I have to admit to being a bit terrified by this Pathologic 3 review I’ve been working on for a while now. Having actually experienced the first game in the series, I was well aware of both the reputation the game has and the reality of how difficult and obtuse it can be. Going into this, I wasn’t sure I’d even be able to survive beyond a couple of in-game days, so sure I was that after day 2, the game would have a spectacular rug-pull that would leave me winded. Let’s just say, that wasn’t the case, and I’m not sure if I should be happy or disappointed.
What Is Pathologic 3?
If you’ve not spent a lot of time reading video game websites over the past few decades, you might have missed the original Pathologic. It’s one of those games that the “games as art” crowd likes to talk about a lot because it’s artsy, challenging, and both janky and grimy in equal measure. There are actually many, many reasons why the first game was talked about so much, and frankly, most of them are actually justified. That said, it was also a game that was nigh-on impossible to get into, so the developers took another stab at it with Pathologic 2, a crack at the same story but made in a way that doesn’t have the player trying to gouge their own eyes out while trying to play.
Enter: Pathologic 3, the third attempt at the same story told in the same town but not really. Unlike the original game, this time we’re exclusively following the story of Daniil Dankovsky, a bachelor of medicine with more than a thimble of arrogance and attitude to match. That’s right, we’re now firmly in the hands of a man once described as “that prickly prick who will doom us all”. Either way, gameplay-wise, it’s a first-person survival game that sees you tasked with keeping your characters alive while the town you’re trapped in descends into chaos due to an indescribable plague.
The Narrative Is the Message
One of the biggest draws of Pathologic 3, as with any other game in the series, is the storyline and characters. You’re not hear to have fun, you’re here to watch a bunch of dirty and miserable people get their shit ruined. The story follows the arrival in a rural town of several characters, the Bachelor, The Haruspex (someone who reads the future in entrails) and the Changeling. All three are doctors of one sort or another, and soon after their arrival, a deadly plague begins to descend on the rural town blasted in the middle of the Russian steppe.
This time around, the story is told exclusively from the perspective of the Bachelor, an educated intellectual from the city who has arrived to try and prove that it’s possible to cheat death. However, unlike previous attempts at telling the story, this game seems to assume that you know what’s going to happen since everything has been completely re-shuffled. The story isn’t told in linear order now; instead, things happen at completely random times, and it’s up to you to piece together what is actually going on.
It’s Gameplay, Jim, But Not as We Know It
While Pathologic 3 has the same first-person survival gameplay as the previous entries did, it’s not quite the same sort of gameplay. This time around, it’s less about finding the scant resources needed to keep you and your ‘bound’ (the people whose lives are tied to yours) alive and more about figuring out what you need to say to whom in order to make the right sort of progress. It’s about jumping back and forward in time and making choices that impact the overall direction of the world. Basically, it’s a ‘choices matter’ game rather than an existential survival horror game. Oh, also, you’ll be spending a lot of time staring at a map screen and watching a line draw itself…woohoo?
If you’ve always loved the feeling and storyline of Pathologic but couldn’t make it past day 2 when all of the food suddenly becomes expensive, then this is the game for you. However, if you were really invested in the whole “the mechanics are actually difficult for narrative reasons” shtick, then you’re probably going to find a relatively shallow and disappointing experience with Pathologic 3. The thing is that the excessive walking and suffering the player went through in the first two games was quite important for deriving the right feeling and conveying the right message, and without it, the game feels more than a little lacklustre.
A Visual and Aural Treat?
Other elements that feel different in Pathologic 3 are the visuals and sound design. If you played the original version of the original game, then you’ll know that the western releases have often had…interesting sound design and visuals. The games have always been ugly as this was sort of part of the point, but while the grime is still around, the jank is gone, and along with it, some of the game’s edge. It looks fine. Nothing particularly stands out when compared with the myriad of other similar-looking games we’ve seen over the past decade.
Sound is a similar story. In the original game, I ended up bricking it when I heard certain noises, such as the plague shrouds that chase you down in infected zones. Here, I barely care at all what’s going on from either a music or sound perspective, and I mostly ended up muting the sound to listen to a podcast or whatever instead. It didn’t help that an insane amount of the gameplay is basically just plotting a route via Map Quest like it’s 1998 all over again.
Final Thoughts
Pathologic 3 is a much more accessible game than any previous entry in the series has been, and that does fly in the face of what the originals were trying to do. That said, there’s a solid chance that this is the only version of the game that some people will be able to make their way through, and the core of the same story and world is right here for you to experience, so it’s a great thing that the game exists. If you can’t stomach the unfairness of the original games, this is the game for you, but don’t be shocked if you come away wondering what all the fuss was about in the first place if this is your only experience with the franchise. You’d probably just be better off watching the HbomberGuy video.
Developer: Ice-Pick Lodge
Publisher: HyperTrain Digital
Platforms: PC
Release Date: 9th January 2026
