice-Pick Lodge and published by tinyBuild, this is a single-player oppressive survival game that will test the most hardcore of gamers. The sequel to the much-loved but problem-riddled Pathologic. Will the 2nd instalment learn from the past? Sadly not, but it’s enjoyable in a macabre way.

That’s some twisted art.

Pathologic 2 has a bizarre opening.

The game begins on the final day of the story. Fires are burning, people are screaming, and bodies are strewn around. You are offered the chance to rerun the 12 days, attempting to rectify the mistakes made. You control Dr Artemy Burakh who is known as the Haruspex. Returning to your father’s home, and your childhood town, your welcome upon arrival is less than warm. Attacked by 3 men hell-bent on revenge, they lose their lives and so the fear and uncertainty begin. It transpires that two people have been killed; the first was a prominent leader, and the other was your father.

The gameplay revolves around; the brutally difficult survival elements, the forming of relationships, and saving people’s lives. The game follows a bizarre day-night cycle to tick you away to the 12th chapter. You must observe key attributes; hunger, thirst, stamina, exhaustion, reputation, and infection. This wouldn’t be so bad, but resources are scarce, and your stats drop at an alarming rate. Add in the lack of autosave facility and it’s clear that Pathologic 2 is out to get you.

Do you dare enter the creepy mask building?

Preventing death is your aim, but can you stop yourself from dying?

With the game giving you the freedom to pick your missions, you can explore and talk to whoever you wish. This non-linear approach gives the impression of an open-world adventure. In reality, you are more likely to die because of the journey you have taken. It’s a tough balancing act, but if you get it right, you are rewarded with a fulfilling story.

You will meet many interesting characters, such as; a child gang known as Soul-And-A-Halves, and Mark Immortell who discusses the punishments that are inflicted when you die. Just in case the game wasn’t tough enough, death incurs penalties; lower health, you are quicker to exhaustion and a reduced hunger bar. These will make you wince, and it makes the gameplay much harder.

Unfortunately, where there is a plague, there is death. In Pathologic 2 it’s your job to save as many people as possible. You must attempt to stem the flow of infections with a medical-style mini-game. It was an interesting and detailed process, but a correct diagnosis relies on limited supplies. It can frustrate you when the success rates are reduced by the harsh game mechanics, and not your knowledge or ability.

Blood on the bed, and a ghostly portrait…..nothing to see here!

Pathologic 2’s brutality is its blessing and its curse.

Every element of Pathologic 2 will test your patience and your survival skills. Looting, crafting, and the mini-games all require an eye for detail. No matter the time spent scavenging, there will never be enough supplies to go around. With limited time available, you will need to make some brutal decisions on who lives and who dies. It’s unfair, heartbreaking, and is a sobering experience. The townsfolk die before your eyes and there is nothing you can do about it.

This hardcore and non-linear approach will leave some players with a bitter taste in their mouth. You’ll believe you’ve missed out on many opportunities, and the game appears unnecessarily harsh. I loved how horrendously cruel it was, and its survival of the fittest attitude. You soon become immune to the cold nature of the world around you. People’s lives soon become a commodity to increase both your reputation and your purse. Just remember, you’re the doctor and what you say goes.

It looks as dark and gritty as it plays.

I applaud Ice-Pick Lodge for their depiction of this cursed town. Grimy townsfolk wander the streets looking for scraps of food and a way to survive. The earthy tones and dull colours add to the sombre and oppressive landscape. Images of death hang around like a bad smell, and the gritty and shadowy world makes you uneasy. I loved the presentation, but boy, did it make me feel on edge. It’s a horrible place to be and looking at it from a first-person perspective only made it seem more real.

This was supported brilliantly by an eerie audio that changed to match each setting. The environmental sounds were perfect, with animals yelping and the wind whistling by your head. The crunch of your feet on the ground, or the howl of someone crying matched the theme and solidified the sorrowful events the town was experiencing. Pathologic 2 steers clear of obvious jump scares, but the sudden change of audio will naturally make you nervous. I admit I jumped countless times, and shamefully it was usually my imagination and nothing more that caused the shock.

Things are heating up.

Lots to learn, but a novel tutorial teaches you.

With so many mechanics all in play at once, it can be complex and overwhelming. Looting, crafting, fighting, and all the survival attributes to observe make this a meaty game to take on. Luckily, the quirky intro acts as a tutorial to unravel all the fundamentals. You’ll learn; how to attack, trade inventories (by swapping hearts), gather water, and navigate the map. You’ll still have lots to learn, but you’ll get to grips with this through trial and error and lots of talking.

You never truly feel comfortable with what you are doing, and there is always a worry you’ll make a mistake. I think this is part of the charm, as you are constantly working on how to be better at the game.

There are so many missed opportunities each day that this begs you to play it repeatedly. You can easily uncover new minor narratives every playthrough. Add in the punishments for dying, that’ll change your approach, and you’ll always be looking at the same scene differently. You have a large achievement list to unlock and hours of brutal gameplay to experience. If you can stomach the harsh reality of Pathologic 2, there are plenty of reasons to return.

Pathologic 2: A Wonderful Nightmare.

Pathologic 2 is one of those survival games that will destroy you mentally and physically. It’s unfairly difficult, it will punish you for minor indiscretions, and will hold a grudge forever. In short, it’s a bit of an arse! But somehow I still loved its evil and sadistic ways. Presented in a touching and sinister way, you’ll instantly warm to the hardship the townsfolk are experiencing. This isn’t a game for the faint of heart, yet I recommend you try it. If interested, you can buy it here! Being a doctor is no easy task, especially when people have the plague and you are short of supplies. Do your best, help who you can, and survive the 12 days.


Pathologic 2 is a dark, gritty and grimy survival game that is not for the faint of heart. Everything wants to kill you, and minor mistakes are punished. Patience, luck and pig-headed stubbornness are required to better this game.

+ Disturbing graphics.
+ Creepy audio.
+ Quirky and excellent tutorial.
+ Plenty of depth to the gameplay.
+ Lots of replay value.
- Unduly harsh at times.
- The stats decrease at an alarming rate.

(Reviewed on the Xbox Series X. Also available on PC and PlayStation.)
Daniel Waite
Daniel Waite
My gaming career started on an Amiga and spans many consoles! Currently, I game using an MSI laptop and Xbox Series X. A fan of every genre, I love to give anything a go. Former editor and reviewer for, I'm loving my new home here at Movies Games and Tech. I can be contacted for gaming reviews on the following email:
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Pathologic 2 is a dark, gritty and grimy survival game that is not for the faint of heart. Everything wants to kill you, and minor mistakes are punished. Patience, luck and pig-headed stubbornness are required to better this game.<br/> <br/> + Disturbing graphics.<br/> + Creepy audio.<br/> + Quirky and excellent tutorial.<br/> + Plenty of depth to the gameplay.<br/> + Lots of replay value.<br/> - Unduly harsh at times.<br/> - The stats decrease at an alarming rate.<br/> <br/> (Reviewed on the Xbox Series X. Also available on PC and PlayStation.)<br/>Review: Pathologic 2