Schisms also appear in the spin-off game, Silent Hill: Book of Memories.
Its most distinct feature is its elongated head, which ends in a cruel blade. Its mouth runs down its entire head and splits vertically, much like several other monsters in previous entries in the series. It has a set of dull teeth that run down the length of its head, and when its mouth opens, its tongue flails about. However, it usually just uses its bladed snout and wicked claws to attack.
Schisms have great speed, so the wisest approach is usually to run away if possible. Schisms are seemingly blind, given that they have no eyes and cannot find Alex if he is entirely silent, flashlight off, and remains motionless.
However, when Alex is forced to face a Schism, the best option is to use the shotgun or some other firearm. If forced into a melee situation, it is best to attack a Schism with the knife or the pipe, which are faster than any of Alex's other weapons.
If possible while in combat, try to attack from the side or the back, similar to when fighting against a Needler. Overall, put all effort into evading a Schism attack, seeing as they are one of the most devastating monsters in the game. They can drain just about half Alex's life if they use their pendulum-like blade to slice at his neck. The player can predict this attack when the Schism lifts its head, growling slightly while it briefly builds up power behind its blow.
The Schism could represent duality because its head is split in two. Given that the head is shaped like a pendulum, a medieval clockwork torture device designed to elicit a confession from a prisoner by dropping a swinging blade incrementally toward their flesh over the course of hours, it could represent Alex's fractured mental state and his slow, steady realization of guilt. The image is even stronger as the Schism stands idle, letting its head swing side to side as it hangs downwards.
The Schism has a boxlike object on its genitals that, coupled with the general phallic shape of the monster's head, may symbolize sexual tension.
Another quality to note is that the Schism's right hand is double jointed and facing backwards, whereas its left hand faces forward. This further symbolizes a dual nature.
Finally, the split head could represent Alex's insanity, as he is separated from reality and his mind is split, similar to the mental disorder schizophrenia (from Greek: split mind). This also links to the ending where he undergoes electroconvulsive treatment, which can treat schizophrenia and other mental disorders.
- If Alex fails to release himself from the Schism, it will cut him in half. To avoid this, the player must wait for a button to appear on the screen and mash it as fast as possible, which will cause Alex to kick the Schism away, giving himself a small amount of time to either escape or attack.
- Four Schisms are found in the Otherworld version of Alex's home, three in the attic and one in the basement. Each Schism represents a member of the Shepherd family and how they felt about the alienation that Alex suffered due to his sacrificial destiny:
- One Schism comes at Alex aggressively, representing Adam Shepherd.
- One Schism hides crouching in the corner, and seems to be crying. This Schism represents Joshua Shepherd.
- One Schism lies hopelessly on the ground, seemingly having given up on life. This Schism represents Lillian Shepherd.
- The fourth Schism is found in Adam's hunting room in the basement. This Schism, representing Alex, has already been beheaded, perhaps representing the lobotomy that Alex underwent in the Hospital Ending. Otherwise, it might be a foreshadowing of his sacrifice.
- When wandering the streets of Silent Hill, if the player reaches the edge of the fractured road, Schisms will climb out of the abyss and chase after the player, but only after first encountering them in the police station. After disabling the town's power generator, multiple Schisms will spawn on the street, along with Ferals.
- Defeating a Schism for the first time will award the player the achievement "Split Personality", perhaps referring to Adam Shepherd's kindness to Joshua and cruelty to Alex. It could also refer to Alex's schizophrenic tendencies. Back when schizophrenia was still largely misunderstood, many referred to it as a "split personality," not to be confused with multiple personality disorder.
- The name "Schism" may refer to the term used in a religious sense: a split/division between organization members, or even between the organization and their connected religions. Although it's easy to see why physical attributes of the Schism could be linked to their name, it may also refer to the broken pact between the people of Shepherd's Glen, the Order and their god, seeing as the Shepherds were unable to fulfill their end of the pact with a sacrifice. This could reinforce the connected symbolism.