Unlike the previous installments, which were set primarily in the town of Silent Hill, this game is set in the southern part of the fictional city of Ashfield, and follows Henry Townshend as he attempts to escape from his locked-down apartment. During the course of the game, Henry explores a series of supernatural worlds and finds himself in conflict with an undead serial killer named Walter Sullivan.

Silent Hill 4 features an altered gameplay style with third-person navigation and plot elements taken from previous installments. Upon its release, the game received generally favorable critical reaction, but its departure from the typical features of the series received a range of reactions.