For those of you unfamiliar with the bleak survival slog that is the Pathologic series. This franchise rose to prominence in its first instalment back in 2005. It had its critics but overall, Ice Pick Lodge’s initial title did provide a uniquely brutal and challenging survival experience. With a narrative that was written with real care and attention.

Fifteen years later, we have a console release for its sequel Pathologic II. A game that is a direct sequel in a narrative sense to the initial title. However, you’ll be perfectly able to jump in without any past experience of the series.

To give you some idea of what Pathologic as a series is. In a nutshell, this is a survival game at heart and a complexly woven one at that. However, it also has a brilliant narrative that will urge you to stick with the gruesome realism of the mechanics.

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Let’s focus on that narrative first. Pathologic II does well to weave small details and nods to the previous title into the new release. All the while not intruding on the new storyline. This being that you take control of Amerty Burakh. A surgeon returning to his hometown after receiving a worrying letter from his father.

This is prefaced with a number of convoluded scenes that represent your future. Of a town burning, its inhabitants being burned and killed. An ongoing plague taking its toll on the town. Then a puppet master figure giving you a chance to have a second shot at saving the town.

The World Is A Stage

What is immediately apparent is that Pathologic II takes a very theatrical approach. With philosophical voiceovers aplenty and characters that love a good metaphor. Not to mention a literal theatre that is incorporated to predict the future based on your in game actions. It lives in the world of the theatrical. Which is both a positive and a hindrance.

The negative side being that it takes quite an investment of time to get satisfaction from the narrative. The game even prefaces that you won’t know what’s happening for the first while in the opening loading screen. Which, although I appreciated, isn’t exactly an excuse.

Piecing The Puzzle Together

The first hour will have you wandering aimlessly, piecing snippets of legible story together. Though a decent level of understanding won’t truly come until your comfortably into the game by a few hours. Though, if you do push on. That’s where the positives showcase themselves.

The narrative is expertly written. The mystery of what has happened to your father is the main plot point. However, there are so many underlying issues to engage with. Such as the two waring factions fighting for control of the town. Both of which representing different ideals. One representing industrialisation. The other representing more tribal and primative ideals.

Pathologic II also does well at journaling the events through an in menu mind map. It showcases the interweaving links in the story and how they branch out. Plus allow the player to follow the story because admittedly, its quite easy to get lost or overwhelmed.

An Evolved Walking Sim

When talking about the narrative, it’s difficult to not also discuss the gameplay aspects and their role. This game takes the conventional walking simulator game and turns it on its head. These games have their fans but are often criticised for being rather flaccid in terms of gameplay. So this title offers a fantastic written narrative. Then backs it up with compelling gameplay that supports the story.

Firstly referring to the survival mechanics. pathologic II pulls no punches in regards to difficulty. It asks the player to play on the maximum and most punishing settings. Meaning that players will be vulnerable, starving, tired and hungry their whole playthrough. Which to its credit, adds to the experience all the more.

Scrounging Is A Necessity

Key areas of success include the economy of the game. This revolves around trading with other town residents as well as merchants. You will have to consider robbing others at the cost of reputation that can lead to more fights. So it may be easier to play it safe. Or perhaps scrounging through trash for bits to trade is a better option.

The best thing about it all is one day’s successful method won’t necessarily carry you throughout the playthrough. With the ever changing tides in relationships and the dynamic effects of the plague. It means that no method will remain a constant. Which truly is a testament to the detail of the gameplay.

Then as there is a two pronged goal of solving the mystery. Yet also decreasing the damage of your actions. There is always an internal conflict within the player. Will you play outlandishly to succeed. Or will you play selflessly to save the town.

Not Your Cliché RPG

Though another thing that Pathologic II deserves credit for is that it avoids normal RPG tropes. Good actions will not always be rewarding. Plus similarly bad actions will not always be punished. It always has the player gambling, plotting and scrapping by through their own logic. Rather than predetermined and transparent logic of different titles within the genre.

The gameplay however, is far from perfect. Where it falls down is through it’s technical shortcomings. Firstly, and arguably most apparently. The load times are painfully long. The game will take minutes to load when starting a save file. It will load for up to thirty seconds to enter a new interior. The game will even load for over ten seconds when crossing across invisible load zones throughout the map. It’s laughable at times.

Technical Shortcomings

It’s a flaw that really hurts the brilliance of Pathologic II’s mechanics. They do so much to immerse the player. So to have such a jarring and obvious issue taking the player out of the experience is a shame. For a title in the eighth generation of gaming, this seems like an issue that shouldn’t occur.

Then the combat mechanics are sketchy at best. There is an argument that these mechanics are janky on purpose. They do offer a certain level of blind panic when they are called upon. Often leaving the player feeling uncomfortable and vulnerable in combat. Which is in keeping with the themes of the game. However it seems just a little to coincidental to be the case. A happy accident perhaps?

Aggravating Navigation

What is a real pain in this title is the navigation. Due to the real time aspects, the slow travel speed is a given. That’s not my issue. The issue is the paths a player can take. If you are traveling to a potential event or character to tend to. The player will often find themselves running into dead ends, being stopped by random debris. Or just obnoxiously blocked by invisible walls. Again, another issue that ruins the immersive appeal this game pushes.

Attention To Detail Is Commendable

Moving onto the artstyle. This game nails what it sets out to do. The themes are dark, gloomy, ominous and to an extent, somewhat alien. This being in the sense that its downright impossible to place this town on a time line. This is a design choice clearly though. This town is made to feel isolated. It’s own entity. Almost like a staged play or show.

The architecture, minimalist, wartime decor, staged events and goliath landmark structures all show a unique personality of this town. This is true right down to the finest of details. Take the bull heads present on the see-saws in the playparks. Which showcase the oncoming invasion of the tribal movement in the town.

Character design also add excellent value to narrative and art design. The models look excellent in the dialouge menus. The close ups are detailed and the models make excellent gestures during conversations. These can be theatrical in excess at times but as a whole, offer additional character development. Making it easier for the player to make satisfying and well reasoned conclusions.

Immersion Breaking Animations

Although the cracks do show when the characters are in open play. The animations are slow and underdeveloped. This can be the NPC’s sliding a metre to sit down on benches. Or perhaps the first meeting with the man in the coffin on the train. With the sound coming before the movement. This is particularly hard to look past. Personally, I audibly sighed on various occasions that these lazy animations occurred.

Disjointed Sound

Which brings me neatly onto the sound quality. The musical score is brilliant. There is a mixed of more modern boppy tunes, ominous overtones and a multitude of tribal drum beats and chanting tracks. They blend together beautifully and are used in exactly the right places. The music score is fantastic, yet the sound quality as a whole is a mess.

As mentioned, often the sound won’t link up with the actions on show. Though the most obvious issue is the issues with dialouge. The recording of these lines are very low quality at times. Half the time there will be no issue. However the other half of the dialouge will sound so distant. As if the character you are speaking to is in another room. The issue is how the audio is mixed. The consistency of the quality is non exsitent. Which is again, desperately hard to overlook.

Suffer Again And Again

Then a final point is the replayability. This game has such an open approach with a real focus on emergent gameplay. Meaning that this game is the epitome of a replayable game. If you want to fully understand all the characters, the setting, see all the endings and fully appreciate all the scenarios that the gameplay aspects will have you endure. You will need a number of playthroughs.

Not to mention all the finer details that the game has to offer. You will consistently be noticing intricate details surrounding the culture of the town. The spots of lore you missed first time around may become more prevalent. Or playing with the knowledge of the first playthroughs outcomes. Previously given info may take on a new meaning.

Theatrical Masterpiece?

Overall, this title has be viewed as an art piece. Much like walking simulators of recent years. It’s still carried by a genuinely fantastic and captivating narrative. However it does have the caveat of a fantastically complex and layered gameplay system.

However, to fully enjoy this one, you have to overlook a number of shortcomings. The loading, the animations and the sound quality are truly destructive flaws. For those that cannot turn a blind eye to these, I completely understand why.

Not to mention, the introductory phase is a slog. The likelihood of you dropping off never to return in the first hour is relatively high. The story is so obtuse for a great deal of time. So if you aren’t able to appreciate the spectacle of the interlude. Again, I completely understand.

Grit Will Be Rewarded

Though, if you do make your way through all those challenging factors. What you are left with is a masterpiece of survival gaming. It puts the player front and centre of all decision making. Has dynamic and ever changing scenarios do deal with. It sticks to its guns of being relentlessly gruesome and difficult. Yet despite it’s inevitable retractors, is all the better for it.

If you enjoy walking simulators. Yet long for more mechanics and intrigue, This ideal for you. If you are a patient player than values story over a refined aesthetic. Then you will appreciate this one for sure. However, if you enjoy heavily guided RPG’s that have transparent ideal playing styles. You will straight up have a bad time with this one.

I can categorically say that I went into this experience with low expectations. Partly due to my own preferences, partly due to critical reception of the parent title. Thankfully though, I was blown away with the spectacle that was Pathologic II. It may feel like a bleak and bizarre fever dream at times. Yet I’m sure I’ll jump back in for another run through.

So that’s our review of Pathologic 2. Do you agree with us? Is this game a mess or a masterpiece? Let us know in the comments. Also a massive thanks to Yulia and Tiny build for a review copy of the game. We are very appreciative. We are also on so be sure to head over there for more review content. Or stick with us for a while longer. Check out our reviews of Artificial Extinction or perhaps you’d prefer our review of Broken Lines. I’m Callum and thank you for reading COG! 

Beautifully crafted narrative
Stellar art design
Brilliant survival mechanics
Great musical score
Load times are laughable
Sound quality is inconsistent
Navigating can be unsatisfying

Review Summary

A game that truly knows exactly what it is. Pathologic II is not for everyone. It’s a brutal and challenging experience that at times is borderline intolerable. Yet it’s that same relentlessness that is its driving force. Technical hiccups stop this title from reaching its true potential. Yet this is still a triumph. A piece of art in game form.

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