These are what we call the 'YMMV items.' Things that some people find in this work. We call them 'your mileage might vary' because not everyone sees these things in the same way. This starts discussions in the trope lists, a thing we don't want. Please use the discussion page if you'd like to discuss any of these items.
Angst? What Angst?: Elle. Sure, she's whiny enough over her mother's uncaring attitude and worried about the townspeople... But her little sister is brutally killed and her mother, who tried to kill her, is also dead, murdered by her maybe-boyfriend. You can actually bring her into the room with her mother's corpse and she will have no reaction, though that's probably a glitch. Perhaps she's still completely in the dark about her family's fate at the end of the game. This gives the ending where she and Alex walk off together an interesting spin. An awkward conversation is about to come up.
Complete Monster: Judge Holloway. Unlike Mayor Bartlett and Dr. Fitch, we never actually see her feeling guilty over killing her own child. She orders Curtis to kill Elle, her own daughter, for little reason and seems to be more upset over Elle's lack of "understanding" than over the idea of her death. She revived the Sect of the Holy Woman, recruited Curtis Ackers to be her second in command and began kidnapping the townsfolk to Silent Hill and brainwashing them into converting. These successful converts were used as Order Soldiers, others were simply tortured to death, which Holloway believed gave them new life through rebirth, until almost the entire town of Shepherd's Glen had either been killed or converted. Alex eventually made his way to the Order's lair under the church, where she began to torture Alex to death by drilling him in the leg.
Several of the monsters have sexual elements to their design. However, none of the characters are said to have sexual issues. Whether they did it just because they thought it was cool or because they misunderstood the symbolism of previous games is up in the air.
There are logs written by Alex about how the hot nurses tending to him are the only things making his stay at the army hospital pleasant, but that none of them give him the time of day.
There is a definite theme of "gashes" throughout the game, with several bisected or conspicuously toothy creatures that assault you, in addition to Alex's tendency to rip open posters and tapestries often emblazoned with a man or a woman and always traveling downwards directly through the crotch. There's also the bizarre apparent metaphors of Judge Holloway deciding to murder Alex with a decidedly Freudian drill, with Curtis taking a chainsaw to Elle. If you really wanted to stretch for it, you could infer that they represent Alex's resentment towards his parents.
Joshua is derived from Yeshua, which "Jesus" is also from. Joshua's death saved Alex from being condemned to sacrifice, and his last name is Shepherd.
Then there's his brother Alex (which means "Defending men.") and their father Adam (an allusion to the first human) and Lillian (derived from Lilith, who in Jewish apocrypha was Adam's first wife).
It's interesting to note, in relation to the Jesus parallels above, the crucifix-type device that ultimately kills his mother.
Goddamned Bats: The swarms which exist to attach themselves to Alex and slowly suck his health away.
Narm: The drama mostly succeeds, but "You gotta be shittin' me!" is not something you should say in a game that's trying to create a creepy atmosphere.
Alex Shepherd is in a mostly abandoned town that is riddled with impassible chasms and infested with killer monsters. If he inspects many of the vehicles in the town, he may wonder, "Why hasn't this been towed? It's clearly broken down." Seriously Alex, is that what's on your mind at that moment?
Recycled Script: One of the more common complaints is how Josh's death is similar to Mary's death in Silent Hill 2, at least in relation to the protagonist. Of course, unlike James, Alex never intended to kill his brother.
They Changed It, Now It Sucks: The fan reaction to the new combat scheme and "Alex the Military Dude" subplot. Many fans were unhappy about the increased focus on action and the difficulty in avoiding confrontation.
They Wasted a Perfectly Good Plot: The revelation that Alex was never in the military. Having a soldier at the business end of the town's latest venture into the macabre provides all sorts of opportunity for playing with various war-related tropes and character templates. Obviously, none of that is actually possible in the long run.
The Woobie: Alex and Elle, especially by the end of the game. Mayor Bartlett and Doctor Fitch could also qualify.