Word of advice: if you want to play this game but have no experience with this series, play Pathologic 2 first. Its much more approachable and will help prime you to play the first game.

I bought this back during 2019 and dropped it for about 3 years, but have since jumped back into this game after completing the sequel, and its made the experience feel much more tolerable since 2 already throws everything and the kitchen sink at you while having enough mercy to allow the player to tailor their misery to their own limits with the in-game difficulty sliders. As a result, I feel much more primed to go into Pathologic 1 now with the right mindset and gameplay loop habits (stuff like doing the rounds with the major characters, digging through trash, trading constantly while walking to my destination, killing thugs at night, etc.)

And if that's still not enough to tolerate how much this game will f*** with you, I would recommend checking out the Relapse mod if you need just that additional bit of mercy. It reduces the speed of the in game clock by 20% and increases all character movement speeds by 20%. This means that while you may move faster, you also have to move quickly when switching through your inventory during combat encounters and be even more cautious towards rats, but it does make avoiding knife throws at least feasible now. It doesn't make the tasks the game puts you through any easier, it just gives you a bit more time in the day to complete your objectives and think things through.

If you can't get through Pathologic 2 though, you probably shouldn't buy and play this game. Save your money and enjoy the story through walkthroughs and video essays (unless you want to just financially support Ice Pick Lodge).