Pathologic: How Quickly Does a Knife Go Dull?

Pathologic by Ice-Pick Lodge is often considered unplayable with a good reason. And while some of it is probably unintended.

Pathologic by Ice-Pick Lodge is often considered unplayable with a good reason. And while some of it is probably unintended, the game is definitely challenging and has a very interesting set of mechanics to consider. Let’s take a look at the good and the bad of the gameplay of Pathologic.

Ice-Pick Lodge Logo
The logo of Ice-Pick Lodge. Not creepy at all

Pathologic Does Not Do Hand-Holding

It you go into the game knowing nothing, most likely, you will die very quickly. There is something of a tutorial, which also breaks the fourth wall, but it only tells you to eat, sleep, take care of your finances and your reputation. You could learn all of that by looking at your character screen. Other than that, the game leaves you alone to learn your lessons the hard way. You can learn a lot from conversations, but how do you learn, for example, to go through every trash bin? It is essential for survival.

That is an example of how the plot of Pathologic is aligned with its mechanics. You arrive to the Town as an outsider (the first playable character is the Bachelor who comes from the capital), and you need to learn its rules. If you do, you can play as Haruspex, who knows the Town already and has an easier time surviving there. And if you manage to get to the third playable character, you start uncovering the secrets the other two characters cannot learn about. It is a natural progression both in the plot and the mechanics.

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Not many people manage to get past the first day of Pathologic


You can play as three different types of doctors, and each is best-suited for a particular playstyle. The first one, Daniil Dankovsky, is a Bachelor of Medicine (or what counts as medicine in a vaguely pre- or barely post-revolution Russia). He is a respected man, and he has no problem getting along with the three ruling families of the town. When playing as Daniil, you can avoid the deadly infected houses (most of the time) and make a lot of money as the prices skyrocket. Daniil’s playstyle consists mostly of running around and talking to wealthy people.

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The main characters of Pathologic: Bachelor, Haruspex, Changeling, the Town, and the Theatre

Artemy Burakh, the second doctor, is focused on traditional medicine; he knows about a lot of elixirs that help him him explore deadly infected houses. The same elixirs can be sold for some extra cash, and Artemy gets good weapons quite early in the game. He is good at brawling, and the game will make you use that skill. Oh, and he has some training as a surgeon, so he can carve out human organs and use them to make medications. Or sell them for money or herbs if you prefer.

Clara, the Changeling, is a healer imbued with supernatural powers (maybe). She can heal and kill people just by waving hands at them. That means, though, that combat with her is absolutely terrible; the killing animation is slow, and it takes a few hits. To make it worse, you cannot use the best weapons because they are too heavy for a little girl. This is the game’s hard mode.

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There are many factors to manage in pathologic

Character Management

You character has health, which is damaged by exhaustion and hunger (and the blows of your enemies), as well as reputation, which is improved or lowered by your actions (and sometimes by people deciding that you are a murderer). There is no leveling up, but you can obtain items that improve your protection against blows and illness. Those are expensive, but if you carry out every quest, you might be able to get your hands on them.

The plague is another mechanic for you to worry about. It infects different houses and areas in the town, and you can catch it, which will affect your health. Between hunger, exhaustion, and reputation, you will have quite a few things to manage as you run against the clock to have all your quests finished in time. The time, by the way, only stops for conversations, and if you are late to an event, it happens without you, costing you the lives of your Bound, who are important NPCs you need to keep alive for the best endings.

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Core Gameplay

There are two main things you do in Pathologic: talk and walk. Quests that you get every day basically require you to walk from one place to another and then to a third, which can be tiring. That said,  you do get a lot of opportunities to loot trash bins and defend yourself against muggers while trying to survive infected houses and bartering with people on the streets. Overall, the game does a fairly good job at distracting you from talking and walking.

The talking is quite curious due to amazing character design and plot; the walking might not be (although you can enjoy the sound design as well). However, the lack of fun in Pathologic’s key quests is likely to be by design. You are not supposed to have fun, you are supposed to be stressed. You a in a plague survival simulator, and your actions matter little in the face of a horrific tragedy. Even as you do your best, the game will greet you every morning with the number of people that died that day from the plague. This is not a fun life simulator, and you are just a human in it with very human limitations.

For the same reason, you can excuse the clunky fighting, although within this game, an unarmed girl can kill a mugger with a knife, which is not very realistic. Then, there is the problem of your hunger rising a little too quickly, and your tools get useless without repair a little too fast. And repair costs money, and money will always be a problem in a plague-stricken town…

Pathologic PC Review Indie Game Fans Review


Overall, Pathologic is quite stressful to play. It is a thriller that focuses on walking and talking but throws in enough things to manage and defend yourself from that you do not get too used to the gameplay or relax too much. The playable characters offer enough variety that playthroughs with them can be completely different, too. There are issues in the gameplay, but a lot of them might be by design, which is very well-aligned with the game’s lore and plot.

Our Rating

3 / 10



6 / 10



6 / 10