Silent Hill 4: The Room begins in the sleepy town of South Ashfield, only a few short miles from the infamous town of Silent Hill. When the game's new hero, Henry Townshend, awakens from a nightmare, he finds that he is trapped in his apartment. Through a portal which mysteriously appears in his home, Henry must match his wits and brawn against heinous creatures and the ghastly undead that lie in wait as he tries to solve the mystery of his entrapment.

Assuming the role of Henry, gamers set off on a fast-paced and highly captivating journey into the depths of darkness, filled with a cast of disturbing characters and monsters. With Henry's apartment functioning as a home base, players will transition between a 1st person real world perspective and a horrifying alternate reality in a 3rd person view.

Further enhancing the action, players can build up their arsenal of weapons in order to battle a number of horrifying enemies who will attack from around any corner or even through any wall. For the first time in the series, gamers can execute more powerful blows when fighting with hand-to-hand combat weapons by activating a new power gauge. Players will also meet numerous people throughout the game, including Eileen Galvin, Henry's next-door neighbor, who will help Henry through this morbid adventure. Gamers will be able to equip Eileen with special weapons to help fend off deadly creatures.