Silent Hill f turned my personal mental health journey into the most evil plot twist of 2025, and I’m not even angry

The pills don't seem dangerous. The slender red capsules are immediately useful in Silent Hill f, like money you didn't know you had in your pocket, though nervous protagonist Hinako's increasing reliance on them may be unsettling to some people. Not to me, though. I'd never let anyone take away my pills.

(Major spoilers for Silent Hill f ahead).

It feels wrong to say that. I resisted taking medication for my obsessive-compulsive disorder for most of the nearly 10 years since being officially diagnosed, but then a period of extreme insomnia hit me like cold water at the end of 2024. I felt like I might drown if I didn't start exploring medication, and I think Hinako's supposedly evil little pills might have saved her, too.

Self-help

Hinako gratefully places the red capsules I find into her mouth like they're indulgent chunks of cake, not just sugar-coated mystery drugs. I don't question her. The red capsules are a good last resort for fighting the increasingly disgusting monsters which have taken over her hometown –– naked, ball-jointed dolls with puckered scars where their nipples should be, pregnant bellies protruding from a faceless mass of hair and legs the way swollen grapes hang on a vine. The pills don't restore my health as effectively as a cloth bandage, and they don't soothe my dwindling sanity meter as much as bubbly Ramune, but they're decent enough at both that I come to rely on them.

By the end of Silent Hill f, I have at least 50 pills piled like stuffed animals in my inventory, and I've learned the truth. Hinako is not the schoolgirl she portrays herself to be, shoving herself uselessly against the locked door that is the unfriendly world of '60s Japan – she's a woman. She's getting married. Those weren't monsters I've been brutalizing with a steel pipe, but guests at Hinako's wedding ceremony. Puddles of their blood in the first possible Silent Hill f ending, Coming Home to Roost, purples the ground.

Earlier, I watched as Hinako was enraged by her dysfunctional parents and older sister Junko, now a pacified wife, as they nudge her toward getting married. She defies them by gobbling handfuls of those red and white pills, the ones I've been feeding her through my entire game. Junko is shocked – she doesn't understand how Hinako keeps swallowing lungfuls of the medicine, which she swears helps her relax. In truth, they seem to be keeping Hinako in a state of fragile psychosis, and the spider lily horror of Ebisugaoka is ultimately all in her head.

Self-flagellation

Most of the other, more "true" endings for Silent Hill f require you don't take any pills for the entirety of your playthrough, which, to me, confirms their mind-altering properties and apparently evil nature. Shu, Hinako's childhood friend with a secret crush, never told her what they'd do to her head. Because of this, I'm initially inclined to think of the capsules as just another method for the men of Ebisugaoka to control Hinako. But I change my mind once I take my nightly fluvoxamine.

Self-care

There are many reasons why I, for so many years, hesitated to take medication. First, there was the nature of my OCD – the disorder is defined by unwanted, intrusive thoughts known as "obsessions" and illogical, ritualistic behavior to suppress them called "compulsions," and I frequently obsessed over the idea that taking meds would ruin my life. What if SSRIs completely changed my personality? What if they didn't work, and I became stuck in the barbed wire of my mental illness forever? What if they made things worse? What if they made my fiancé break up with me?

In 2024, I couldn't sleep. I obsessed over it, compulsively read nightmarish articles about insomnia, and clawed my way down into a dirty, depressive hole. I decided I had no choice but to die. Instead, my therapist suggested medication.

For the first time in 25 years of debilitating symptoms, I decided pills were worth the risk. Later, I listed off the new medications I was initially prescribed at the pharmacy – gabapentin, trazodone, Lexapro. I remember bristling against the societal stigma I felt wrapping me like shedding snake skin. These were crazy pills, I thought. Why couldn't I be like the beautiful, normal people I imagined all around me, floating from happiness to happiness like all-natural fairies? I hate asking for help. But I was in desperate need.

It's now been a year since I started taking medication for my mental health, and, for the first time in my life, I feel safe. I'm no longer worried about what people think of me for taking meds, and I'm proud of myself for taking them. They've calmed my symptoms and helped me love being alive.

I imagine Hinako's red and white capsules make her feel the same way in the patriarchal confines of her reality – they allow her to transcend it. A woman in a blood-stained wedding dress, Hinako on meds defies societal expectations. She isn't nice, she's a goddamn murderer, but she'd rather be on the run than a wife.

It's her ideal self. In my case, my ideal self is a person who doesn't waste daydreams on sharp knives. We aren't quite the same, but I believe our pills set both me and Hinako free. We're two flightless birds finally ready to look up at the sky.

The best part of Silent Hill f is also my favorite from Bloodborne, and it has nothing to do with "Soulslike" combat.