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Of the creatures that appear in Silent Hill 2, Pyramid Head is one of the few that is overtly masculine in appearance, whereas the other monsters generally have feminine features to them, with the exception the Door/Abstract Daddy. Pyramid Head resembles a pale, muscular man covered with a white, blood-soaked robe reminiscent of a butcher's smock. His most outstanding feature is a large, red, triangular helmet that covers his head completely. It was reportedly designed to appear painful to wear, suggesting that it serves as some kind of punishment. In interviews with the chief artist responsible for creating the character it is stated that the initial thought process behind the pyramid shaped helm was to create an iconography of "pain". In other accounts the helmet has been described as an elaborate executioner's mask.
Like the Nurses in the game, Pyramid Head wears plain white gloves with partially connected fingers, either to conserve polygons or for a unique effect. Early designs show him with a strange tattoo on his left shoulder, but this does not appear in the game. Pyramid Head is usually armed either with the Great Knife or a lightweight spear. However, he can also attack with a strangle grip, during which a black tongue-like protrusion "stabs". Similar to an attack used by other creatures in the game, he can also perform a headbutt which can cause an instant death. Lastly, he can use an extremely slow overhead chop with the Great Knife, which also causes instant death (except in Easy Mode).
Pyramid Head does not speak, but grunts and moans painfully inside the helmet - his breath hisses through the helmet grilles. His actions display shocking brutality as shown during the game in two separate scenes: he sexually assaults and violently kills two Mannequins and a Lying Figure.
In all of his appearances Pyramid Head punishes his victims in extremely painful and violent manners both physically and mentally.
As revealed throughout the game, Pyramid Head's appearance was a variation of the outfits of the executioners from times past, who wore red hoods and ceremonial robes to make themselves similar to Valtiel, an "angel". Pyramid Head was created from "the townspeople's idolatrous ideologies". Pyramid Head also shares traits with Valtiel, such as similar gloves, cloth stitching, and following the protagonist of the game. According to documents created for the release of Silent Hill 4: The Room, a sect of the Silent Hill cult (the "Valtiel Sect") wore the executioner's costume depicted in Silent Hill 2.
In Silent Hill 2, Pyramid Head serves as a symbol of the repressed anger and guilt of the protagonist, James. Pyramid Head functions as both an executioner of Maria, and the constant tormentor and punisher of James. The fact that he's seen molesting various monsters could be symbolic to James Sunderland's sexual frustration, seeing that James' wife has been deceased for 3 years.
Throughout the game, Pyramid Head is a tenacious antagonist who follows James through Silent Hill for an unknown reason. Unknown to James, Pyramid Head is a physical manifestation of his guilt over his wife Mary's death. James first encountered Pyramid Head in Wood Side Apartment in a dark corridor on the third floor. Although Pyramid Head carried an executioner blade, iron bars prevented him from reaching James and killing him. Seeing no other option, Pyramid Head watched James enter the room next door. When James left the room and reentered the corridor, Pyramid Head had vanished into the darkness. James later encountered Pyramid Head a second time when he was attacking two mannequins and killed both of them and James hid in a closet. After killing the mannequins, Pyramid Head noticed James in the closet and moved towards the closet to kill him, but James was frightened and pulled out a pistol and shot Pyramid Head multiple times in the helmet. Pyramid Head shrieked in pain and staggered out of the room and retreated. Later, Pyramid Head encountered James a third time in Blue Creek Apartment, where he attacked James with his giant knife. James tried to escape, but the door was locked. Pyramid Head attempted to kill James, but James used his gun to fend off Pyramid Head. A shriek outside urged Pyramid Head to let James escape and he fled the room. Later, Pyramid Head encountered James again in a fenced room in Brookhaven Hospital. James was heading for the elevator to depart downstairs, but Pyramid Head moved in from behind and struck James down with his knife and sent him into the fence, which broke off and sent James falling into the darkness below, while Pyramid Head watched from above. Later, Pyramid Head went to the basement of the hospital and found James, who survived the fall, and a woman who resembled his wife Mary named Maria. Pyramid Head chased the duo through the basement. James finally made it to the elevator, but at the last second, Pyramid Head caught up and stabbed Maria with a spear, killing her, but James was able to flee again, and the door slammed on Pyramid Head. Later, James found a painting in Toluca Prison, which depicted Pyramid Head with a spear with mutilated corpses hanging upside down in the background, to which James thinks "it's him."
Depiction in film
Pyramid Head appears in the 2006 film Silent Hill and its 2012 sequel Silent Hill: Revelation, listed in the credits as "Red Pyramid". In the films, Pyramid Head's design is noticeably different from that which is depicted in the games. Christophe Gans, the director of the first film, noted that despite the name, Pyramid Head's helmet is actually "a basin and not a triangle at all". Apparently, "it was impossible to make an authentic replica of the shape and actually have a real person move under it.". Pyramid Head's "very deformed body" in the game was also altered into a "tall, powerful character a little like the Warrior God in Stargate". Gans has also stated that Pyramid Head's appearance is conjured from a female perspective.
In both films, he is portrayed by Roberto Campanella.
In Silent Hill, Pyramid Head once again acts as a tenacious antagonist and is first encountered by Rose Da Silva in Midwich Elementary School while looking for her daughter Sharon. After being rescued by a police officer named Cybil Bennett, the two women narrowly avoid attacks by Pyramid Head, who attempts to cleave them with his Great Knife. Pyramid Head departs when the darkness is lifted but reappears later on when Rose, Cybil and Anna are about to enter the church of her fellow devoted believers presided over by a religious zealot named Christabella. As Anna throws stones at Dahlia Gillespie, the mother of Alessa, the darkness falls once again and she is grabbed from behind by Pyramid Head. Rose and Cybil then watch in horror as the monster lifts Anna into the air, flays her and then throws her entrails at the church doors.
In Silent Hill: Revelation, Pyramid Head appears more as a protective force and is even mentioned by Heather Mason as the protector and assassin of Alessa. Pyramid Head can be seen operating the carousel at Lakeside Amusement Park and he also helps Heather on a few occasions, since Heather is the manifestation of the good side of Alessa's soul. The first example of this is when Heather is being grabbed by prisoners in Brookhaven Asylum - Pyramid Head appears in a corridor and slices off the prisoners' arms so they cannot harm Heather. Later in the Sanctuary, when Claudia Wolf, leader of the Order of Valtiel transforms into the Missionary before the eyes of her frightened followers and tries to kill Heather, Pyramid Head comes to her aid once again and fights off the Missionary. Despite sustaining several injuries during the battle, Pyramid Head emerges victorious and decapitates the Missionary before walking away.
- Pyramid Head makes an appearance in the game Krazy Kart Racing published by Konami as a playable character, along with Robbie the Rabbit.
- A chibi Pyramid Head appears as a playable unlockable character in the Nintendo DS title New International Track & Field. To unlock him, the player must obtain bronze in all events in Single Event mode. His design is more reminiscent of the Pyramid Head of Silent Hill 2, though the helmet seems to combine aspects of the original with those of his film counterpart. The game mentions that Pyramid Head was on "a brief but enjoyable killing spree" in Hollywood — a clear reference to the film.
- Pyramid Head could be purchased as a costume in the now-defunct PlayStation Home. He was available with the Great Knife or without a weapon.
- Pyramid Head is available in Super Bomberman R.