Story
James Sunderland visits Silent Hill after receiving a letter from his wife Mary, who died of a mysterious disease three years earlier. He makes his way into town and discovers that it’s deserted, enveloped in mist and full of monsters. He meets other characters along the way, including Laura, a small girl who was in the hospital at the same time as Mary, and Maria - who looks identical to Mary. James also finds himself stalked by Pyramid Head, a monster with, well, a pyramid for a head. At the end of the game it’s revealed that Mary didn’t actually die of her disease - she was suffocated by James, who couldn’t stand to see her suffer and wanted to put her out of her misery.

What it all means
Everything in SH2 is a product of James’ twisted mind. His frustration at his wife’s body being ravaged by the disease - and resulting sexual frustration - is made explicit in the game’s monsters, which are all made up of female body parts - plunging necklines, long slender legs and so on. Pyramid Head - whose appearance is a deformation of Civil War-era executioners - serves as his judge, condemning him to witness the death of Maria multiple times throughout the game. Depending on the ending, James is either forgiven and released from his personal hell, or doomed to repeat it for eternity. In that respect, James’ Silent Hill is a kind of purgatory.

The endings
Leave: Mary forgives James and he leaves Silent Hill with Laura.
Maria: James leaves with Maria, but she inherits Mary’s illness.
In Water: James commits suicide by driving his car into Toluca Lake.
Rebirth: James performs an ancient ritual to bring Mary back to life.