The Heart of Darkness Medal is an item obtained in Silent Hill: Homecoming. It is one of three medals used to solve the Medal Puzzle in the Otherworld Shepherd House, it is located under a cabinet on the second floor in the guest room.
When examined, it is revealed that the Heart of Darkness Medal is awarded "For permitting others to suffer". It likely references Alex Shepherd's grief caused by accidently killing his brother Joshua. It could also represent the suffering Alex caused on Joshua's final moments, and for causing the grief and suffering in his household. Alternatively, it could also represent the suffering the Order caused by kidnapping and torturing the Shepherd's Glen townspeople.
- The Heart of Darkness closely resembles a Purple Heart. The Purple Heart is a distinction awarded by the U.S. Military for those wounded or killed in battle, while the Heart of Darkness is awarded for allowing others to suffer.
- The Purple Heart could reference Joshua's death by drowning, as when the body is deprived of oxygen, the skin turns purple.