Pathologic 3 - review

You’ve surely heard the saying that for the gravely ill, time passes slower—that a single day lasts like a whole year, each new dawn just another circle of hell where the same agonies are relived over again, and even every drift into sleep might mean the end. 'Sleep is death’s little brother,' as the game itself reminds us.

In Pathologic 3, time is diseased. Days can stretch on forever, they can be relived over and over, and in doing so, one can at least temporarily dodge the inevitable—the death around which everything in this game revolves. Daniil Dankovsky, led by whispers of an 'immortal' man, arrives in a nameless town to find a cure for death, only to be immediately caught in a wretched chain of events. It is only then that he learns the man he’s searching for is already a corpse, and the plague is gearing up to swallow the town whole.

You can’t save everyone… or maybe you can?

The big one—the absolute core around which the whole experience pivots—is time travel. Early on, Dankovsky gains the ability to effectively loop the same day ad infinitum, twisting the day's outcome until it fits. In practice, if you’re not happy with how a specific chain of events played out, you can just fiddle with your clock at any moment, snap a link in that chain, and start the day all over again.

What we can take from this is that time isn't the antagonist it was in the first two entries; quite the opposite, it’s actually an ally. The game does a great job of showing just how conceptually 'unpredictable' time travel can be. I could’ve sworn my decisions in the early days were the right ones—I would’ve bet on it. Instead? They resulted in a massacre of the main cast, and I was forced to crawl back into the past to try and snap that chain of bad calls.

Of course, this doesn’t come cheap. The 'currency' we use to rewind time is called amalgam. To win back those stolen hours, you have to hoard it, and there are a few ways to go about it. The first—one with heavy psychological weight and snarky commentary from Dankovsky—involves smashing mirrors. The second is tied to completing certain quests. And the third? The one you can pull off at any moment? That involves euthanizing those beyond help and literally harvesting their time for yourself.

This is not Pathologic 2 and it’s good like that

Let’s get one thing straight—and I’d underline this in red if I could: this isn't Pathologic 2. If you’re stepping into this world hoping to relive the same grueling suffering and sheer cruelty that defined the second game’s loop and narrative, you’re going to be disappointed. Pathologic 3 brings a lot of new ideas to the table; some hit the mark, others less so, but one thing is for sure—this is Ice-Pick Lodge swinging for the fences. It’s their most ambitious project yet, and honestly? It’s a total breath of fresh air.

However, aside from the non-linear flow of time/narration, perhaps the most significant change in Pathologic 3 is the mania and apathy system, which completely replaces the typical survival system, focusing instead on the psychological toll it takes on Daniil, affecting not just him but even time itself. Instead of hunger, sleep, or health, it's about finding a psychological balance for a man who is increasingly going insane from dealing with all that’s going on around him.

Items that are colored blue are those that feed apathy, slowing down Daniil's movements to a painfully slow pace, driving him to despair, and in extreme cases, even preventing him from talking altogether. In worse circumstances, it can even lead to suicide. On the flip side, items that are colored red are those that feed mania. These items increase mania's speed and energy, but instead, deal damage to his health that quickly outstrips his usual level. However, it seems like a constant tug of war between two extreme sides. Even just moving around seems to feed apathy, but it's up to you to try and stabilize it through dialogue, situations, or using substances like alcohol and drugs.

Although survival mechanics have been cut and the game is naturally easier, navigating the segmented map still isn't quite as simple as it looks. In zones where the plague has taken hold, besides the sick who'll try to hurt you in their mania, you have to keep an eye out for the physical manifestation of the sickness: the Shabnak—a mythical steppe creature standing about three meters tall. You can drive her off with a special shot, but you only get one of those per day. Then there are the red zones where the plague is only just starting. In those areas, the doctor from the Capital will be forced to wave his pistol around just to keep a malicious mob from killing him.

Being a doctor and the town’s manager

The Bachelor did, after all, arrive in town as a doctor, and as such, one of the things he’ll be doing every single day is diagnosing patients. To cook up a temporary vaccine that suppresses the plague—buying the town just one more day of life—you have to correctly identify the underlying illness in patients whose symptoms are being smothered by the pestilence. The mechanic really peaks with the 'special patients' who show up daily and have a nasty habit of lying and misleading you about their condition. Because of that, before making any final calls, you're forced to scour the houses of the sick and interview families, neighbors, friends, and local kids; if none of that helps, you're even down to questioning the homeless—all in an effort to unpick these small, neatly written mysteries.

The second part of the job, which the Bachelor takes on quite unexpectedly, is managing the town’s resources. From your laboratory in Stillwater, you track the plague’s progress and assess the damage on a wooden board; here, you make daily decisions based on the resources you have left, extending the town’s life and, in turn, unlocking more days for time travel. It all sounds a lot simpler than it is in practice. This is Pathologic, after all—every decision can be the wrong one and lead straight to someone’s ruin.

So, who’s the liar here, Inspector?

Along with the gutsy gameplay changes, Pathologic 3 rolls out a pretty ambitious narrative structure. Every day kicks off with the Bachelor being hauled forward in time to the Capital, where an Inspector grills him on everything that’s happened. Since you’ve got the power to rewrite the past, it’s wild to watch the accusations leveled against you shift between cold, hard truths and total nonsense. On the story front, that non-linear twist means some characters don’t get the same spotlight they used to, but the plot remains fantastic—told in a way that’s never been more engaging.

Aesthetically, Ice-Pick Lodge is ditching the 2019 horror vibe for a return to their roots. In practice, that means gray takes over the infected districts and yellow dominates the riot zones, while any real 'visual luxury' is saved strictly for the safe havens.

The system that eats itself

Time travel is, no question, a fascinating concept, but it’s sadly out of sync with the other two systems—patient diagnostics and town management. While I still fully believe the diagnostics are interesting and uniquely done, they lose their weight when you consider that we can basically always go back in time and 'fix' our decision about a patient’s illness. It makes decisions lose their meaning when you know for sure that you'll eventually hit the right combo in a later loop. This spills over into the town management too; it simply becomes obvious that these mechanics would’ve seen their perfect form in a linear approach like the one we’re used to.

The apathy/mania system is another new feature that loses its impact, mostly due to the dialogue. The idea is that the Bachelor’s state in a conversation can shift toward one extreme depending on the choices we make, but the problem is that it’s really hard to judge which option will increase what. I suspect the problem is the English translation—it’s rough, and the errors are way too frequent for a final version. In theory, it sounds fine, but in practice? A casual chat with a child on the street can push you to the brink of suicide with no way of predicting it. It’s very possible the developers realized the core issues with the system themselves, which is why they placed items all over the world that can influence your mental state.

It's worth noting the presence of game-breaking bugs. Unfortunately, though a large number of bugs have been fixed so far, you can still end up in a situation where it’s impossible to progress. Personally, I didn't have any problems, but judging by info from the internet, they’re still present to a non-negligible extent. I’d also add, just a bit randomly before the conclusion, that the soundtrack is solid, but it lacks that unique identity and a few banger tracks that stay with you forever.

Day 12: time for the final judgment

Reading this review has likely left you with many questions regarding my final judgment. As someone whose favorite games are Pathologic: Classic HD and Pathologic 2, I can say I’m not disappointed with what Pathologic 3 has become—it’s true there are fewer of the hallmarks that make this series what it is, but it’s also the most accessible entry so far and a great entry point for new fans. It definitely lacks polish, and some systems feel unfinished or maybe too ambitious considering time travel is extremely complex even in theory, but it has to be said that Pathologic 3 is an experience like nothing else on the market. In many ways, it’s probably the first game since Disco Elysium with this much philosophical depth.

Ice-Pick Lodge has once again proven they are one of the most brilliant studios today, but I sincerely hope this is our last return to the Town-on-Gorkhon for a while. I’d love to see their raw ambition and creative audacity manifest in something completely different—far from the Russian steppes and cities left at the mercy of the plague.