Pathologic 2 (2019) is an ambitious remake of 2005’s Pathologic. Reconstructed by Ice-Pick Lodge, the same studio that created the original, it’s a gorgeous and haunting survival game about confronting a dire plague in a rural town in the Russian Steppe. It’s bizarre, dramatic, and unsettling, relentlessly punishing the players’ every small mistake to drive home a sense of desperation and misery.

A Miserable Experience

Pathologic 2 is deliberately unpleasant to play in a number of ways. It’s cruelly difficult and often obtuse. Resources are incredibly scarce, hunger and exhaustion creep up quickly. Effective time management is a lost cause, and simply getting around the town can be an ordeal.

Being on the brink of death is pretty normal

From the beginning, there is uncertainty about what to do, where to go, and who to talk to. As the days go on, the doctor’s problems multiply and become insurmountable. Plague strikes strangers and friends alike. Focal characters may not survive without quick attention and the expenditure of precious resources. I began the game at the intended difficulty, but after a long time struggling decided to turn it down. Even with the easiest settings, it’s still unrelentingly punishing.

Pathologic 2 does not want you to see everything. It punishes you with permanent consequences each time you die, and it tempts you with promises of relief in exchange for unknown sacrifices. Despite its length, it still gleefully denies the player from seeing everything there is to see.

A Flair for the Dramatic

It’s also filled with striking visuals. In the steppe and on the streets of the town, the strange silhouettes of impossible buildings loom in the golden twilight. Interior spaces are lit starkly, reminiscent of a stage play. When conversing with the townsfolk, they loom uncomfortably close in the frame, with stark, pale lighting bearing upon them from the side.

I took more screenshots in this game than I did in any other game I played this year. And that’s not because it was pretty (it was) or spooky (it was), but because it was striking. Pathologic 2 has a running metanarrative thread about theater and storytelling, but it also expresses those sensibilities in its visual design. Most of the games on my Game of the Year list (and last year’s) are pretty. But Pathologic 2 is visually impressive in a wholly different way. It’s indulgent, evocative, and deeply eerie.

Embracing the Strange

Pathologic 2 gets away with quite a lot of bullshit by virtue of sheer audacity. The reward for toiling through the town’s endless hostilities is something brazenly weird and theatrical, something truly unique. Characters are unsettling and unforgettable, speaking often in elaborate metaphor and with curious gait and turn of phrase.

The game tells a story about industrialization, community and conflict, and the abuse and destruction of indigenous people and culture. But it’s also wrapped in a curious metanarrative about fate and drama. It has a fascination with the roles a person plays within a story. Sometimes, it’s hard to tell if it’s trying to say something or simply dazzle with melodrama and metaphor. But even then, it dazzles nonetheless.

Focal to the story are the Steppe people, an indigenous people partly based on a multitude of Eurasian cultures native to the actual Russian Steppe regions and surrounding areas. I’m generally wary of cultural amalgams like this, and try to be thoughtful of the ways in which they may misrepresent the people that inspire them. But there’s a degree of remove to Pathologic 2‘s depiction; the Steppe people are strange and superstitious, but so are the rest of the townspeople. It’s all part and parcel with the surreal, dramatized atmosphere of the entire game. The Steppe people inhabit the world in a nuanced and thoughtful way, evocative of (and critical of) the abuses and appropriation of indigenous cultures in the real world.


I’m obviously not an authority on the merit of its adaptation of indigenous cultures. However, Pathologic 2 seems sincere in exploration of loss of culture and the complexities of integrated communities. I couldn’t find any critical writing about the game from the perspective of any of the communities it references (at the very least, nothing in English), but I’d be fascinated to see it.

Thanks to its insistence on being brutally punishing, Pathologic 2 winds up being a very qualified recommendation. Below are a couple of fantastic pieces that get at what’s so unique about it, in language that may be more convincing than mine.

https://medium.com/the-pile/pathologic-2-who-inherits-the-earth-92c42a5c5418 (this has spoilers, but there are warnings)

https://www.pastemagazine.com/games/pathologic-2/uncertainty-is-the-normal-state-in-pathologic-2/