>>715306330
Pyramid Head (Doctors) is (are) also supposed to represent James' hatred for doctors who couldn't save Mary, similar to how Bubble Head Nurses represent James' lust towards nurses back when Mary couldn't give him any due to being bedridden in the hospital and physically weak. The scene at the Blue Creek apartments where Pyramid Head kills the mannequins looks like sex because it's supposed to hint at James' sexual frustration back when Mary was ill. Masahiro Ito even said that he was originally making a cutscene with Pyramid Head and Bubble Head Nurse at the Brookhaven hospital but Konami told him to cut it from the game because it looked even more sexual and rapey than the scene with the mannequins

>>713763648
nta but PH is kind of both. the way he makes movements with the mannequins is supposed to hint at James' frustration back when Mary couldn't give him any. Ito even said that he originally worked on a cutscene that took place in Brook Heaven hospital where Pyramid Head was supposed to make very similar suggestive movements with a Bubble Head Nurse but Konami told him to cut it from the game because it hinted at rape even more. the scene with the mannequins at Blue Creek apartments was risky enough.

PH is also supposed to represent James' hatred towards doctors who couldn't save Mary back when she was sick. PH is wearing white surgical gloves, a white medical apron, and his "Great Knife" (which you find on a surgical table) is not actually a knife but one of the two blades of giant surgical scissors, which explains its weird shape (Ito originally even wanted James' blade to look different). At the end of the game it was even revealed that there are multiple Pyramid Heads which makes sense. You have Bubble HEAD Nurses and Pyramid HEAD Doctors, which mirrors Nurses and Doctors from SH1.

James also says "You were going to punish me for my sins" after PHs killed Maria for the third time with their spears. James could've referred to Maria but I think PHs kept punishing James throughout the game regardless.