I just finished this game yesterday. I wasn't expecting this you know, people bitched that an American company handling it would fuck it up and I didn't take that seriously but those filthy Gaijins have really fucked it up. They've taken the series in a direction that I don't like and I'm not talking about the new controls. All the surrealism and inherent strangeness you usually find in Silent Hill has been replaced with straight up gore. What I'm talking about doesn't really become an issue until later in the game but you'll know what I'm talking about when it starts happening.
The guys making this weren't restrained at all by censors and the only area that benefits from this is the monster designs. They all look fantastic and a few of the later bosses are incredible. Definitely the best in the series so far, the way the look and the way they move. The nurses at first are so voluptuous that it's comical but the way they get around is disgusting. I think most impressive though is the games boldness in giving the schism monster a big black penis.
One last complaint is all the people you run into. More than anything I think this is detrimental to the Silent Hill experience. Rather than have the story progress through esoteric memos some npc will pop up and explain everything. In previous installments a lot of the juicy details are surmised through notes and such which sets a certain mood, in this one information is mostly learned through cinema scenes which is terrible.
I didn't judge this game the way I normally judge games. There's a lot to like here; aesthetics are pretty great, the fighting system isn't bad and of course those monsters are really exceptional to look at. Ultimately though I had to decide if they had screwed up the things that make Silent Hill so grand and I'm pretty damn sure they did. Way to go Amerikajin faggots, why don't you go make some First Person Shooters since you love them so much, am I right fellas.