Pathologic Classic HD Review


2009’s The Void was a formative experience for me. Ice-Pick Lodge’s Russian-existentialism-em-up introduced me to videogames as tone-pieces, works where every element from the gameplay mechanics to the sound design contribute to a singular atmosphere. It opened me to the knowledge of games being more than distractions, throwing off prescribed wisdom with something that didn’t excitedly show you what gee-whizzing fun you can have but actively lied to you about how to survive. As such, I’ve been anxiously following the progress of Ice-Pick Lodge’s kickstarted remake of Pathologic, predecessor of The Void and instigator of the company’s cultist fan-base.

Anxious for two reasons. Firstly, the remake aims to iron out the many eccentricities that are both easy fodder for critics and essential parts of what make their games so loveable. Secondly, as a chap who’s never played Pathologic, the democratising of game development that’s rocketed since its release have made capital-A art games a dulling sight. Disappointment is likely. But in a baffling twist, Ice-Pick Lodge had been concurrently working on a HD remaster to sit alongside a full remake, a half-step release to allow fans to play the game as originally intended. This was my jumping off point, a second chance to tour Pathologic with the same standards I would’ve had ten years ago.

It’s as gorgeously dishevelled as I hoped.


There’s clearly something wrong. Everyone can sense it but has yet to give it a name. You’re a, one of a choice of three, healers – a guess working doctor in a time where the scientific method is still in an adolescent phase. You’re drawn immediately into a murder mystery, an historic conflict between three prominent families and a twisted spirituality that maintains this haunted limbo. It quickly becomes apparent that you’re seeing the first signs of a plague, an infection which keeps the town on the edge of blood-vomiting terror. Your job is to survive, piecing together the story through a deluge of conflicting information. Even while you’re busy trying to quarantine, characters will try to convince you, not without reason, that there’s something more sinister around the corner.

The plot is never fully explained, never tying up neatly. What’s here contributes more to a desperate tone more than creating an engrossing narrative. You’re always one step away from grasping what’s happening, matching your panicked fight to save your own life. There’s a meta-narrative, laughing at your attempts to understand. The game begins with your choice of protagonists arguing over their methods on a stage. Every survived day is rewarded with your actions being played out on that same stage by a troupe of actors. These actors are NPCs in the world, acting as a near useless tutorial. Rather than provide help, their goal is to mockingly point out your role in the game – you have to follow your pre-determined path or cease to exist. Your job as saviour is wrapped in darkest fatalism where you can never truly win.

You’d be forgiven for thinking that Pathologic is terrifically dry, the interactive equivalent of going on a first date to an Ingmar Bergman marathon. Tedious and pretentious. But merely the act of living in Pathologic is the most tense and stress inducing game I’ve played in years. Of main concern is your level of hunger and exhaustion, the struggle for even the crumbs of a cracker paints every moment. The economy of the town shifts as the threat grows in intensity. By the fifth day you’ll be looting houses for medical supplies just so you can trade them for some bread. There’s a natural brutality, an emergent internal debate over whether to risk having to murder your way out of a stealing spree or to sell your precious bullets to feed yourself until tomorrow.

Ultimately, what puts the modern spate of crafty-survivalisms to shame is an actual desire to continue onwards. An actual fear. You’ll build relationships with the enigmatic citizens of the town, wanting to know more, wanting to save their lives. This isn’t just a procedurally generated sandbox, this is a an actual world you’re inhabiting with its own sense of pride, insecurities, culture, customs. I fought tirelessly not only out of a completionist compulsion but because I didn’t want this cast of haunted aliens to forget me, to forget the good deeds I bled over. There’s an actual punishment for your defeat, something most games aren’t brave enough to try.


Pathologic is insanity shaped into a video game. Elegantly beautiful insanity. Insanity formed by external forces into a detective story. Half-crippled insanity limping toward a deterministic conclusion. Insanity that is impossible to turn away from. The highly-wrought poetics of the dialogue, executioners dressed as ornate plague-doctors, picturesque streets creeping with darkness – a painted corpse of a village. There’s hints of Kafka, hints of Francis Bacon, hints of Camus, all synthesised into a Dostoevsky acid-flashback. Video games are, more than any other medium, created by committee. It’s rare to see a game of this scale which is so personal, so particular to the creators. But, unfortunately, Pathologic is fundamentally broken.

As just stated in my effluvia of praise, the game ties together its story and gameplay mechanics, making your trials feel all the more immediate. But (and this is a large, all-encompassing but) having your end goal, your drive, be narrative led means that your eventual death is ten hours of wasted time. Not planning for Pathologic‘s unexplained systems leads to ten hours of re-reading the same lines of dialogue, repeating the same quest lines, trawling across the map for the fifteenth-thousandth time. The Void mediated this by rewarding your lack of foresight with multiple endings. Pathologic just pats you on the bottom and whispers that maybe you should make extra saves next time. Defective on an intrinsic level.

Even though I’d gladly spend another ten-thousand words writing folk songs about the heroic deeds of Sir Pathologic, it would be unfair to not mention that there’s no single element of the actual gamey part of the game that works correctly. The combat is a complete mess that somehow manages to both feel sluggish and weightless. The map randomly decides whether it feels like updating with relevant information and is barely helpful in navigating through the identikit houses. Progressing through the game means wandering into a house with the hopes that the inhabitant may have a new dialogue option.

There’s baffling quirks you’re just expected to stumble upon: drinking water can tucker you out to death, children absolutely love razor blades, drunks are the only consistent source of bandages. Given the dedication to creating a helpless tone, I’m half-tempted to chock this up as an attempt to make the player feel powerless. But after my fifth death, I inwardly seethed at the shoddiness, letting the gothic chorus of the title screen music soothe me back in.


The music almost makes up for it. It’s mostly atmospheric, not drawing attention to itself, but what’s here takes the strange turn of sounding entirely out-of-place. Contradicting with the old-world setting, the music goes for a style which I can only describe as Edwardian John Carpenter. Mix and matching the tropes of medieval Europe with electronic beeps and boops may seem like an odd choice but it becomes a companion to the otherworldly quality that everything else strives for. Today’s horror convention of screeching violins is undercut by a subtle soundtrack that has an understated creep to it. It never reaches the highs of The Voids ‘Uta’s Grotto’ theme, but it still itched the back of my skull in the way that only great music can.

The art direction also takes liberties with the setting. Abattoirs, gothic cathedrals, creaking medieval stages exist in the shadows of towering, MC Escher, obelisks that silently speak to you of the mysteries yet to come. But that high-definitionness, the selling point of this re-release, turns once muddy textures crisp while retaining only a percentage of what made them beautiful. Like many early 3D games, the abstraction that made them work is ruined once the Victorian fog is lifted into stark clarity. The graphics aren’t improved here, the faults are just more obvious. Not that anything is particularly bad, the eerie atmosphere remains, but that atmosphere worked best when the environment was left more to your imagination.

So how do I process Pathologic down to a numerical score? This is one of the best games I’ve played in years, it seems to have been made to the specifications of my exact sensibilities. But I’d be remiss to not mention how essentially damaged the finer points are. And these aren’t cosmetic features, they’re innate parts of the game. Pathologic is a lumbering, hulking mess, but it’s one which is capable of such macabre beauty, creepiness that will set the tone of your nightmares for weeks to come. Pathologic is a ten-out-of-ten in my heart and, if it’s not clear by now, I suggest you take the opportunity to experience it yourself. One can only hope that the remake fixes the issues without removing what makes Pathologic so special.

REVIEW CODE: A complimentary PC code was provided to Brash Games for this review. Please send all review code enquiries to

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