Pathologic 3 is the rare game about healing that knows healing can be cruel

Videogames have given us many fascinating healing mechanics and ideas about healing, from the motley support playstyles of Overwatch to the musical cooldown management of Wild Growth, but one thing developers rarely capture is that healing is an expression of power over somebody. However kind, it has the potential to be demeaning, intrusive, even abusive.

In my experience of doctors and hospitals, healing is a competition between interpretations of sickness and injury, where the doctor has at their disposal all the crushing cultural authority and ornate vocabularies of modern medicine. The patient’s own self-knowledge – amassed over years of living in and with their own flesh – risks being recast as ‘amateurish’. And this is before we get into the weeds of different conceptions of bodies and how they relate, which a doctor – especially an overworked, desensitised one, fighting a wider crisis – might be inclined to dismiss as mysticism or superstition.

Pathologic 3 asks you to heal a plague-ridden Town that doesn’t quite want to be healed, because it doesn’t entirely consent to your imported ideas about bodies. It certainly doesn’t appreciate your bedside manner. Your character, the Bachelor, is an arrogant, deteriorating, overread fool. He has come to the Town chasing the myth of an immortal man, Simon Kain, from whose flesh he hopes to extract and synthesise a cure for death. As fanciful as this may seem, the Bachelor is otherwise scornful of anything his academic training deems impossible. He has no time, initially, for what the townsfolk know and believe about their own bodies, a corpus of provincial custom and meatlore that is only ever half-visible within the circuit of his science.

From the Bachelor’s point of view, healing the Town is an aggravating negotiation with dabblers and charlatans, time-wasters and clowns. Once you finally open a hospital, after unlocking the game’s time-rewinding mechanics, you can meet and diagnose a number of patients each day – talking to them about their symptoms, examining their torsos and limbs, taking samples of their skin and excretions for microscope analysis. Sometimes, you’ll also head out into the Town to investigate homes and workplaces for contributing environmental factors and possible red herrings: poorly ventilated labs, dirt floors full of bacteria, coughing friends.

All the people you treat have the devastating Sand Pest plague, but all have been granted a slower decline by the competing presence of another, more everyday disease. This co-morbidity gives you the opportunity to study the Pest and concoct vaccines, but only if you correctly diagnose the secondary infection. Vaccine rollouts and other emergency decrees such as curfews are drawn up on a board in your apartment, governed by two intersecting lines. One shows the rate of infection, which will end the game if it gets too high, and the other, the fear and anger of the townspeople, which elsewhere manifests in rioters who will beat you to death on sight.

The Decree Board is where the role of the doctor in Pathologic 3 overlaps mostly obviously with the abuses of the tyrant – or of the tyrannising system. The Pathologic games are political fictions as much as they are literary fantasies about disease. Each route through the game to the aftermath of the plague is also a decision about the kind of society you want to emerge from its ruin. At least at this stage in my on-going playthrough, the Bachelor’s decrees make me think of Michel Foucault’s portrayal of plague-stricken towns as bringing about “the utopia of the perfectly governed city”, in which individuals are surveilled and labelled and locked in place against infection. As a healer who can have houses boarded up, districts closed, the Bachelor can’t help but further what Foucault calls “the penetration of regulation into even the smallest details of everyday life”, even when he is demonstrating some kind of empathy.

To diagnose your patients, you have to peel away their defences and grope towards some understanding of the person as a whole – an act of both tenderness and predation, control. You have to suss out their loves and regrets, their working days and private lives, their secret shames and unspoken fears, their traumas and delusions. The language your patients use is imprecise, improvised, and there is always a note of contempt as the Bachelor refits their colourful or evasive accounts to the approved terminology of the game’s Casebook screen.

The Bachelor’s tendency to see the townsfolk as ignorant hicks lends significance and character to what might otherwise be regarded as a production limitation. When under physical examination, each patient in Pathologic 3 appears as a headless, spotlit, near-naked torso, with parts brusquely listed for inspection. The majority of the cast share these body models, in curious echo of how the named dead in Pathologic 3 are represented by outwardly identical masked actors, posing beside the corpse. Instead of recognising individual bodies, then, you must distinguish the suffering by their afflictions: rashes, scars, bruises, inflammation. This is how the Bachelor is trained to see people, or rather, to not see them: as reusable canvases for the signs of different diseases, tallied against your Casebook.

Still, there is a delicacy to the examinations, a trace of empathy and consensuality fostered both by the kinder bits of dialogue writing and by the animation of intervening movements. If it’s the same body each time, the body itself has personhood. It turns slowly on instruction, placing its feet like a sleepy dancer. There’s a simple grace to how it rotates its forearms outwards to show you the palms. In any case, indexing those symptoms will only get you so far. I’ve yet to meet a person in Pathologic 3 who had every symptom given for a certain diagnosis, and every diagnosis I’ve made has been an educated guess, not least because the passage of time and the pressure from other tasks makes it hard to gather every last scrap of data.

This dependence on guesswork – softened by the game’s time travel mechanic, which lets you replay each individual diagnosis if you get it wrong – is part of the process by which the Bachelor learns to compromise with the Town, which is far too phantasmagorical and strange to fit Foucault’s reading of the quarantine zone as a tightly disciplined ‘utopia’. The Bachelor’s methods do get results, but neither the Town nor the Sand Pest entirely agree with his disciplinary categories and measures, shrinking away from his hands without appearing to withdraw; there is always the sense that he is operating upon his own reflection. In particular, there is little room in the Bachelor’s mind initially for the notion that the Town might actually be a single, suffering body, encompassing the buildings, their denizens and the soil beneath.

These notions manifest frequently in character descriptions and dialogue, with people openly characterised as pieces of a larger organism. The Town’s spiritual leaders, Simon Kain and his brother Georgiy, are referred to as the “shining mind”; their brother Victor is “the hands that create the bricks for building castles in the air”. The Saburov family are the “load-bearing bones”, reflecting their role as administrators, while the local beef baron Vlad Olgimsky has a belly “as vast as his abattoirs”. In homage to the Town’s dominant industry, the districts are named for parts of cattle – the Marrows, the Hindquarters, the Flank. Even time in the Town is somatic: it’s a fluid “like blood, or dew, or tears”, that is produced in the Cathedral and kept in bodily “vessels”. Stop the clocks, and locals may stop moving in “solidarity”, reducing infection levels by a fraction.

If this is a body, it is a body formed through tense and choppy compromise between the requirements of industry, emblematised by Olgimsky, and the bloody and bovine mysticism of the indigenous Kin. The Kin maintain that the ground beneath the Town is a fickle, furious deity. They object to any violation of this sacred sunken body, even if it’s just laying water pipes. They are mistrusted and resented by other Town dwellers, but they are also respected and relied upon, for their allegiance with the bellowing earth is a central component of the Town’s meat trade.

As a university-trained outsider, the Bachelor is the least equipped of the original Pathologic’s three healer protagonists to grasp and work with these animalistic insights and incorporations. He is frequently at odds with the other two healers, the Haruspex and the Changeling, who appear unpredictably in Pathologic 3 as they continue their own, shadowy fight against the plague, using very different methods. Still, the Bachelor is also obliged to work with the Haruspex and Changeling, if only because he needs more hands at the wheel. In the process, he must acknowledge that they sense and are capable of things that elude him.

Local custom forbids the Bachelor from wielding a scalpel, for example. He can only scrape the epidermis, tick his boxes, and make airy judgements about unseen organs. Sometimes, even to look at a body is an affront. When the Bachelor attempts to study the corpse of a murdered man, an embalmer reproaches him that “the wounds belong to the body, they must not be disturbed, just like the body must not be disturbed by a gaze.”

To get inside the bodies of the townsfolk, the Bachelor must conspire with the Haruspex, a native physician who has the right to break the skin. The Haruspex sheds light in passing on the Bachelor’s own apparent bodylessness. In a departure from the previous two games, the Bachelor doesn’t eat or drink or experience fatigue. His is an intellectual struggle, as you are openly told in one of Pathologic 3’s many thinly veiled self-commentaries. Still, the sharp-nosed Haruspex notes that the Bachelor does have a body, and that it is ailing – “it smells of pond scum”. It’s a jolt because of course, you can’t smell the Bachelor’s body either. It makes you wonder whether you’ve been playing a traditional survival sim after all, and only think otherwise because the Bachelor defiantly refuses to perceive his own flesh.

The Changeling, meanwhile, attends to certain fantasies the Bachelor conceals with his learning and microscope, including a susceptibility to the occult that cuts the varnish of his professorial manner. Early on, she tells you that the plague itself has a singular body, Shabnak – a crawling vortex of bone and miasma who prowls infected districts and is more visible and dangerous, the more her existence is acknowledged. The Bachelor may scorn this as mumbo jumbo, but Shabnak appears to him regardless, and he can even crudely fight her using his funky prototype fumigation devices. As The Changeling archly points out, “why you, with your head of solid oakwood, can see her is a very interesting question”.

The other two healers lend intrigue to the already intriguing premise of a game about healing in which healing may be vicious and unwanted, an imposition and an unkindness. Being locally born, the Changeling and the Haruspex speak for the Town as patient, refusing the Bachelor’s discipline until he relinquishes a few of his own illusions. This, at least, is the approximate conclusion I have reached with this latest instalment of Butchering ‘Butchering Pathologic’. As with my previous article on The Clock, it’s possible I will return and revise this piece once I reach the end of the game, reappraise my list of symptoms, and diagnose anew. Next up, Part 3: The Curtain.