The last line of the tweet clarifies that the design wasn’t just a clone of the well-known monster: “This figure became Pyramid Head ultimately.” Ito has said that Pyramid Head was supposed to be uniquely linked to the Silent Hill 2 protagonist, James Sunderland, even going so far as to claim that Dead by Daylight features the incorrect Pyramid Head. Rather than a normal foe, the creature was meant to be a symbol of James’ remorse.
The nurses from Silent Hill 2 also closely relate to James’ story but are recurring characters in the film series. Even as one of the scariest nurses in horror movies, it might be argued that one of the reasons Silent Hill 2 has become a psychological horror classic, if not the genre’s definition, is the way Ito’s monster designs tie in so well to the tormented protagonist’s mind.
