If you ever thought, "Boy, surviving a deadly outbreak in the middle of a Russian town while controlling mystical time-travelling powers sounds like a lot of fun," then Ice-Pick Lodge has the game for you. Meet, Pathologic 3.
Title: Pathologic 3
Genres: Psychological horror, survival adventure, narrative RPG
Developer: Ice-Pick Lodge
Publisher: HypeTrain Digital
Release: January 9, 2026 (PC, PS5); January 23, 2026 (Xbox Series X|S)
Platforms: PC (Steam), PlayStation 5, Xbox Series X|S
Price: $39.99
Xbox Play Anywhere: ✔️
Xbox Game Pass: ❌
Seen from three different character perspectives: The Bachelor (Daniil Dankovsky), Haruspex (Artemy Burakh), and The Changeling (Clara), Pathologic became a renowned cult classic. In turn, Pathologic would generate a remaster, or reimagining, of the game for the first time, known as Pathologic 2.
The game would refine the vision into something haunting, something fans would find unforgettable, putting you in the shows of the local healer (Artemy). Now, with Pathologic 3, they've given us the third perspective fans of the series have clamoured for, the Bachelor's route, complete with the mind-bending mechanic of time-travel.
You, the Bachelor, have 12 days to diagnose patients, manage a collapsing town, and confront the mind-breaking workings that bend your science-based mind. While nothing comes easy, Pathologic 2 felt like an exhaustive, never-ending endeavor of tumultuous mistakes. Pathologic 3 gives the Bachelor a unique leg up: the ability to send his consciousness back through time.
The whole time travel isn't a simple rewind button; instead, it's a desperate "do-over" which allows the player to revisit earlier days, rewrite mistaken actions, and witness the ripples of those fatal decisions. Saving life comes at the cost of something else, and the game's world will remind you that every decision comes at the expense of something equal.
The time-traveling mechanic has turned tension into something even more terrifying. Every trip back and forth comes with unknowingly related consequences that will inject new horrors you might find even more regrettable than those you wished to fix.
The Town, a Steppe settlement located somewhere in Russia that seems placed during, or surrounding the events of the Russian Revolution in 1917, becomes the backdrop for one of the most unsettling environments I've gamed in: a hand-crafted maze-like crumbling architecture, bleakly foggy districts, and townspeople who speak in roundabout riddles.
The sound of the environment itself is as unsettling as the sights ahead. Encompassing all 360 degrees of the player, it stands as a constant reminder of danger in all directions. Akira Yamaoka, the legendary composer behind Silent Hill, fills the soundtrack with eerily crimpling ambiance that fills the mind with dread and suffering.
These constant visual and sound horrors will remind you, the player, of one striking truth: Pathologic 3 isn't here to hold your hand. If anything, the time-travel makes every decision somehow more personal, as though you're the one responsible for the terrible, pathological crimes haunting this epidemic town. Ice-Pick Lodge is notorious for treating its players like adults capable of handling regret, pain, and the occasional existential crisis.
Your journey through the world of Pathologic 3 entirely depends on what you witness, what you pay attention to, and who or what you deem worthy of saving. Not everything can be, not everything should, but Pathologic 3 will put you through the wringer to make sure the choice you made has the most emotional impact, regardless of whether you like it or not.
To top it all off, Pathologic 3 has introduced the Apathy and Mania system. Too much Apathy, and your character loses speed, inevitably giving in to it all with a single bullet. Too much mania, and your character begins to lose health under the endless waves of anxiety.
Striking a balance rewards players with an extra boost to speed. Leaning slightly into mania produces a greater walk speed, while Apathy slows the Bachelor to a crawl. A clinical dose of medicinal items, both hurtful and alleviating, will make you question just how scientific this drug-using doctor really is.
That scientific mind is tested through rigorous study of infected patients. By checking their fluid samples, bodies, and belongings for clues, you'll need to piece together how people become infected, how the disease develops, and more.
For all these reasons, I can't wait to spend another 20 to 30 hours running through each and every one of those 12 days. Unraveling the past, present, and future of the Town might come at the cost of my sanity, but nothing in this world worth its weight to play is easy to digest.
Pathologic 3 is yet another entry in a series that will spiral the mind to depths it may not wish to go, but one it deserves none the less. Not for the sake of the pain it might bring to the mind of the individual, but for the strength of narrative you'll seek in all your games afterward. That, or maybe you're just the kind of person that likes punching fate in the face with a time machine that's powered by shards of glass.
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