(Caution Minor Spoilers)

Pathologic 2 is an episodic survival adventure game with a psychological narrative developed by Ice-Pick Lodge and published by tinyBuild Games. The first episode will be released on PC, Xbox One, and Playstation 4 on 23 May 19 and will detail the adventure of their first character, known as the Haruspex. At least two more episodes will follow the initial installment.


Survival is the name of the game in Pathologic 2. The first story is set in a plague-ridden town where every aspect of your well being is constantly in jeopardy. Survival mechanics such as thirst, hunger, disease immunity, exhaustion, and physical health all play a big role. The game strives for survival realism in a pseudo-realistic environment in which you must balance the time you spend alongside your goals, and the very reputation your character has with the town.

You will have a reputation in each of the town’s districts and many of your actions will affect that reputation in either a positive or negative manner. Citizens will respect you, hate you, and tolerate you based on your interaction with the world around you and the choices you make to accomplish your goals. Many will try to beat you up outright and hinder you as much as possible. You can either choose to fight back enough to get them to submit, or you can kill them and use them for medical research. The choices you make will obviously impact the way that other residents interact with you.

Combat in Pathologic 2 is straightforward and simple. There are mechanisms for light attacks, strong attacks, and guarding in unarmed combat. Using weapons is obviously more lethal but you may need to resort to force if your back is up against a wall and you don’t want to lose time as a resource.

There is a traditional grid-based loot mechanic in play that supplements your survival. You’ll need food, water, money, scalpels, weapons, and many other objects used for quest completion. Residents will also notice if things go missing and will attribute it to you accordingly. You may not always want to steal some items as they may weaken your immunity to the plague. For example, food looted in a plague rich area will not necessarily be safe to eat, but it may be your only option if the situation is dire enough.

Although the NPCs will often confuse you with their dialogue, the quests are not difficult to follow thanks to the in-game quest journal. You ‘ll come across many objectives, all tracked by a node graph which outlines your next steps. The writing is mildly distorted by the theme of the game, so this is helpful since some players may not be able to infer all that is being said.

Story Synopsis

The initial episode places you in the shoes of one Artemy Burakh, also known as the Haruspex. He is the son of the town’s doctor and his family is well respected. Artemy has spent some time away from home studying medicine until his father sends for him. This is where his adventure starts. He arrives home to find it in turmoil, with his father dead and the town blaming him for their dire situation. As the story unfolds, players will have to reconcile their own decisions with the plots advancement. Whether you choose to save one area or another will have lasting effects such as hostility and the availability of resources including time.


Pathologic 2 controls as any other KBM first person PC game. WADS and the keyboard will be used to interact and move while the mouse controls the camera, looting, and combat. And although I wasn’t able to change any bindings in the demo, the options for full remapping and customization were present in the menus.


The graphics are standard for a game of this caliber. The art direction however, has a certain gloom to it that I found to be extremely enjoyable. Switching to the sense mode transitions smoothly and reveals hidden elements such as NPCs you can converse with. In game areas are often fairly detailed and lend themselves to the overall theme of the game. There are many dark and visceral elements to the areas and many NPCs will emit a morose or downcast demeanor. Overall, the graphics and art direction very much fit the gameplay and tend to sell the game’s idea without issue.

On a personal level many of the small things really spice up the appearance. Utilizing blurred transitions in menus, the biological graphs for a journal tracker, and animalistic masks and appearances of many characters really shows the attention to detail you want to see in a game like Pathologic 2. The spirits in particular remind me of art straight from Hayao Miyazaki’s playbook.

Note: Unfortunately, the game may not be very well optimized for all PC builds. My build for instance far exceeds the requirements of the game, yet I still experienced slowdown and stuttering in some scene transitions and certain areas. This occurred even when lowering the settings to their minimum. Additionally there were some missing textures though they were few and far between. This may or may not be a demo related issue or it could be an isolated incident.


The various effects also contribute very well to the games overall atmosphere. From screams to the sounds of cutting flesh, Pathologic 2 will have no difficulty convincing you of your environment. It was evident as I passed through each area that ambient sounds were chosen with care. Aborigine instruments played as you traversed the steppes, while in different parts of the city effects were either alive or equally desolate.

The voice acting in English was often theatrical in nature. Much of the acting was scene appropriate and felt genuine. Within the game, there are options for both English and Russian as well as subtitles.


The music selection for each scene and area were very impressive both in their composition and placement. I find that with any horror or psychological game, the atmosphere and music are what really helps sell the story. Pathologic 2 shines very well here. The vocals in each track range from eclectic and inspiring, to mystifying, all the way to downright creepy. Composed by Vasiliy Kashnikov, with contributions from the band Theodor Bastard, the Pathologic 2 OST is nothing less than atmospheric purity when combined with each setting.


Pathologic 2 looks to be an enjoyable survival thriller which any enthusiast of the genre will enjoy. With a truly dark, rich, and commanding atmosphere, just being inside the world itself is sheer tragic delight. Hopefully, any optimization issues will be worked out before the final release. tinyBuild seems to be taking their time with Pathologic 2 for quality control purposes so its very likely that the final experience will be smooth. Having long commanded a cult following, this new installment in the Pathologic series will hopefully be a cut of surgical precision.

*tinyBuild also released Pandemic Express, for which we also have a review here.

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