This is based on opinion. Please don't list it on a work's trope example list.
Tear Jerker / The Suffering
The evil ending, in which Torque discovers that he murdered his wife and children; following this, he transforms into his insanity form for good, destroys the boat sent to rescue him, and charges off into the wilderness of Carnate Island in search of prey. As he vanishes into the forest, we see the photograph of his family (now stained with blood and dirt) and read the message on it that Torque couldn't bear to read: "This is us, T. Us without you. The only way we can really be happy. Goodbye forever- Carmen."
The good ending hits pretty hard, too. "He said to leave you alive. Only you. Enjoy your new life."
The neutral ending, where Torque's family dies to simple domestic abuse.
The sad tale of Horace Gage, an inmate who murdered his wife on a conjugal visit because he believed it was the only way he could keep her safe. After being executed, his spirit remains trapped on Carnate in perpetual agony, at the beck and call of the electric chair he died in. After a lengthly boss battle, Torque manages to put him out of his misery, though not before Horace says this:
I think we got somethin' in common. We know what love is, we know what it is to love a woman. You'd do anything for her, am I right? And somethin' else we got. We know what it is to lose it, lose it all. To not be in control...
Just about any conversation with the ghost of Torque's son, Cory: the worst one was probably during the second game, in which he contacts Torque while apparently high on heroin, whispering "It helps me forget all about you..."