I believe that the figure of stretched flesh with the surgical instruments opening it up and prying it, spreading it too is a representation of Alessa suffering in the hospital.
Exactly that also applies to the Wheelchairs, The bloody walls, The Nurses, The bloody beds\ also the covered corpses, Etc those images had to do something with Alessa's suffering during her hospitalization, *By the way Alessa used a wheelchair to move around from the age of 7 to 14 so you can tell why she'd hate those things
The writhing shadows on the surfaces of walls and creatures are related to the Burns poor Alessa received during the ritual of resurrection, (Which also explain Why "Heather" got the same kind of burns/marks in the so called Mirror Room), Which also approves my previous theory:
He who enters SilentHill also enters "the range of the Alternate World's grasp" and don't forget the Alternate World is a world of nightmares and delusions of a person's come to life. And a place of there "darkest memories take shape (like Alessa's in SH1 and SH3, Heather's got nothing to do with this for she is merely stuck in the middle of this Phenomenon except that she carries this "GOD" which I believe is actually the Satan/Devil)". So what did we learn today? (everyone See's silent hill in his/her own way.).
Still following? that might also explain the other creatures the Dogs,Closers,Numbodies,InsaneCanser... they might be Alessa's other fears.
While im still here this also explains the conflict between mary and maria:
for a fact they are one and the same Maria was (in a sense) "Born From A Wish"
James desired a sexual relationship with his wife Mary. When she had gotten sick
she could no longer peak James's sexual interest. Maria, is the Mary that James
wished Mary was.
A woman with sexual allure, and a lustful atmosphere about
her, as I said earlier He who enters SilentHill also enters a world of delusions
(Maria is the Mary that James wished Mary was,
that's her purpose in SilentHill to invade James's thoughts and mind making her his top concern,(you see? thats why we see Maria die several times in James's journey to get his attention this also answers the "When mary really died" topic)
Even when it seems that James has her
(in the ending called MARIA) she begins to cough just like mary She is sick as well. She will die
and James will relive the agony. for you see for James this's a lose lose game poor guy.
by the way remember the PH scene where he rapes a Mannequin and after he's done with her he kill's her? well this's how James see's himself after what he have done to mary he killed her AFTER she had gotten sick and she could no longer peak his sexual interest... NO im not saying that Mr.sunderland and PyramidHead are one and the same, but James's darkest memory reoccurred infront of his eye's just like I mentioned earlier
Oh im way off topic so ill just stfu....