Silent Hill 2 follows James Sunderland through a masochistic gauntlet of self-inflicted punishment occurring some time after he euthanizes his wife Mary, who was terminally ill with an unspecified fantasy disease. In the town of Silent Hill he finds a few other people stranded in the muck of their own subconscious; Angela, Eddie, and Maria, who looks and acts strangely similar to Mary. Only Laura, a kid who knew Mary, seems to be unaffected by any of the town’s oddness.

James’s descent through the strata of a psychic netherworld to, one way or another, atone for killing Mary is commonly read as a Freudian punishment dream. This is worked into the game’s foundations—as Gareth Damian Martin wrote, on both a micro and macro scale the architecture of Silent Hill 2 is an expressive Freudian topography built to ferry players into its ever-darker depths.

But there is more to James’s inferno than a simple morality tale. Martin wrote that “it is the implications of this Freudian reading, not the reading itself, which is important.” Pointing out the symbolism in Silent Hill 2 is a well-worn tradition in part because its expressive level design prompts players to think about what they’re seeing.+ The threads soon untangle as the player follows the game’s cue and considers every aspect of its art as a component of a larger thematic project.

Everything James sees in Silent Hill—his “otherworld”—is a projection of something in his mind, no matter how buried. The same goes for Eddie and Angela: Eddie’s otherworld amplifies his body dysmorphia and his anger at the people who bullied him all his life, while Angela’s otherworld is a hideous outgrowth of the sexual abuse she’s lived with for so long that the addition of actual flames to her personal hell barely registers. After watching a videotape of himself smothering Mary in the Lakeview Hotel, after wending his way into the naked core of his psychosis, James’s projections peel away and he sees the hotel as it truly is in the present, not as it was in his memories; gutted by fire at some point after James and Mary visited the town.

James isn’t merely tormented by the town’s—his own—grotesquerie. Nested inside his overt confusion and disgust there’s something else with an equally powerful hold on him. Silent Hill is more than just a supernatural judicial system; especially in Silent Hill 2 it seems to manifest and magnify a person’s feelings toward themselves or others, feelings like survivor’s guilt and sexual inadequacy—or sexual desire.

Thanks to Ito Masahiro’s grimy, loaded creature design, the sexual dimension of James’s version of Silent Hill is obvious—but, I think, underdiscussed outside of listing a presumed and nonspecific sexual frustration among James’s motivations for killing Mary. James may have resented his wife for what he felt was forcing him into the role of caretaker, rather than the uncomplicated role of lover, but the explicit evidence for this is all post hoc—Maria’s relative sexual openness, the priapic and brutal physicality of the “red pyramid thing,” and the latex-bound, fluid-smeared designs of the creatures James encounters in the town are all generally cited to support this reading, rather than things James himself says or does. For reference, we know James is an alcoholic and resents Mary for “taking away his life” because he says so.

James fixates on the paraphernalia of medicine and sickness—nurses, bile, pustules, contagion, and amputation all figure in his psychosexual delirium. Philosopher Julia Kristeva names the abject as that which “disturbs” categories of order and identity, a thing which negates and opposes and fascinates. James’s Silent Hill is poised on the edge of abjection, a place that vomits forth what he does not want to know and cannot stop thinking about.

James is repulsed by and attracted to physical illness. He repeatedly murders the projections of his own fetishes and is pursued by a hulking, sexually violent executioner with a frightfully big sword. He externalizes his fascinated disgust with his wife’s mottled, changed body as rotting dolls of flesh that taunt him with their shapely gams. No matter how many of these apparitions James beats into the ground with a lead pipe or spiked piece of wood they keep coming: Chittering, twitching, spewing bile.

Mary’s debility was both burden and beacon for James; perhaps it was his own attraction to her decaying body that he felt he could only answer with annihilation as much as it was some unspecified resentment. He is at the mercy of his perversions, not self-possessed enough to make sense of or outgrow these blind urges. Maria, Mary’s malleable double, is cast in the image of conventional straight male fantasy; the other side of James’s desire is found in the restrained, deformed bodies of the monsters that wander his Silent Hill—bodies that reflect Mary’s terminal immobility, a helplessness which bleeds into and is indistinguishable from more stereotypical sites of sexual fixation like legs, lips, and breasts. The writhing “lying figure” has an enviable bubble butt and platform boots in addition to a kind of flesh-wrought bondage suit that restrains its folded arms and zips over its face. James doesn’t just resent his wife’s illness—he wants to fuck it, and is disgusted by his own desire to do so, but still, and on and on and on.

In Brookhaven Hospital James finds the “bubble head nurses,” whose bulging cleavage and latex-wrapped, impossibly twisted heads allude not only to James suffocating Mary but the horrific implication that he liked it—that he took sexual pleasure from killing her. The staggering, broken-limbed nurses may as well have condoms stretched thin over their swollen faces; James weakly fights them off with whatever weapon he has at hand, attempting to restore dominion over the purulent discharge of his abject desire.

Japanese models bound in bandages, eyepatches, and slings characterize the work of photographer and cartoonist Romain Slocombe. Slocombe claims his photos “enhance the femininity of the model” and draw the eye in a different way than conventional costuming might—it is a kind of medical bondage. His wincingly fetishistic conception of the models as “broken dolls” is reflected in the incongruously poetic titles of pinku and splatter movies like 1998’s Tumbling Doll of Flesh and 1985’s Flower of Flesh and Blood, which with the philosophical-historical blessing of ero guro art, muzan-e prints, the Marquis de Sade, and Georges Bataille relish in the detailed debasement, murder, and dismemberment of women.++

In this light, it’s no surprise that James re-learns the truth about Mary’s death via a literal snuff tape. Only through the act of watching himself kill Mary can he finally accept the truth; only by playing voyeur to a murder he committed can he conceptualize it as real. Bataille wrote about the killing of Christ as a wound inflicted both by and on humanity, a preordained sin whose “loathsomeness” taints every person and yet unifies them with God. “The guilt is a wound lacerating the integrity of every guilty being,” he wrote. Thus in James’s hell Maria dies again and again; even the woman James created for himself is not spared from his pathetic, annihilating desires. James sees himself dead from a gunshot wound to the head, a punctuation mark from another world. He journeys through a nightmare woven from the fabric of his fetishes, his sins, his repression, his plain uninteresting stupidity—constantly confronted with holes, sticking his arm into holes, jumping into holes, finding only more depravity beyond. The guilt is a wound; the guilt is a hole.

Mary’s full letter, read over the game’s credits, reveals the depths of her love for James. All she wanted was for him to move on after her death and be happy. Mary blamed herself for the illness that destroyed her body, calling it a “terrible thing” she did to him. She waits, “wrapped” in her “cocoon of pain and loneliness,” for death. But it was her husband she wanted, not death. She wanted him to embrace her, to stay by her as she faded away.

Instead James kills her to free himself and recedes into the narcotizing fog of his self-loathing. But he can’t stop probing the wound. He fetishizes the act itself, the illness, the hospitalization, all of it metastasizing into a tumorous labyrinth to house his sin. The version of Mary-Maria that James ultimately finds on the hotel roof is a saint of suffering, wearing a filthy habit and crucified upside-down like Peter in a metal cage, swarming with moths in her resplendent decay. The flower of James’s sin blooms in her; here is the full weight of his perversions, immobilized, medicalized, willful and yet an object, dead and yet forever in pain.

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• Silent Hill 3 builds on this approach in telling a story of reproductive horror that moves through lurid, anatomically suggestive spaces.

++ See also the cycle of pink movies in Nikkatsu’s Roman Porno line that focused loosely on “nurse fetishism,” with titles like 1972’s Seduction of the White Angel, 1975’s Nurses’ Secret Chart: Randy White Uniforms, 1982’s Nurse Diary: Beast Afternoon, 1984’s White Uniform Story: Rape! … you get the idea.

Astrid Rose is a writer & critic. Follow her on Twitter.