Pathologic was a game reviewed here by illhousen… a decade ago, god we’re old. He had the advantage of being able to play the game in the original Russian instead of its bungled English translation. However, recently several years ago the game was rereleased on Steam with a much better English translation, alongside its sequel/reimagining Pathologic 2. Farla and I have been interested in the game for a very long time (even attempting to play the old incomprehensible version), so we thought we should play both the whole way through and give our own thoughts.
If you’re not familiar, Pathologic is a survival horror/immersive sim… thing where you play as a doctor trapped in a rural village during the outbreak of a strange, supernatural plague. It is known for being incredibly grueling and punishing, requiring you to manage survival meters like hunger and exhaustion in addition to janky combat where you can die from a single hit, all while you must complete objectives under the yoke of a strict real-time clock that’s always ticking — think Majora’s Mask, but you can’t time travel. It flopped on release for obvious reasons, but became a cult classic among those of us who appreciate weird, deliberately counterintuitive games. Unfortunately, it ended up a bit too weird even for us; it felt like it tried to do too many things at once and as a result it’s hard to tell what the story was even trying to say.
Also, what it does say is… questionable. As is usual for games of this type, much of the popular analysis just stops at “Wow, isn’t it amazing that it has themes and asks hard questions?” without evaluating the answers it provides to those hard questions. They also tend to gloss over how deeply weird the games are about women, especially the second one.
When you start a new game, you are immediately thrown not into a cutscene or menu screen but directly into gameplay. You find yourself on the balcony of a theater looking through a first-person perspective. To actually begin the game you must walk across the balcony to the exit, but you may optionally watch the play being performed on the stage: An odd conversation between the three player characters as they argue about their various conflicting philosophies, ultimately resolving to each pursue the disease in their own way.
This right away introduces us to several of the game’s themes: This is a story about different medical philosophies and definitions of “healing”, but it’s also a very cynical story where people splinter over petty ideological differences rather than uniting together against a common enemy. In addition, there is a metatextual element as evidenced by the symbology of the theater: The player is an entity within the game world separate from the player characters, manifested as this silent, invisible observer to the play borne out on the stage. Furthermore, the scene does not require your direct input — it progresses at its own speed regardless of if you’re watching, and you can in fact ignore it entirely. This subtly introduces perhaps the most important theme of the game: the inevitable passage of time. This is a world that exists separately from the player’s actions and advances on its own clock; if you are not at the right place in the right time, the story will proceed without you.
It is only after this that we get the standard video game opening: You pick your character, followed by an opening scrawl and introductory cutscene. Your three choices are Daniel Dankovsky, a hotshot city doctor who cleaves to rigorous science and logic; Artemy Burakh, the prodigal son of the town shaman who has just returned from university, blending modern science with traditional medicine; and Clara the Changeling, a faith healer who claims she can cure the disease with her miracles. Clara is locked until you complete one of the other two and for good reason. This is not merely a choice of character class; each of the characters has their own completely different storyline as well as unique mechanics.
What the game doesn’t tell you is that this is effectively the game’s difficulty selector. Dankovsky is easy mode, Burakh is hard mode, and Clara is Nightmare Masochist mode. My condolences to players who naively started with Burakh because they thought he sounded cool, but the game very clearly intends you to start with Dankovsky, as his mode gives you a lot more guardrails before throwing you off the deep end.
So, now it’s time for the tutorial! Immediately after you leave your patron’s house, you will see these… individuals:
Despite their appearance, they are not enemies (in fact, they’re immune to damage) but your tutorial NPCs. This is presented in-universe as them being actors from the local theater, and their dialogue is clearly referencing game mechanics while never explicitly breaking the fourth wall, continuing our metatext theme. They tell you about the in-universe clock, the survival meters, and that your actions can affect your reputation.
During this conversation you will learn about a particularly weird quirk of the game: Unlike in most games, dialogue trees rarely loop back to to the start. Once you pick an option, the conversation just continues along, and you won’t know what was behind the other options unless you restart. This is very explicitly deliberate, but to be honest I question the purpose. Possibly it’s to make conversations sound more natural (in which case lol, because the dialogue is anything but), but in practice it makes everything much less immersive because you have to quickload a million times to fully explore a dialogue tree. Which of course players will do and which they must have known players would do, because this is a story game, so of course players want to read all the text! Unfortunately, if you do, you’ll find the branching is in fact quite shallow; most of the alternate branches are either completely identical or provide a bit of additional information before rejoining the main thread. This makes redoing conversations feel like frustrating whack-a-mole more than anything else.
Now, your tutorial buddies don’t tell you the most important part of the game, which is how to make money: DUMPSTER DIVING. Can you believe that people will just throw away hot commodities like bottles and knitting needles? I’m not joking: the town runs on a barter economy that allows you to convert this trash into useful items like food, bullets, and bandages (which are immensely valuable for some reason). Dumpsters are regularly refreshed with random items, so as long as you remember to scrounge for trash on your walks about the town you’ll rarely ever want for money.
There is another complication to this, and it’s the part every new player mentions: In a bit of realism, once the outbreak hits and the town is quarantined, merchants immediately begin price-gouging, with food prices multiplying tenfold on the very second day. Dankovsky starts with a pretty sum, but it’s reduced to pocket change by the sudden inflation, which can quickly bankrupt you if you didn’t stock up on the first day. To make this even more punishing, prices abruptly drop on the next day, so if you justifiably believe the inflation will only get worse and try to buy up everything on day 2, you’ll find out you wasted your money. In a rather unrealistic twist, however, merchants will generously buy your items back at the new market rates, so you can still catch up pretty quickly by gaming the barter economy. Criminals (who you can kill without consequence, more on that later) also have their money drops automatically scaled to the new rates the moment the clock hits midnight, so you can get quick cash that way too.
But doesn’t everyone say the game is a super grueling resource management gauntlet??? Well, it can be, but it’s really all smoke and mirrors. The difficulty largely relies on ignorance: You’re never told to dumpster dive, so new players won’t have a source of income until they figure that out. You’re never told prices will change or how, so it’s easy to get blindsided by inflation. And that will, in fact, render you pretty broke after a day or two! This is what most new players remember: The double whammy of their money becoming worthless (due to the surprise inflation) with no way to restore it (due to not knowing to dumpster dive). That creates a strong impression. But the truth is, it’s a paper tiger. Once you figure it out, the economy is actually very easily gamed. The inflation rates are constant across all routes, so if you remember them from your first playthrough, then on the next you can easily dodge the price-gouging by buying low or selling high in advance. (Clara’s route, which requires you to have played through once already, seemingly relies on you knowing to do this, as she starts with no money but the highest-value food item in the game, which will sell for a fortune on day 2.) New wealth is injected into the economy from thin air via the dumpsters and enemy drops (which almost always provide a profit over the bullet spent to obtain them), so there’s never a feeling of truly finite resources. I amassed a considerable piggy bank around day 3 or 4 in every route and was able to comfortably coast on that for the rest of the game.
This is kind of a theme with the gameplay. Various quests, especially in Artemy’s route, will spice things up with intimidating setpieces, but they’re also paper tigers. The most blatant of this is Artemy’s second trial, which sets your hunger to 100% for the duration… but as you’ll quickly find out, you don’t actually die when your hunger maxes out, you just slowly lose health. This health loss rate — the actually dangerous part of hunger — isn’t affected by the trial, so the situation looks very scary but is actually quite manageable. As can probably be expected from an indie project cobbled together in 2005, the game systems are actually deceptively simple and very easily gamed once you see the wires. The developers tried to make up for this deficit by deliberately obscuring the wires as much as possible, but that only works for so long.
These paper tigers evidently work well enough for blind players, given the press the game has gotten… but I’d say the game doesn’t truly work on either end of knowledge. Because the game is so punishing of failure, you will have to reload a bunch and learn to game the system in order to progress at all. There are a lot of games that use paper tigers, but they usually avoid actual failure states, because that requires mastering the system and thus exposing it for what it really is.
Another aspect to the resource management is a reputation system, which effectively just functions like another health meter. If it drops below a certain threshold merchants will stop selling to you, and if it drops really low townspeople will attack you on sight. It’s primarily affected by quest decisions but is also reduced by killing people, and can be restored through good deeds like treating the sick or uh… killing people. See, the game makes a distinction between normal townspeople, who it’s bad to kill, and criminals, who it’s good to kill. While the framing of calling it “reputation” means the game isn’t saying this is objectively right (unlike, say, Fallout), the game never really interrogates this either, even when “innocent” townspeople frequently sympathize with the criminals and insist they’re only victims of circumstance. Ordinary townspeople will also sometimes go on murder sprees, but they’re still flagged as “innocent” (which is a whole can of worms I’ll get into later). To further muddy this, criminals drop really good loot, so you will often be killing them for personal gain, which… is the exact same reason they’re killing people, so why are we any better? I think this might have worked if you lost the reputation gain from killing a criminal if you looted the body.
None of this actually matters aside from Clara’s route and the first day of Artemy’s route, because you have no reason to take any action that lowers your reputation aside from a few one-off set piece choices and it’s trivially easy to restore. Clara is the only time you have to actually engage with this mechanic because her reputation drops automatically; the other healers should have had something similar or any gameplay incentive to drop your reputation at all, really.
More minor complaints: Health should have been flavored as a negative meter for consistency with the others (perhaps “wounds” or something), and there should have been separate meters for damage from combat and damage from poison, because it’s incredibly silly that you can fix a medical overdose with bandages.
Of course, since this is a story about managing a plague outbreak, there are also disease mechanics.
The disease first shows up on day 2, and from day 3 onwards entire districts of the town will become “infected”. The screen takes on a sickly green tinge, and you can see that the disease seems to affect the town itself, with scabs appearing on buildings and roads:
The disease itself manifests first as creepy clouds of skulls, then later as red angels of death that actively chase you:
So it is immediately clear that there is something supernatural about the disease. If you are infected it’s extremely bad; the disease will slowly reduce your health over time, or not so slowly as it progresses. You can treat it with antibiotics, but they only reduce your infection by a proportional amount. The only way to cure yourself completely is through “shmowder”, a dubious mixture of random medicines that also reduces you to critical health, or Artemy’s panacea, of which there are a strictly limited number throughout the game.
…In practice, though, this is also a paper tiger. Every healer has a quest where they must test shmowder or panacea on themselves, giving you a guaranteed cure midway through the game. After that point, you have access to sanitary equipment that gives you enough protection against infection that you can actually completely nosell disease clouds. (Not indefinitely, because equipment degrades with use, but repairing it isn’t terribly difficult.) Even if you are infected, it’s trivial to accumulate antibiotics by supplying kids with sharp objects, and you only need to take about one a day to keep infection at negligible levels. (It doesn’t help that you can quicksave anywhere, so save scumming every time you get infected is entirely feasible.)
This is rather at odds with the insistence the Sand Plague is super ultra deadly and completely baffles medical science. I think I would have reduced the effectiveness of sanitary equipment and conventional medicine and made either the growth rate or the health reduction happen much faster. Additionally, we’re told the shmowder cripples people for life, but we can get back on our feet after a few bandages or a quick nap — it should have permanently reduced your max health or something.
On day 4 we discover the disease has one weakness: it can’t survive without a living host. This means that after it’s killed everyone in a district, that district becomes safe — but it’s also empty and lawless, inviting looters and criminals. This is supposed to be scary but in practice it’s actually a treasure trove, since unlike the disease clouds you can solve enemies with bullets, giving you plenty of time to loot the houses yourself. You’d think this would tank your reputation but no, you gain reputation from killing the evil looters to become a looter yourself.
The day after that, dead districts are repopulated and become normal districts again.
I’m sorry, what? We’re told the disease killed literally everyone — remember, the district couldn’t become clean unless that was true! — but the next day everyone’s back to normal? Where are these people coming from? Why does the town never run out of them?
The game even makes a point of giving us ever-mounting death tolls at the end of every day, but it never actually matters because NPCs just respawn endlessly. This, more than anything, is what turns the survival aspect of the game into a farce: survival gameplay is only tense with limited resources, but here your resources are ever-renewing. Every day, “dead” districts are repopulated with NPCs who inexplicably have a full stock of items to trade you. Worse, these districts can be infected again, completely restocking the pinata for you to loot the next day. By the end of the game my pockets were overflowing with cash and items thanks to this.
This isn’t just a gameplay issue — like the paper tiger disease mechanics, it’s a story one. We are constantly told that this is a tense survival situation where the plague is tearing through the town and government resources are stretched to breaking. The gameplay could have made us truly feel this by permanently wiping districts off the map, denying us access to the helpful NPCs we depend on for our daily bread. But no.
So that’s the gameplay, more or less. In the next post, I’ll begin discussing the plot with the Bachelor’s story.