Symbolism, psychology and literary genre are essentials of "Silent Hill", a survival horror video game series consisting of 9 installments.
Silent Hill - a town that mixes the reality and the psyche of its visitors. Monsters are symbolised according to the psychological and emotional conditions of the main character, James Sunderland, Pyramid Head being one of them.
Pyramid Head is "a monster with a hidden face". His lower body that resembles human but the face is simply a large triangular head. Instead of having a voice, he just moans painfully, and of course it is frightening. In the story, Pyramid Head represents "distorted memory of the executioners" and James' guilt, resentment and wish for punishment for killing his beloved one.
At Silent Hill, everyone you meet is your true self.