Pathologic 3 is a psychological, survival horror game filled with death, decay and a mysterious plague. Developed by Ice-Pick Lodge and published by HypeTrain Digital, Pathologic 3 was released on January 9th, 2026. Players take on the role of Daniil Dankovsky, aka the Bachelor, a doctor with extensive research on death. Daniil answers a summons to a distant, isolated settlement, chasing the trail of a man whispered to be immortal. However, shortly after arriving, a plague sweeps across the town. Though the plague’s origins are a mystery, that’s just one of the mysteries that fill the town. Daniil must take on the role of an investigator throughout this story of intrigue, deception and oftentimes, confusion.
Some of Daniil’s main tasks include examining sick patients and making diagnoses, imposing rules and enforcing quarantines, solving mysteries, and balancing out his own mental state. There are horrors hiding in the plague, riot outbreaks as the town grows dissatisfied and even time-travel. Buildings seem to float in air. The town’s people includes some very interesting types, such as the daughters of Suok, the theatre crew, and my personal favorites, the worm people. With it’s complex story and non-linear time approach, Pathologic 3 definitely grabs your attention in the beginning. However, it’s easy to feel lost at first because the game hurls you straight into its mysteries instead of easing you in. So, get your prototypes charged and your microscopes at the ready, because it’s time to discuss Pathologic 3…
Disclaimers
…after a few quick disclaimers. I’d like to first start by saying that I went into this game completely blind. I have not played nor heard of the first two installments to this series. To the best of my knowledge, the game’s don’t play in a fully linear fashion and tell different perspectives from different characters, all whilst being in the same setting. It is not “mandatory” to play the first two in order to have the whole picture. However, I’m sure there are connections (looking at those theater guys) that may help give you at least a better understanding so that the story isn’t as confusing.
The second disclaimer is that Pathologic 3 is complex, both in game mechanics and in story. I’m keeping this review simple and spoiler‑free, though I may still overlook a few points worth mentioning. Pathologic 3 may be best experienced first hand as you play. The TLDR is that even when the game gets confusing or disorienting, it still leaves me wanting more. There is mystery and intrigue here that keeps me guessing, even after spending hours exploring. This is one I can recommend to players who enjoy a complex mystery and psychological horror. Reviews on steam are very positive and I can see why.
The last quick disclaimer is more of a trigger warning. Pathologic 3 is not for the faint of heart. There is a lot of death, a lot of decay and a decent bit of drugs. There are also moments that include Daniil…”going out on his own terms”. I personally don’t get squeamish or uneasy when it comes to tough subjects like this, but I wouldn’t feel right if I didn’t give a warning beforehand.
The Town & It’s People
The Town that serves as our setting is in pre-revolutionary Russia. The map is broken up into sections. To travel, players must search for archways and then plot a route to their destination. If you are travelling through a section that is plagued or rioting, the travelling will stop and require you to manually walk through the area, avoiding the dangers within. The setting is quite expansive, bigger than what it looks like on the map. I was tempted at many times just to walk around and explore the map, taking in all the interesting sights, but time is of the essence. The setting is beautiful and a pleasure to look at, despite it’s grim and gritty appearance. The developers at Ice-Pick Lodge definitely did an amazing job with the visuals.
Upon arriving, players quickly learn that Daniil doesn’t hold the town and it’s traditions with high regard, and potentially rightfully so depending on your views. Children are common thieves, some people look strange and inhuman, and everyone seems a little too comfortable with death. Some townsfolk will lie to you and others might refuse to talk to you. By carefully choosing dialogue options, players can help steer the conversation towards one direction or another. This can help players slowly learn more about the town and it’s people. Time also stops during dialogue, which is beneficial since I wanted to talk to everyone and keep the dialogue going as long as possible.
Again, Ice-Pick Lodge did a great job with the character design. From children wearing dog masks, a shadow with a blank mask, an entity made of bones and the plague, and worm people—all are beautifully designed and interesting to look at. For me, this is definitely a major pull factor.
Daniil Dankovsky, Plague Doctor Playing as Mayor
A major gameplay element is, of course, trying to find a cure for the plague that sweeps through the town. Every day brings a new set of patients to examine, each diagnosis nudging you closer to understanding the plague. There are many potential diagnoses and it will require a keen eye and clever deduction skills to make the correct one. To make your diagnosis, you can pick up clues from your conversation with the patient, examine their body for any signs or symptoms, and take a better look at samples taken using your microscope. Sometimes you may even need to investigate the patient’s home in order to gather more clues, especially if you believe the patient is lying to you.
As you begin to crack down on the plague, you will need to step up and take some control over the city. You may need to enforce rules and quarantines, declare curfews or deploy patrols, as you see fit. Your management of the town will come with consequences, some good and some bad. It’s another semi-complex aspect to the game, but necessary if Daniil wants to cure the plague. He is a doctor afterall. What else is going to do, try to flee and get thrown in jail? (wink-wink, nudge-nudge)
Many Mysteries Hidden in the Miasma
Along with being a doctor and intermittent mayor, there’s one more hat that players will need to put on—detective. Pathologic 3 brims with mysteries, but none loom larger than the plague itself. Early on, players learn that perhaps the plague is more than just an illness, as it takes on a physical form hiding within plagued areas of the town. After meeting another odd kid, they inform us of an entity called Shabnak. The entity looks like a tall women, covered in bones, who hates fires and Daniil’s prototype. She will pursue you whenever you are inside of a plagued area and without any real hiding spots, players must choose to either temporarily stop her or move fast enough to get away. This is probably where most of the horror takes place as it’s a tense, slightly frantic chase any time she is near.
However, Shabnak is just one of the mysteries in this small town. With massive help from the Thoughts section, the different mysteries and leads are pieced together, trailing one way or another. Often there will be multiple objectives to take care of and routes to travel with limited time in the day. It is important to use your best detective skills to determine what takes precedence in your objectives. By using concentration mode (a sort of survivor sense that highlights important objects), players can search for clues, messages or other people that might assist in solving mysteries. The mysteries feel intricate and well-thought out. Even with so many unanswered questions, I’m enjoying the twists and steadily piecing the story together. Ice-Pick Lodge did an amazing job at grabbing my attention and keeping me hooked.
Managing Mental State & Time
There are two consistent factors in the game: Daniil’s mental state and time. At the top, Daniil’s mental state is shown as a bar, ranging from apathy to mania. If Daniil is too manic, his health will begin to drain. If Daniil is too apathetic, he loses hope and attempts to…”go out on his own term.” Players must maintain a decent balance between the two by interacting with objects, choosing the right dialogue options, or with the many drugs that are at Daniil’s disposal. Players can obtain more drugs by looting, crafting or purchasing them from the various children-ran markets throughout the town. You can purchase items through trading various trinkets, such as nuts or marbles. Over time, Daniil will tick towards apathy so keep this in mind as you balance out his mental state.
The story of Pathologic 3 does not follow a time-linear narrative. Not only does the story jump around, but players can too with the use of time travel and a resource called alamgam. There are only twelve days in total to save the town and solve the mysteries. Players can go back to previous days in order to correct a diagnosis or tie up unsolved ends. Use amalgam sparingly because it’s a finite resource. If players get a game over, they will need to use alamgam in order to reload a previous save. Though I like the idea of a non-linear narrative, I do find the time travel to be a bit too complex. I wish it was a tad bit simpler, as it can be a little frustrating if you need to return to a previous day because you missed one or two things.
“Why do they continue to normalize death?” – Serafima Voiceline
There is still more I could discuss with Pathologic 3 but this review is a tad bit long. So, in conclusion, I want to applaud the developers at Ice-Pick Lodge for a job very well done. The first update of bug fixes and quality of life improvements has already been released. As gamers, I think we can all appreciate when developers care about their games and the feedback they receive from it’s players. It’s just the cherry on top for what already is a very enjoyable game.
Overall, despite my many confusions, I enjoy the game’s complexity. The narrative is super enticing and has my attention and is full of twists that I was not expecting—and I’m only a few hours in! The gameplay is yes, complex at times and can be slightly confusing in the beginning, but I think that’s part of the charm to the game. Once you get more comfortable with the many elements in play, things will start making a lot more sense. As someone who went in completely blind to the Pathologic series, I thoroughly enjoyed my time and will continue to play, potentially after I give the previous installments a try. This is one that I can happily recommend!
Keep safe from plagues and their bodies, and thank you for reading!
