Review Mazinkaiser 5/5 · Jun 23, 2025
Pathologic 2: Down by the River
Pathologic 2 is an intense and unrelenting survival experience, but for those who stick with its world will find an incredibly rich and engaging adventure that everyone has to experience.
Pathologic 2 starts as a remake of one of the routes of the original Pathologic - the Haruspex, a doctor and surgeon known as Artemy Burakh, returns to his hometown …
Pathologic 2 is an intense and unrelenting survival experience, but for those who stick with its world will find an incredibly rich and engaging adventure that everyone has to experience.
Pathologic 2 starts as a remake of one of the routes of the original Pathologic - the Haruspex, a doctor and surgeon known as Artemy Burakh, returns to his hometown and finds a mysterious plague ravaging the town at an alarming rate. While maintaining hunger, thirst, exhaustion, and immunity/infection levels the player will seek to cure townsfolk, gather supplies, follow mysterious visions, trade with children, and fight for their lives in a dark alley.
The town is comprised of 12 days in several districts - the first couple of days are fairly normal, and subsequent days the districts will cycle between infection, a ravaged post-infection period and back to normal. The player has a "thoughts" tab instead of a quest list, which entertains various places/people to interact with in a thoughtfully modern manner. Instead of quests the player feels they are forced to do the player may entertain their curiosity and see where it will lead them. This is important as the game (especially its "intended difficulty") will make it impossible to do everything and manage supplies, which may result in death (which permanently reduces stats for ALL saves - be careful!) and saving every important character may become a fool's errand.
For the Haruspex-specific version of Pathologic, 2 is very focused on brewing tinctures/serums, giving out medication, and doing surgery. Organs pay a high price in certain markets, herbs brew powerful immunity tinctures, and managing pain is critical to treating the diseased. The mechanics don't feel vague or poorly explained, which is what makes it a wonder that the game is still so tough to manage even as you don't feel like the game is hiding any core mechanics from you.
Why play such a game that feels cryptically designed to subvert your chances of mastery? Without spoiling too much, the dialogue and narrative is the meat of Pathologic 2's game and what makes the game incredibly satisfying to play. Characters are fully fleshed out and have their own arcs which may flexibly be cut short by death, and as the player grapples with plot developments and other discoveries your own quest may also push in a radically different direction.
The visuals are incredible, a higher fidelity boost to the dusty and oppressive Steppe from the first game. Characters feel just as bizarre and intriguing as the original and every drop of blood and dingy brick makes for a very engaging atmosphere. The only thing I would knock Pathologic 2 for (compared to 1) is the soundtrack. After the masterwork of the first game's soundtrack the second takes a much more muted and ambient approach. This makes areas feel less distinct and hides the more impressive tracks deeper in the game.
Pathologic 2 is a game that begs to be played with its difficulty in mind, though settings exist to tone down various survival aspects to be less antagonistic. Pay no mind to the "intended experience" button though, as even the easier difficulties will not give the player enough time to do everything or master the game. It's an enchanting experience with deep mythology and meaningful themes behind the surface-level misery that people will often associate with these kind of games. Even if you can't do a perfect run, the game will still be an amazing trip.
