June 17, 2021 | 11 minutes read | Tags: The Red Carpet

Pathologic: Revolutionary Lessons from a Video Game

What once might have seemed like a radical situation, far removed from our everyday reality, aligned itself with our own experiences of living through a dangerous pandemic.

Pathologic: Revolutionary Lessons from a Video Game

Pathologic (2005), and its remake Pathologic 2 (2019), takes place in a fictionalised version of the Russian steppe, set during a “civil war” in the early part of the twentieth century. The game starts within the so-called Town-On-Gorkhon. Cut off from supplies and lacking in both medicine and food, the situation is only made worse as a mysterious pandemic begins to sweep across the town, threatening to infect anyone and everyone, including the protagonist. The series quickly became a cult classic. An awkward and gruellingly difficult game to play, yet rich with weird and complex writing. The game experienced renewed interest across social media due to the similarities between its narrative and the global outbreak of coronavirus. What once might have seemed like a radical situation, far removed from our everyday reality, aligned itself with our own experiences of living through a dangerous pandemic. We too must deal with the bureaucratic nightmare of eugenicist leadership, balancing our needs for material and physical security — our desire to socialise and remain connected to our communities — with the constant risk of catching the virus. The game has offered a way for people to work through their anxieties, recontextualising their experiences through the thematic lens of the game. Pathologic asks the player to pick one of three healers, each of whom experience only a piece of the game's enigmatic narrative. Whilst the game makes no direct reference to socialist ideas, it raises important questions for revolutionary strategy. What is the nature of subjectivity and self-transformation? How should we interact with our communities?

Daniil Dankovsky, the Bachelor:

Daniil is a reluctant protagonist, a Bachelor in Thanatology (the study of death). Though he comes to town for his own self-centred aims, hoping to find a cure for ageing by talking to the supposedly immortal Simon Kaine, Daniil is trapped by the plague and forced to offer the town his assistance. Although he is a well-educated doctor, his presence ends up being a greater hindrance than help to the town, as Daniil struggles to listen to anything beyond his own ego. His pigheaded ways and inability to abide questions by those he considers his academic lesser brings him into conflict with both the mystical healer, Clara the Changeling, and Artemy, surgeon and shaman herbalist to the local indigenous people.

Daniil is a dogmatic “rationalist”, a scientist who is unable to engage with the world as it is, preferring the concise reality presented in books. While it is hinted that Daniil grew up less privileged, he appears consumed by his rising status, becoming used to a world in which nothing appears beyond his control. He finds comfort in the elegance of theory, but is distasteful of the reality of medical practice, and so desires to recreate the control he finds in his lab outside of it, including over death. Within the circles of Capital academia, Daniil is said to be an expert within his field of study; his prowess is discussed by other characters within the game, who claim to have seen the Bachelor return a dead woman to life, though the details are kept vague. Regardless, the positive impression Daniil makes on his fans and friends has little impact on the rest of Pathologic’s cast, and stuck within the town, he finds himself constantly coming into conflict with the local population. Unable to access his equipment and lab, his constant assertions of his skill and reputation only further isolates him from the people, making him out to be a fool, powerless in the face of the disease.

Not only can Daniil do nothing to help the problem, his entrenchment in the academic culture of the Capital leads him to deny the validity of the traditional Steppe medicine, causing him to make a number of decisions which sabotages the work of the town's surgeon, Artemy. As the game goes on, many in the town make it clear to Daniil that he is impressing no one but himself. Daniil’s failures force him to ruin his crumbling self perception, and the only strategy his weakening self image can conceptualise to survive is become increasingly detached from reality, rejecting the results Artemy achieves with the local indigenous tradition, further cementing himself a fool to the local people. We increasingly understand Daniil’s self belief isn’t rooted in reality, but a facade to cover up his own shame and fear.

Though Daniil desperately seeks to change the world, he can’t allow himself to be changed by those around him, and so he is trapped within himself, only further speeding up the progression of death and disease that he wants to halt. Daniil’s undialectical process of medicine is not out of the norm within his bourgeois training. To conquer death would be to “perfect” the craft of healing, giving little regard for the act of living.

Daniil can only imagine a body in vacuum, removed from the dialectical process of existence. Artemy (discussed below), however, sees the body, and the person attached to it, as an organism in the larger ecological environment. He understands that for the social body to survive, medicine must also mean targeting societal and cultural ills. Life must be more than merely existing, it must be full of meaning and chances to connect, which leads to an evolving process akin to biological life.

Daniil's arrogance is rooted in the fact he is unwilling to question himself and bend in the ways that are demanded of him. He is unable to cope with the idea that he must change in accordance to his surroundings. As this truth becomes clearer to him, he does not humble himself in the face of a greater challenge than anticipated, but  throws himself into his pre-existing knowledge. This lack of trust leads him to being lied to, manipulated into serving the goals of others. To Daniil, the town is too “backwards” to help itself, too infested with indigenous belief not rooted in “logic”, and so he sees himself as the protagonist of the story, the outsider turned savior. Daniil is unwilling to listen to the same people he is offering help, and echoing the nature of his bourgeois learning sees the relationship between doctor and patient as one sided. Daniil only understands a relationship of hierarchical power. Relationships move in only one way, and that direction is dictated by those who most have the power to dominate. He can only view death, disease, and failure as adversaries to battle, rather than an experience from which lessons can be learned.

The authority Daniil abuses as a healer is a reflection of our own medicine system under capitalism. Doctors come to see patients as a tick-box list of problems to be solved, or people to be molded to fit the idea of the “perfect person”, much like Daniil’s goal is to “perfect” the living body beyond death. Daniil is motivated to save those he deems his friends and intellectual betters, those who he deems useful to society. There are parallels to be drawn with real-life doctors and their readiness to deny treatment to those deemed “undesirable”, or coerce those who don’t fit the bourgeois model of a “productive citizen'' to change. The doctor's power gives them the ability to ignore the concerns of patients, even denying the reality of the patient's own experience if it doesn’t fit into the doctors pre-existing notions of “health”. Yet if the doctor's oversight results in more serious complications, the burden of responsibility is still ultimately placed on the patient for even being ill. Doctors are encouraged to see themselves detached from the community they serve and instead see themselves as enforcers of “objective” medical fact. Doctors aren’t taught, however, that this “objectivity” is a reinforcement of the harmful ideology of Western society, recreating the same structures of violences which overwhelmingly affect marginalised people and bar them from effective care, something which Pathologic highlights through Daniil’s anti-indingeous sentiments.

Artemy Burakh, the Haruspex:

Artemy, in comparison to Daniil’s rigidity of character, is a person that lives on the borderline of many cultures. Part Steppe, part Russian. Trained in both the herbal medicine of his Steppe people and sent to learn surgery within the Russian metropole, Artemy has spent his whole life as an outsider and through this experience has learned to reflect on his position within the world. Having never been afforded the luxury of clearly fitting himself into any one system or identity, Artemy’s flexibility has been his survival, allowing him to avoid dogmatism and adapt in whatever way was required. In the town’s eyes, Artemy is more the hero than Daniil, being given the unique position of Menkhu, the only one allowed within the Steppe’s laws to perform surgery on another human. However, Artemy does not see his role as one that makes him a hero, but rather a servant of the people. Artemy, shocked by the revelation that his father’s death has given him this title, initially resists the role and the responsibility that comes with it, but realises that, ultimately, to do nothing would let the town die. The game is sympathetic to the idea that Artemy resists the position of authority he is thrust into. Artemy fears that the responsibility granted to him has the potential to cause massive harm, something he wants to avoid because of his deep love for Town-On-Gorkhon. However, as much of a burden as it initially feels to Artemy, he quickly realises that he has the training to save the town, and that to do nothing and make no decision would in itself by the most heartless choice of all.

Artemy does not consider his life more important than anyone else. He is not special because he is the hero of the story, but instead simply a small part of a greater whole. The game, both mechanically and narratively, places Artemy alongside the people of the town. Like the others, he (and by extension, the player) struggles to find food to eat, struggles to make himself heard above the town's factional politics, and struggles alongside the other healers to find a cure. There isn’t even immunity, as he must constantly work to not catch the same plague he treats. It’s because Artemy is connected to the town's plight, not by a detached professionalism but lived experiences, that he is able to go above and beyond for his fellow kinsman. To help the people, you have to understand the people. To understand the people, you must be of the people. Being of the people means situating yourself within their world and letting yourself be transformed by the experience. To transform the outside world, we must also transform our inner world. Artemy’s humility and sense of duty is something that allows transformation to occur in a way Daniil never could, for his training as a bourgeois academic only allows him to see himself as the deliverer of salvation rather than the receiver. However, if Daniil allowed himself to be transformed by the town, coming to terms with the cycle of death and life in the same way they do, it would both free him from his greatest and most limiting fear and allow him to better confront the disease. The world can’t be changed through pure intellectualism, through reading theory without practice, and like Artemy we must immerse ourselves in our surroundings, grow our lives alongside the communities we seek to transform, and in turn be transformed by them.

The game, at least in Artemy’s narrative, is not utopian. It understands that for one thing to grow, another must die. Artemy, whose healing is closely connected to the cycles of life, understands this more than anyone. While Daniil seeks to create life ever-preserving, and therefore corrupt the natural dialectical process of growth, Artemy is instead forced to see that the world can’t continue how it is without perpetuating the same power structures, and the misery they bring. This is demonstrated through the character of Big Vlad, the owner of the town's abattoir, who holds a dangerous amount of power over the local indigenous people. He is the only character from the town that the game does not require you to keep alive. He, perhaps more than anyone, is impeding the future, and so for a better world to be made, the old one must die. Death within the game, however, is not treated lightly. The game makes it apparent that each life is scared, but vulnerable. Everyone is part of the same social and physical structures. Even the children aren’t innocent, angelic or simple, but influenced by the same forces as the adults in the town, breaking into different factions which reflect the diverse opinion of their adult counterparts. The game knows we are all caught in a web of connections, only allotted the power to pluck the strings that bind us, but never break free without losing those same connections. Connections, the game argues in the conclusion of Artemy’s childhood rival, Rubin, that can help keep us alive in times of desperation and horror.

The town itself is a living entity, one that can be rendered sick, and eventually killed. The first sign of the sickness within the game is the image of your childhood covered in a strange-looking fungus, the same disease which causes the pandemic. The town itself is shaped like that of a two-headed bull, important to the Steppe mythology, with each district named after an organ which represents its metaphorical and social function. The game makes it clear that there is no difference between a place in which one lives and the ones living within it. There is no future without the town, and every life lost is something that kills it. Life is sacred, and everyone who is saved will shape the town's future in a significant way. From genius architects to small grubby children.


The figures of Daniil and Artemy act as contrasting models for us to consider how we should approach the difficult, revolutionary task of transforming both ourselves and the world. The game asks us to reflect on how much we should rely on dogmatism. What balance of the ego should be reached.

Daniil feels he is owed respect due to his position, but Artemy sees himself as a humble servant, understanding his position means aligning his own desires with the town's, attempting to navigate it's complex structure by bending himself to it rather than trying to reinforce his own reality.  He understands that there is little division between the transformation of the internal and external, individual and environment. Instead, they are interdependent. He puts aside his ego, while Daniil wields it as a shield against criticism from those he believes beneath him, which includes essentially everyone in the town.

In most Role Playing Games, completing a quest will always have a positive outcome. In Pathologic, the completion of a plotline often has a detrimental impact on the town. In this way, the game encourages thoughtfulness. It questions the logic that action itself is inherently good. Both Artemy and Daniil are, in the end, driven towards action through limited information, resulting in an unfavourable outcome which harms the town and its inhabitants. Only within the third playthrough, where one plays as the character Clara, do we understand the mechanisms at work behind the games narrative, and see a positive outcome from the synthesis of the lessons Daniil and Artemy learn from their respective narratives. The game argues that individualistic attempts at heroism can never fully succeed and mass participation is a necessary part of changing the world for the better.

Pathologic sets itself apart by creating an immersive and embodying experience that allows us to engage with concepts within a space in which error has little consequence. It questions the conventional wisdom of player agency leading to success, and instead incorporates the ability for player actions to lead to failure, encouraging a slower and more thoughtful pace. While video games are often akin to a race to the finish, following objects without thought or choice, Pathologic is specifically built to limit the players actions through incorporating the cycle of time, and all the limitations that can bring. The game provides us with an engaging space for us to reflect on its themes, without the same harm failure would bring in the real world.

However, no matter how well a video game is able to examine oppressive power structures and encourage self reflection, it can replicate those same power structures. Towards the end of this article's writing, an accusation of grooming was made by a female student against their teacher, Nikolay Dybowski, head of Icepick Lodge, and lead writer for the series. Although this was a recent revelation for  English speaking fans of the game, members of the Russian gaming community described Dybowski’s behaviour as  an “open secret” in Russian fan forums. With this revelation, important discussions were sparked regarding the game’s relationship to gender, pointing out that misogynistic elements present within the series have been overlooked.

It is a mistake, of course, to remove a game from the context of its creation. Whilst Pathologic is complex and nuanced, the revelation of Dybowski’s reprehensible behaviour shows that in the wider world, even media with thoughtful meditations on the nature of power can be used to recreate those same abusive structures.
The video game industry is ultimately a capitalist one, rife with misoynogy and plentiful stories of abusers (majority cis men) using their power to abuse the workers under them to gain success and a cult-like followings. All art produced under racial capitalism is indelibly marked by it, and despite the revolutionary lessons we might take from it, Pathologic is no exception.