My run is on POTD + all (only up)
I think it works as intended, cuz I saw some skulls on the map
However, as you mentioned, the journal might be bugged. There are 0 skulls in my journal. So I am either extremely lucky (0 high level quest, which is less likely) or there are some problems with the quest journal.
Health/Endurance system is not as good as the current one. In POE1, you have to rest from time to time only to get the health back, especially against some enemies with raw dmg attacks. And the endurance regen is less effective due to the limited health pool.
Monk wound -> MIGHT
Monk empowered attack -> +100 acc +100 pen (crit + pen)
Combined with Inner death ( high base dmg & very high crit dmg)
That translates to easily 1K+ physical dmg & 800+ lightning dmg
Well, I guess this simple empowered attack can 1-shot almost any enemy in the game