Video Game: Pathologic

"You can escape anything, even the punishing hand of the Inquisitor...but you can't escape yourself."

A 2005 game, the debut of the small Russian indie game developer Ice-Pick Lodge. As for its genre... ummm...

Pathologic is set in a town in the middle of nowhere, and infected by a strange disease. The game follows the story of three people, healers, who have all come to the town for their own reasons, and have drastically different methods. However, just as you arrive, an epidemic starts, and the town is quarantined. At that point, the game puts you in control and gives you 12 in-game days to do quests and protect yourself and others from the disease, by some very dubious methods.

The first storyline is that of a young Bachelor of Medicine, Daniel Dankovski, who has been asked to come to the town to scientifically establish that one of the residents is over two hundred years old. However, the man dies as soon as he arrives and Dankovski is strong-armed by the local aristocrats into using his skills and equipment to research the plague. He quickly becomes buried in their intrigues.

The second storyline is that of a Haruspex, Artemii Burakh, (pronounced "ahr-TYEH-mee BOO-rakh", with the "kh" sound like the "ch" in Bach or loch). He is one of very few people allowed the knowledge and right to cut open dead human bodies. His father shared his profession and lived in the town, but died recently, and his son was called to take his father's place. However, the people believe that he killed his father, forcing him to dodge angry mobs.

The third storyline is that of Klara, the Devotress, the young woman who many believe is either a messiah, or a demon. She is able to either heal a person or utterly destroy them with a gesture of her hands. Mysterious and with an unclear past, she nevertheless performs her deeds in the certainty they will benefit...something.

There are three main families in the game, all in some way fighting against each other for the control of the town. Other than them, there are loads and loads of other characters, all somehow related to the story.

The game received many good reviews praising its atmosphere and picked up dozens of awards in its native country. Sadly, the English translation was absolutely incomprehensible, which, coupled with the developer being practically unknown outside Russia, resulted in poor sales. (Though retranslation projects have been planned, none were ever finished.) This is not a game for everyone. As with many Survival Horror games, Pathologic has no parts that can really be considered conventionally "fun". From a technical standpoint, it didn't age well, and there's a lot to take in in order to master its brutally complex mechanics. It is, however, a very powerful, emotionally draining experience, and not to be missed.

Ice-Pick Lodge had started a Kickstarter campaign to create a remake of this game in September 2014. This remake aims to improve the translation, graphics, quest structure, and several other aspects while striving to maintain the atmosphere, themes, and overall storyline.


This game provides examples of:

  • Acceptable Breaks from Reality: The game notably averts most of these. Many of the gameplay mechanics are surprisingly realistic - the In-Universe Game Clock is a major constriction and is constantly ticking, enemies take few hits to kill but ammunition is scarce, using weapons or wearing clothes decreases their (very limited) durability, being Stupid Evil and reducing your Karma Meter will get you killed, etc. This may be one of the many reasons why the game is maddeningly difficult and no part of it is described as "fun", even by fans.
  • Adam Smith Hates Your Guts: Justified by the epidemic and supplies not coming into the isolated town anymore. Fortunately, the value of your items and the quest rewards scale as well. Also inverted on occasion, where prices will sometimes decrease on the next day. Increases are far more common, though.
    • Karl Marx Hates Your Guts: All shopkeepers except Gryph and the barkeep for Stamatin's pub have the exact same prices for their wares, and your items will always sell for half the price it takes to buy them.
  • Alien Geometries: The bizarre Polyhedron at the edge of the city.
  • Aloof Dark-Haired Girl: Maria Kain, resident haughty, cold and aloof Femme Fatale.
  • Anachronism Stew/Culture Chop Suey: The world of the game bears resemblance to a typical Siberian outpost city of Tsarist Russia, circa the World War One period. But there are several much more modern elements present, especially in terms of clothing and medicine. Not to mention the many Low Fantasy elements, the strange, timeless atmosphere and the fact that about a third of the characters have decidedly non-Russian names. Essentially, the setting itself is as enigmatic as the cause of the disease and the backstories of the various characters.
  • Another Side, Another Story: All three main characters have their own agenda.
  • Anti-Hero: Most characters, including the playable ones. Particularly the Haruspex, though, who even starts out with critically low Reputation.
  • Anyone Can Die: In this case, Anyone Could Die based on your actions.
    • Though, more specifically, only the characters who would "give their life to you" will "die because of you". Each player character has a set of named NPCs that are important in their tale, and who will live or die based on what the player does.
  • Arch-Enemy: Professor Tehlmann, mentioned in the letter in the first day of Dankovski's scenario, who is a bitter enemy of Dankovski and his laboratory "Thanatica".
  • Arranged Marriage: Is promised for Capella and Khan, who are from Kain and Olgimskiy families respectively.
  • Back Stab: Doing this with any melee weapon (any actual weapon, that is, not your fists) will result in a One-Hit Kill. Just hitting the person's back isn't good enough, though; you need to hit a very tiny area located around the base of the neck.
  • Badass Longcoat: Dankovski. Also, damn near everybody who wears a longcoat.
  • Beautiful Void: Day 12.
  • Betty and Veronica: The Player Characters do not engage in romance during the game, exactly, but there is stated attraction or affection for each one from two individuals, one lawful and virtuous and one more morally grey.
    • Eve and Maria for the Bachelor.
    • Ospina and Aglaia for the Haruspex.
    • Block and Griph for the Devotress.
  • BFG: The army's cannons used in the ending scenes are fucking giant. And they're mounted on railroad tracks!
  • "Blind Idiot" Translation: Zig-Zagged — the English language translation is very spotty. At times, it's a train wreck, at other times it's decent, and every now and then the incomprehensibility will actually add to the atmosphere. However, it can make it hard to know what to do. (The worst errors are in Day 3 and Day 6 in the Bachelor's scenario, as well as a letter on Day 12.)
  • Boom, Headshot: It's usually a One-Hit Kill. Try to get the hang of it, since anything that conserves ammo (see below) is a very useful technique.
  • Boss Battle: Exactly one, and it isn't even necessary to progress the plot — Oyun in the Haruspicius' scenario, if you discover that he killed Artemiy's father.
    • Arguably, there's also the hunchback and his squad of arsonists in the Bachelor's scenario, though he isn't much tougher than a regular enemy. And again, it's optional.
  • Boss in Mook Clothing: The rebel soldiers. They're the only enemies in the game who use firearms — and, unlike in most video games, they're just as deadly as in Real Life. Fortunately, they only appear in a select few quests towards the end, but when they do, they appear in droves, requiring extremely careful or quick sniping to dispatch.
  • Bottomless Magazines: Forget it. Ammo is scarce.
  • Breakable Weapons: All weapons have 'durability' scores that go down when you use them. Though weapons can still be used even at 0% durability, the game averts Critical Existence Failure; melee weapons will dull and deal less damage, and ranged weapons will become less accurate. Fortunately, you can repair weapons for a modest sum by talking to a certain type of NPC.
    • Equipment also has a durability score that goes down the longer it's worn, though it seems to play Critical Existence Failure straight.
  • Breaking the Fourth Wall or No Fourth Wall: Depends on how you look at the theater themes present in the game's narrative.
  • The Caligula: Nina Kain, deceased mother of Maria, often acted this way, though she still was beloved and respected by the Town's people.
  • Central Theme: Sickness and decay, both in the physical and metaphysical sense, are the most obvious ones. Though the theme of sacrifice - that everything comes at a price - is also important.
    • The former is present throughout much of the gameplay: Despite being healers, the three playable characters have to cause a lot of death, and their morals (and general well-being) decay along with those of the towns' inhabitants.
    • The latter is especially prevalent in the Multiple Endings — there is no truly "perfect" or "good" ending. All three of them are a trades that require the sacrifice of one thing to save another. You have to decide for yourself which one is most suited to you.
  • Changing Clothes Is a Free Action: Although the inventory menu is the only one to avert Menu Time Lockout, your character still puts on/removes clothing instantaneously. Yes, even a plague mask.
  • Character Development: Up to Eleven with EVERY. SINGLE. CHARACTER. Even the bystanders have impressively realistic and interesting personalities.
  • A Child Shall Lead Them: If you choose Haruspex's ending, his Adherents - the town's children - will be the future of the city.
  • Children Are Innocent: Played with to hell and back. The kids in this town see a lot, know more, and have their own baffling rituals and motivations.
  • City of Weirdos: Certainly a town being ravaged by plague is going to have its civic order break down, but it quickly becomes clear that the town was on the far end of the bizarre meter long before you arrived. The sickness is just making the weirdness slightly more visible.
  • City with No Name
  • Closer to Earth: Compared to what we hear of the other Inquisitors, Aglaja, the only female Inquisitor we know of, is extremely fair, kind, and reasonable. (Only relatively, though — she's still quite terrifying in her own right.)
    • The trio of "aristocratic women" (Lara, Julia, and Anna) are also portrayed as much more level-headed and trustworthy than the actual ruling families, who are primarily male.
  • Combat Medic: All three main characters can use painkillers and bandages to heal themselves and other characters. Artemiy can also dissect corpses and make drugs from tvirinum and organs.
  • Cosmic Horror Story: Of a rather unusual kind, but it still shows.
  • Cosmic Plaything: Everyone, including the player character.
  • Creepy Child: Laska. Ospina, too.
  • Critical Existence Failure: Limping around and heavily bleeding from innumerable bruises and cuts? No problem — you'll still be able to walk, aim, and fight exactly as well as when you're at 100% health. This wouldn't normally be that notable if it wasn't for the game's otherwise strict adherence to realism.
    • Somewhat averted with the exhaustion and hunger meters: though you won't feel any adverse effects from them until they reach 100%, once they do, your health will begin to drop instead.
    • Completely averted with the infection meter, though: the higher it gets, the faster it'll rise, the quicker you'll lose health, and the more disorienting the Interface Screw will be every subsequent time you're infected.
    • Averted with weapon durability. Melee weapons will get weaker with less durability, and ranged weapons will become less accurate.
  • Culture Chop Suey: Culture of the game's country is close to late Tsarist Russia, with many elements of modernism style in architecture, names are vaguely-Slavonic, and culture of Steppe is similar to one of native Siberians, Mongolians and Buryats.
  • Cutscene Incompetence: At one point, you enter a dungeon reasonably well-armed and with a killing score comprising of dozens of thugs. Then a handful of unarmed mooks approach you and beat the Player Character into a pulp while you watch helplessly.
  • Cutscene Power to the Max: Subverted. The opening cutscene of Artemiy's scenario shows him beating a group of armed muggers to death with his bare hands...however, once gameplay starts, it becomes apparent that the battle took its toll on him, as his Life Meter is at critical levels.
  • Darker and Edgier: One review called Pathologic "Oblivion with cancer, in a good way."
  • Dark World/Genius Loci/World Gone Mad: Which one depends very much on how you look at it. And they're not mutually exclusive.
  • Daylight Horror: Absolutely. Could very well be the best example of this trope when it comes to video games.
  • Deus ex Machina: Some see the Devotress' ending as this, since Klara describes it as a perfect solution, preserving both the Polyhedron and the town, seemingly nullifying the importance of the other options, which have to sacrifice one or the other no matter what. However, this is subverted once you actually play the Devotress' scenario, and discover that her solution isn't as wonderful as it first appears.
  • Dialogue Tree
  • Diesel Punk: The town's architecture, aesthetics and level of technology evoke this, in a very dreary fashion.
  • Disc One Nuke: It's possible to get a gun and a decent amount of bullets on the first day in both the Bachelor's and Haruspicius' scenarios. This will go a long way towards helping you to survive encounters with relative ease, and you won't get any more guns until day 3 or 4.
    • In the Bachelor's scenario, one reward for a sidequest on day 4 is a repellent cape, one of the best pieces of equipment in the game. Normally, the cape doesn't appear in shops for three more days.
  • Downer Ending: If you refuse to make a decision on the final day, or fail to complete the game properly, you get treated to a horrific montage of the town overcome by the plague, right before the army comes and destroys everything.
  • Eerie Pale-Skinned Brunette: Maria Kain, Katerina Saburov and deceased Nina Kain.
  • Eldritch Abomination: Albino. It's not evil, BUT WHAT THE HELL IS IT?
  • Eldritch Location: A lot of them. Including the town itself. But the "Apiary", the Polyhedron, and the town's gigantic Abattoir take the cake.
  • Empathic Healer: How the Devotress' Healing Hands work.
  • Fan Translation: invoked One that tries to fix the "Blind Idiot" Translation, here. (One of the developers is even part of the project!) It's been "in progress" for half a decade, though. Don't count on it being finished any time soon.
    • There was another fan translation on Reddit and a patch was released which can be downloaded here. It only covers about 10 - 20 percent of the game, mostly the crucial parts like the letters and diaries. The translator, meradorm, decided to halt the project after IPL announced there would be a remake (which was to be crowdfunded); because they figured that a lot of people would donate to the Kickstarter just for the chance to play Pathologic in proper English.
  • Fantastic Drug: Tvirinum.
  • Femme Fatale: Maria Kain.
  • Find the Cure: Your goal, as well as trying to hinder the spreading of the disease (and despair) among the surviving people.
  • Fire-Breathing Weapon: The army that arrives in the city at mid-point in the game's story includes a creepy-looking squad of men armed with flame-throwers. Since the army arrived to ensure the area is quarantined and to keep the plague from spreading... it's not hard to guess who their targets would have been.
  • Fire-Forged Friends: Dankovski and Andrei Stamatin fought together during some unexplained revolt when they were university students.
  • Firing One-Handed: Every weapon except the rifle. Yes, even the Sawed-Off Shotgun.
  • Flat Earth Atheist: Well, more like flat-earth materialist. The Bachelor is very confused by the town's supernatural activities and unsuccessfully tries to find scientific explanations for them.
  • Fragile Speedster: The marauder enemies. They're extremely agile and skilled in melee combat (traits bolstered by the fact that you fight them in small, cramped rooms), but can be killed with a single rifle shot anywhere on their body.
    • A weapon example is the revolver. It's relatively weak and pretty inaccurate, but its large magazine size allows you to fire multiple bullets in quick succession — useful for dealing with large mobs before you get the shotgun.
  • Friend in the Black Market: Griph is one to the protagonists.
  • Friend to All Children: The whole town mourns Simon, but children are especially sad, crying that "The Grandpa" died.
  • From Bad to Worse: The infection and the town's attempts to combat it. And the Executors are harbingers of despair. If you see one, be prepared for some very bad news.
  • Gaia's Vengeance: The infection is spreading because the land is either sick or enraged. Different people have different theories.
  • Gainax Ending: No matter which one you get, it's going to make your brain blow a circuit.
  • Gambit Pileup: Every character has his\her own agenda, secrets and plans. Up to Eleven in the Bachelor scenario, who has to deal with the endless political scheming of ruling families more than other two protagonists.
  • Gateless Ghetto: Avoided. Most of the houses can be broken into. All you need is a lockpick.
  • Genius Bruiser: Artemiy. Burly and taller than the other player characters, and an excellent hand-to-hand fighter, but he's also an alchemist and something approaching a shaman.
  • Getting Crap Past the Radar: Dankovsky to Saburov: "But I need the dead tissues not for entertainment, but for struggle against the illness!"
  • Glass Cannon: The arsonist enemies. Their firebombs can deal high amounts of continuous damage, and have long range, but they have just as much health as regular townspeople, meaning they can be killed with a single rifle shot.
  • Golden Ending: Sort of. If you manage to save everybody's adherents during a playthrough, at the end sequence you get to choose between the three endings listed below. Doing this is very hard. You get some extra Fourth Wall Breaking scenes from the theater too.
  • Good Old Fisticuffs: Your basic weapon, and an Emergency Weapon at best.
  • Grey and Gray Morality: The line between good and evil is chillingly thin, hard to discern and easy to cross in this game.
  • Guide Dang It: A lot of sections, especially the effects of items — only a few actually have helpful descriptions, and there's almost no way beyond laborious experimentation to tell which foods are most efficient (bread and smoked meat, by the way). Fortunately, there is an official guide that is very helpful.
    • There is a specific example that the walkthrough doesn't help with due to a wonky translation — in day 7 of the Bachelor's scenario, there's a sidequest that involves collecting the mask and overall of an Executioner. However, there's a very narrow window of time for it to actually trigger — you need to talk to Mark Immortal after performing the penultimate step of the day quest, but before actually completing it. Semi-justified, since the sidequest relates to the day quest, but it's still bothersome that the game doesn't tell you this anywhere.
    • Even more specifically (also due to translation weirdness), there's one that's a Guide Dang It within the official guide itself! In the section describing the aforementioned quest, the guide mentions that the overall is in a "pit" that's "opposite of the cemetery". These are pretty confusing directions — what it's actually referring to is a small, rectangular morgue that's on the other side of the train tracks, across from the cemetery.
  • Harmful Healing: The childrens' powder is one of the very few ways to reduce your infection level, but it takes a lot of health (around 90%). Considering what it's made of, it's a miracle it can do even that much good.
    • There's "harmful buffing" as well, of sorts - many medicines that boost your immunity have an adverse effect on your health and exhaustion as well, though not nearly to the extent of the powder.
    • Though the powder is perhaps the most prominent example, due to the game's multiple survival meters, this happens for most healing items. Usually, something that restores one bar will reduce the other — for example, eating lemons will decrease exhaustion and increase immunity, but it'll also increase your hunger. Painkillers will allow you to gradually regenerate health, but greatly increase exhaustion. And so on...
  • Have a Nice Death: When you die, you get a short cutscene with the Executioner and Tragedian symbolically playing out your death scene on the stage of the theater.
  • Healing Factor: Taking painkillers will cause you to regenerate health over time. It's very slow though; don't rely on it. They're best used right before sleeping, especially since they shoot your exhaustion through the roof as well.
  • Heal Thyself: You'll be doing that a lot. The only means of restoring your health, though (the actual health, not the infection level), are rest and...bandages. That's right, you can remove the symptoms of almost anything with a couple of bandages. Perhaps it's not about healing the injury as it is about keeping your body functioning by any means.
  • Healing Hands: The Devotress' hands, apparently. Also a subversion, since she can incapacitate or even kill with them via her Psychic Powers.
  • Hell-Bent for Leather: Dankovski's snappy leather gloves and snake-skin coat. He is even called in-game by some "that dandy from the capital."
  • Heroic Sacrifice: Most of Klara's Adherents, if you choose her ending.
  • Hero with Bad Publicity: All of them.
    • Artemiy starts the game wounded, weaponless and with a very low reputation (due to the accusation of being his father's killer). The first challenge in playing his character is basically restoring his reputation to a bearable amount while not getting killed by the City Guards, who will hunt him down at first sight.
    • Dankovski, outside of the town, is condemned and persecuted for his unethical experiments by authorities, press and his personal enemies among other scientists. The town's inhabitants are superstitiously wary of his comparatively modern methods.
    • Klara is mysterious, has unclear origins, and must contend with extremely bizarre rumours about her nature and actions.
  • Hobbes Was Right: The overall decay of both the city and human society within is downright disturbing. But, the more you explore and learn of the city's mysteries, it's hinted at that:
  • Humanoid Abomination: Worms, a.k.a. Odong. Though they speak like humans, and their bodies and most of their faces are hidden by their clothing, what we see is very hard to consider entirely human.
  • The Igor: Andrei Stamatin, though he assists not a Mad Scientist, but Mad Architect.
  • Immortality Seeker: Dankovski is a rare heroic example. It doesn't come up much, but it was why he came to the town in the first place.
  • Improbable Aiming Skills: Despite (presumably) never having held a gun before the game begins, the three healers become remarkably adept with their weapons as soon as they pick them up.
  • Infant Immortality: Justified.
  • Ink-Suit Actor: Most of the main character NPCs have faces identical with their small photo portraits seen in the conversation menu. Some of the actors used for the photos are members of the dev team (e.g. Artemiy's portrait shows one of the game's writers).
  • Insurmountable Waist-Height Fence: Used with both fences and edges of the playing area. Lampshaded when in a dialogue, one of the playable characters randomly notes that he can't climb fences and pipes. All the more ironic since he does just that in a cutscene earlier in the game.
  • Interchangeable Antimatter Keys: Subverted. You can only use lockpicks to get into locked buildings. They still inexplicably break when you use them, though.
  • Interface Screw: The map switch.
    • If you get infected, the screen becomes blurry and zooms in and out periodically. If your infection meter is already high, the screen will also black out for a few seconds.
  • Invulnerable Knuckles: Attacking unarmed suffers you no penalty, unlike when using a melee weapon, which decreases its durability. Possibly justified in the case of Daniel and Artemiy, since they wear gloves. (Klara doesn't, but she attacks using her Psychic Powers instead, so the issue is avoided.)
  • Judge, Jury, and Executioner: Played as straight as it gets with the Inquisitor. Just look at Aglaja's introductory cutscene.
  • Just Before the End: The town has certainly seen better days.
  • Justified Tutorial: Once you arrive in the city, the Executioner and Tragedian will be waiting patiently at your doorstep. If you talk to them, they will explain the various game mechanics and survival strategies via colourful metaphors (as is typical for them).
  • Karma Meter: The Reputation meter is an interesting and realistic variation on this. It's actually, for all intents and purposes, another health meter, and one of the most important ones at that. If you squander your Reputation, an already Nintendo Hard game will become even more difficult, as important NPCs will refuse to help you or provide shelter, most likely resulting in your unavoidable death.
  • Kill 'em All: Potentially. Even likely, if you aren't resourceful and shrewd enough. In the Downer Ending, the army obliterates the town, the Polyhedron, and all the remaining townspeople.
  • Knife Nut: You can use a scalpel or a bigger ordinary knife as melee weapons to defend yourself (or others). Firearms are the more powerful and safer to use weapons though, since melee fights in the game are fast and brutal.
    • Another example of this trope are the looters, who seem to be expert knife throwers. Like, ridiculously adept at it... Thankfully, you can dodge the blades if you think and move fast enough.
  • Knight in Sour Armor: The Player Character (and, by extension, the player) will definitely become this by the end if you try to play morally.
    • A Non-Player Character example: Aglaja has some shades of this. She wants to find a way to cure the infection with minimal losses — she doesn't want to go all-out Utopia Justifies the Means. Her morals and methods are still rather dubious, however.
  • Let's Play: There is one for the Bachelor and one for the Haruspex on the Something Awful discussion board.
    • The Devotress has an archived one with a smoother translation.
    • The gaming blog "Pathologistics" has two players playing both characters concurrently. The beginning is here.
  • Loads and Loads of Characters: Every storyline character is named and is a major player in the story. The rest are just ragdolls.
  • Loads and Loads of Loading: Every single time you enter/exit a building. Also, that ridiculous fog due to draw distance limitations.
    • The fog isn't even good enough to hide the limitations in some areas — you can actually see textures appearing and disappearing.
    • At least the loading is quick and you won't even notice it on high-end computers.
  • Love Martyr: Eve. Her obvious affection for Dankovski is taken for granted, she commits suicide, though for other reasons, and Dankovski is too distressed, tired and burdened to feel much grief.
  • Lovecraft Country: The village and surrounding steppe have all the trappings of this trope, even if it's not in the right "country." A run-down village in the middle of nowhere with odd customs, a dark secret, and a Cosmic Horror Story lurking in the background.
  • Magic Realism: Combined with Cosmic Horror Story. Unfortunately.
  • Malicious Slander: The players characters are victims of some, and other characters deploy it as a weapon. It's not hard to work people up into a frenzy, the way things are going.
  • Meat Moss: Seen in the the city districts and quarters that got hit by the plague. On buildings, the paved streets... Even seen bricks with scabs and pus?
  • Meta Guy: The Executioner and Tragedian are "stage hands". Although, despite this claim, they are surprisingly participant in the main story, usually a herald of things going From Bad to Worse. It's likely that this is another layer of Mind Screw.
  • Menu Time Lockout: Accessing your map, diary, letters, or status screen pauses the game, and you will be thankful for it, since it's one of the few Acceptable Breaks from Reality the game uses. This is not the case for the inventory menu, though — see Scrappy Mechanic.
  • Mighty Glacier: Not a character, but a weapon; the rifle. It's quite powerful and extremely accurate, but can only hold one bullet at a time, meaning you'll have to sit through a lengthy reload animation every time you fire it.
  • Mind Screw/Everyone Is Jesus in Purgatory: Hooooo boy. Excessive weirdness abounds in every detail of the story and setting. The "facts" are often deliberately contradictory and obtuse. And the dodgy translation makes it even harder to tell just what exactly it all means.
  • More Dakka: Nope. An automatic weapon would be useless due to the scarcity of ammo, anyway.
  • Multiple Endings: All are bittersweet, at best.
    • The Bachelor: Destroy the town to save the Polyhedron.
    • The Haruspex: Destroy the Polyhedron to save the town.
    • The Devotress: Save everyone in the town and preserve the Polyhedron, but sacrifice most of her Adherents.
    • Or, if you refuse to choose any of the endings, the military destroys everything.
  • Name of Cain: The Kain family.
  • Never Bring a Knife to a Fist Fight: If you've come under attack, it's generally better to cripple your enemy with a firearm first, then hit or stab him. As long as you have ammo, that is.
  • Nightmare Fuel Station Attendant: You will learn to fear the Executors. Whenever you see them...it's a bad sign.
  • Nintendo Hard: It's pretty easy to waste time and resources at the start of the game in a way that will totally screw you over by the endgame.
  • No Antagonist: Despite their conflicting methods, all the Adherents wish to put an end to the disease and restore order to the town. Even the thugs and bandits only rob out of necessity.
  • Nominal Importance: When you talk to any of the characters, an icon with a black-and-white photo appears in the corner of the screen. With storyline characters, it's a person resembling the model. With random people, it's a creepy ragdoll.
  • Noodle Incident: Recent February Revolt, which was mentioned a couple of times. And Andrei mentions during his first meeting with Dankovsky some student revolts, in which they both took part.
  • Nothing Is Scarier: The plague-ridden quarters and areas of the city. Some would argue that the whole town and its surroundings qualifies.
  • Not That Kind of Doctor: A rather bizarre variation, in that the Bachelor is referred to as a doctor, despite the fact that he's... well, a Bachelor Of Medicine.
  • Obvious Beta: Definitely. The game's innovative and well-written story and atmosphere are often marred by the rather clunky and buggy engine. There are quite a few annoying bugs that can mess up the gameplay or disrupt its otherwise highly immersive atmosphere. And the wobbly and seemingly rushed English translation and dub needlessly add to the already existing issues.
    • Fortunately, the developers say that they're planning to create a Video Game Remake sometime in the future that fixes these issues. Judging by how badly the Fan Translation is going, though, it probably won't happen any time soon.
  • Officer and a Gentleman: Alexander "General Ash" Block. He's a surprisingly nice, poetic and reasonable guy.
  • Offstage Villainy: Anna Angel is rumored to be a former member of "Diamond Ace Caravan", an infamous gang of murderers and child kidnappers which was executed a few years before game. It's also heavily implied that she murdered the girl who gave her a shelter.
  • One-Letter Name: One of Dankovski's associates for Thanatica sends him a letter during the first day, signing it simply "Your A."
  • Ominous Latin Chanting: The main menu theme. The rest of the game features examples of Ominous Steppe Nomad Chanting, interspersed with haunting, predominantly female vocals. They greatly add to the already gloomy atmosphere of the game.
  • One Bullet Clips: Sidestepped. The revolver is reloaded offscreen (the character pulls it down to their side first), avoiding the need for custom animations depending on how many bullets it currently has. The rifle is reloaded on-screen, but it has a literal one-bullet clip, so the trope doesn't apply. Played straight with the shotgun, however, which is also guilty of the "reload more visible shots than you actually have" subtrope.
  • One-Hit Kill: Back Stabs and headshots will result in these.
  • One Stat to Rule Them All: Keep your Reputation high at all costs. It's the hardest type of health to restore, and has far-reaching consequences if it gets low.note 
  • One Steve Limit: Averted; there are two characters who go by the name of "Alexander". They're both referred to by their surnames, though, so the problems with the trope are sidestepped.
  • Organ Drops: They're only available to the Haruspex, since he's the only one who knows how to cut them out.
  • Plague Doctor: Characters reminiscent of plague doctors pop up as the decease spreads throughout the town.
  • Player Needs Food Badly: You need to eat and even sleep regularly, since you can die not only from infection or low health, but from hunger and exhaustion as well. And if you're wondering how a person can die from starvation within only a couple days, the Tragedian who explains the game's rules at the beginning basically says "that's just how things are around here."
  • Powered by a Forsaken Child: All of the healers' methods to cure the plague. The Haruspex cuts organs out of people and needs a special variety of blood, the Bachelor is cold and ruthless in his experiments and willing to sacrifice the town itself to save what he views as its only worthwhile features, and the Devotress needs to have several people euthanised to work her miracle.
    • Somewhat related, the Polyhedron is kept upright by a massive spike that goes deep into the earth. This "wound" getting infected is what causes the disease in the first place. Or, possibly, hit some sort of container of the plague and let it out. It depends who you ask.
  • Powers That Be: The Authorities.
  • Power Trio: The three lead characters qualify, despite the fact that they don't work as a team at all.
  • Putting on the Reich: General Blok is quite fond of a vaguely Nazi-ish salute, though he is by no means evil.
  • Production Foreshadowing: "After I lay my hands onto you, you'll have gold, silver and cobalt running through your veins." Huh.
  • Psychological Horror/Surreal Horror
  • Ragtag Bunch of Misfits: The three main characters. Sort of.
  • Random Effect Item: Twyrine. Sometimes it functions like a painkiller, sometimes it messes with your immunity, sometimes it decreases infection slightly. Mentioned in its description, where it says that many of its effects haven't been discovered yet.
  • Real Is Brown: The whole town. Possibly justified, as it's in the middle of a steppe (and in the middle of autumn), and is thus covered in sand and mud all the time.
  • Reality Is Out to Lunch: And weirdness is on special.
  • Reckless Gun Usage: The reloading animation for the Sawed-Off Shotgun shows the Player Character using the stock "flick the gun back to close it using its own weight" technique. In Real Life, this is actually a rather dangerous action that can damage the gun.
    • There's also the fact that the characters insist on Firing One-Handed with everything except the rifle, despite the fact that trying that with a Sawed-Off Shotgun (or even a revolver, depending on the caliber) should result in broken wrists.
  • Revolvers Are Just Better: Averted. The revolver is the least accurate and second-weakest gun in the game. Its only real advantage is a relatively large magazine size, but More Dakka is a horrible strategy in this game, so that's not terribly useful. (And just in case you still want to try that, its ammunition is the most expensive as well.)
  • Romanticism Versus Enlightenment: The Bachelor's scenario makes a case for the Enlightenment, while the Haruspex is on the side of Romanticism.
    • This is a very difficult case, because the Bachelor's party stand for beauty, art, higher thinking and abstract ideals, while the Haruspex's supporters stand for prosperity, practicality, tradition and basic comfort.
  • Rule of Three: Three playable characters, three ruling families, three town districts, three gangs of kids... it goes on.
  • Save Scumming: You'll be doing this a lot.
  • Scenery Porn/Scenery Gorn: Despite outdated graphics, architecture in the game is strikingly beautiful, and so is the landscape of the Steppe. And when the town is ridden by plague, it's Scenery Gorn.
  • Science Hero: Dankovski.
  • Scrappy Mechanic: Lots.
    • You can't run. At all. Only walk at a leisurely pace. Coupled with the brutal In-Universe Game Clock, this can cause the game to range from Nintendo Hard to nigh Unwinnable.
    • The weapon selection is annoyingly clunky, since it's only available by opening your inventory (which is the only menu that averts Menu Time Lockout). This wouldn't be necessarily bad — but imagine you need to switch to another weapon quickly in the middle of a fight with a local looter.
    • This is very minor compared to the other two, but... Melee weapons often have multiple attacks — for example, when unarmed, your character may execute either a quick jab with their left fist, or a long windup punch with their right. However, there is no way to control which attack is executed (it's random), so you have no idea whether you can afford to be right next to an enemy, or if you have to start further back because your character is going to twirl their knife in the air dramatically before plunging it in a downward stab. Given how incredibly important timing is in melee combat, this can be quite irritating.
    • Fortunately, ranged weapons avoid this problem, for obvious reasons...however, just drawing a gun takes an absurdly long time; the animation for the revolver in particular makes it look like your character's moving through molasses. Needless to say, this can result in problems when you're being charged at by a crazed mugger.
  • Secret Character: The Devotress...kind of. She's clearly displayed on the character selection screen, but can only be played if you've completed one of the other two scenarios. She is also played up as the most mysterious of the three healers in the other two scenarios.
  • Shout-Out: The original Russian title of the game is More. Utopia (Мор. Утопия), being a reference to the most famous work by Thomas More.
  • Show Within a Show: The Theater puts on a play each night after midnight. Attending it is completely optional and has no tangible benefits, but you might learn something if you do.
  • Sibling Yin-Yang: Andrei Stamatin and Pyotr Stamatin - the former is cheerful, extroverted and prone to violence, and the latter is drug-addicted, shy, introverted and sad.
    • Nina Kain and Aglaya Lilich. Nina was psychotic, passionate and highly emotional, while Aglaya is cold-blooded and efficient. They both, however, are ruthless, highly intelligent and charismatic.
  • Sissy Villain: Gryph, the leader of the thieves, talks with a noticeable lisp and dresses like a woman.
  • Slasher Smile: Several characters find the Bachelor's smile unnerving.
  • Slave to PR: Your player character, quite literally. See One Stat to Rule Them All, below; managing your reputation is really important in this game.
    • Even moreso if you're playing as the Devotress, since her Reputation decreases constantly. She has a bit of an easier time recovering it than the other heroes, though, due to her Healing Hands.
  • Sliding Scale of Idealism Versus Cynicism: The protagonists are mostly despised. The people are small-minded and selfish idiots. Dankovski's "Love Interest" commits suicide. Guess which side the story's on?
    • Here's a quote from a review that explains this:
      "In a single word, Pathologic is dark. And not 'we're going to make our sequel a darker, more adult experience' dark. Not 'teen angst' dark. Pathologic is an endlessly bleak game with an atmosphere that smothers all hope. It's 'pensioner breaking a leg in his bedsit and no one finding out until the smell starts to get unbearable' dark."
  • Snark Knight: Artemiy, all the time.
    • Daniel can be like this too, depending on which options you pick in his Dialogue Trees.
  • Sniper Pistol: Averted. Every weapon has an accuracy value (a random variance of how far the bullet actually hits from the crosshairs), and the revolver has the worst accuracy. If you want to snipe, you need to use the rifle, but even that's pretty unreliable at low durability. (It's also not a Sniper Rifle, i.e., no scope, so aiming over long distances with it can still be difficult.)
  • Soul Jar: Appears to be the primary purpose of the Polyhedron, though that's not all it can do.
  • Spell My Name with an "S": Aglaja/Aglaya/Aglaia. Daniel/Daniil, too.
  • Spiritual Successor: Turgor (a.k.a. Tension or The Void).
  • Standard FPS Guns: Calling Pathologic a "standard FPS" would be laughable, so many of the traits inherent to the guns don't apply, even if the game does still involve guns.
    • Knife Nut: There are two kinds, both of which have limited durability, undermining their use as Emergency Weapons. They can cause a One-Hit Kill if you use them to attack an absurdly tiny hitbox located around the back of the neck, but due to the fact that people shift from side to side when walking, as well as the rather long delay when attacking, it's very hard to actually pull it off.
    • Handgun: The derringer is roughly equivalent to the pistol in most shooters, but you can forget about ammo being plentiful.
    • Revolvers Are Just Better: The revolver actually subverts many of the standard tropes surrounding it; it's more powerful than the derringer, but still one of the weakest guns overall.
    • Sniper Rifle: The rifle is hard to classify, actually — while it is the most accurate weapon, it doesn't have a scope, so it's not a Sniper Rifle. It's not a Marksman Gun either, since it can only hold one bullet at a time.
    • Sawed-Off Shotgun: You only get it halfway through the game, though it is quite effective at killing large mobs.
  • Stupid Evil: Acting this way is one of the quickest ways to doom yourself; going on random killing sprees and kicking puppies will drive down your Reputation fast.
  • Survival Horror: The most pronounced aspect of the game, at least genre-wise. And an unusual take on the genre at that: You're not fighting monsters, the darkness, etc., but an abstract unnerving evil in the forms of The Plague, the effects of insanity, despair, and general human senselessness.
  • Talk to Everyone
  • Tall, Dark and Snarky: Very arguably Dankovski.
  • Timed Mission (plus In-Universe Game Clock): Basically the entire game. All quests must be finished the day they were received. The game spans 12 days, you know this from the very beginning, and you will be reminded relentlessly.
  • They Do: During the Harsupex's party ending cutscene, Agalya and Artemiy look very suggestively at each other.
    • And during the Devotress' ending cutscene, we see her and Block hugging.
  • The Clan: Three of them. The Kains, the Saburovs and the Olgimskys.
  • The Plague: A visible cloud of disease that will actively chase you. Or a cloud of disease that sometimes appears as a red-brown angel.
  • The Power of Blood: And how...
  • Town Full Of Mind Screw Secrets
  • Translation Trainwreck: The game itself has a notoriously awful translation, but isn't this bad. The manual, on the other hand...
  • Trauma Inn: Averted for the most part. Though exhaustion will always decrease, you'll only recover health if you take painkillers beforehand. It can also be a double-edged sword: hunger will always increase while sleeping, as will the infection level if you're already infected.
  • Trial-and-Error Gameplay: Sadly, quite a lot of it if you're playing for the first time. The aforementioned Scrappy Mechanic and In-Universe Game Clock don't leave enough room for bigger screw-ups on part of the player.
  • Twist Ending: More like a series of twist endings that get progressively more twisty, to be precise. Nope, we won't dare spoil it for you. Your mileage will definitely vary about whether it's more of a Karmic Twist Ending or Cruel Twist Ending.
  • Utopia Justifies the Means: An important theme in the game, but especially in the Bachelor's ending.
    • The more literal translation of the game's original Russian title - Pestilence: The Utopia - hints at this, along with a short throwaway dialogue with one of the town's Upper-Class Twit NPCs.
    • Also, Russian word for pestilence is "Mor", making the title a Shout-Out of Thomas More and his Utopia
  • Video Game Cruelty Potential: In-universe, during a bonus scene in the Polyhedron, but minus the "video" aspect of "game." No, seriously.
  • Video Game Physics: It's mainly used just to calculate falling damage - and it's pretty unforgiving about it too. The player characters' legs must be made of plaster to break from such short falls.
  • Waif Prophet/Mysterious Waif: Klara, the Devotress.
  • Well-Intentioned Extremist: Many of the characters who look like they're going to be the Big Bad turn out to have their own beliefs, morals, and reasons for their actions, turning them into this.
  • Wham Episode: Day 6 in the Bachelor's scenario. Up until that point, things have actually been going surprisingly well — you've managed to set up a hospital and isolation ward, and your fellow scientist Rubin has even managed to isolate a vaccine (albeit at a cost). But then everything starts going to pieces.
    • Firstly, Rubin has a My God, What Have I Done? moment because of yesterday's events, and turns himself into the authorities. It's possible that he will be executed, leaving you on your own in the battle against The Plague.
    • Secondly, a plague carrier somehow managed to infiltrate the hospital you set up, killing hundreds of people. The town is now degrading into madness and hysteria trying to hunt town the perpetrator, whom they suspect to be a demonic witch.
    • Thirdly, Saburov has gone mad with power — power you gave him yourself. He's now arresting people with wild abandon and on little basis. If you don't pay their bail by midnight, the Inquisitor will almost certainly hang them.
    • Fourthly, a mob of arsonists is trying to burn down the Apiary because they believe it's the source of the plague. Even Vlad Senior, the overseer of the place, doesn't seem very concerned about this — and he later reveals that the infection has indeed found its way into the Apiary.
    • To top it all off, the Inquisitor and their forces are poised to arrive the next day, and if you can't stop the disease by then, they are likely to take the reins themselves and destroy the plague at any cost.
    • Probably not coincidentally, this is the point where the red-brown angels of death start appearing in the infected districts.
  • What the Hell, Townspeople?: Invoked by Artemiy in a few sarcastic jabs.
  • Wise Beyond Their Years: Notkin, Capella, and Khan.
  • X Meets Y: It's as if the works of Mikhail Bulgakov, Franz Kafka, some works of German Expressionism Hieronymus Bosch and China Miéville were thrown into a single pot and cooked thoroughly into a delicious Mind Screw horror soup.
  • You ALL Look Familiar: Every NPC except the named ones.
  • You Killed My Father, Prepare to Die: Oyun killed Burakh's father. He gets what's coming to him.
  • What You Are in the Dark : One of the main themes of the game. The plague and the methods you employ as a character in order to stop it and save the city could be interpreted as one big Secret Test of Character.