A prequel to the first Silent Hill installment, Silent Hill: Origins takes place several years before the events of the first game. Origins is set in the eponymous, foggy, and rural small town located in the northeastern United States. The town is characterized by the "Other World", a supernatural location periodically encountered by the protagonists of the series. Most frequently assuming the form of the town, the Other World causes the characters to experience delusions and various symbols from their unconscious.
Origins introduces Travis Grady, a trucker with a troubled past who suffers from nightmares. Returning characters from the first installment are Alessa Gilespie, a young girl who possesses supernatural powers; licensed practical nurse Lisa Garland, who has a drug addiction and dreams of being an actress instead of a nurse; physician Michael Kaufmann, who supplies Lisa with illegal drugs; and Alessa's mother, Dahlia Gillespie, a member of the town's cult which plans to bring its malevolent god into this world.
Driving past Silent Hill as a shortcut, Travis swerves his truck to avoid hitting a spirit manifestation of Alessa. While following the spirit manifestation, he stumbles upon a burning house and rescues the real Alessa, who was immolated in a ritual to impregnate her with the cult's god. Losing consciousness outside the house, he awakens in the town and resolves to learn if she survived. During his journey, Travis unlocks his repressed childhood memories and defeats monstrous forms of his parents: his mother had been committed to a local mental institution after attempting to kill him, and his father had killed himself, unable to live with the guilt of having his wife condemned. Additionally, Travis kills the Butcher, a monster that has been slaughtering other monsters.
Travis continues following Alessa's spirit manifestation, which refuses to speak to him, and gradually collects pieces of an unknown pyramid-shaped object; after collecting all of the pieces, he assembles them to form the Flauros, an artifact which contains a trapped demon and can be used to amplify thought. Alessa's spirit manifestation uses the completed Flauros to increase her powers and free herself from Dahlia's spell, which had inhibited her abilities. Dahlia reveals that the cult plans to use Alessa to give birth to its god, before leaving to take part in the ritual. Travis heads to the cult's ritual grounds, and sees members of the cult, including Kaufmann, surrounding Alessa's burned body. Incapacitated by Kaufmann, Travis defeats and imprisons the demon within the Flauros in a dream-like state.
Three endings are available. In the "Good" ending, Alessa uses the Flauros to manifest a baby with half of her soul, stopping the ritual, and her spirit manifestation carries the baby to the outskirts of the town, seeing Travis off as he returns to his truck and cheerfully drives away from Silent Hill. Dialogue follows to reveal that the protagonist of the first game, Harry Mason, and his wife find and adopt the baby, naming her Cheryl, while Dahlia and Kaufmann plan to cast a spell to draw the other half of Alessa's soul back to the town, setting the events of the first Silent Hill game in motion. In the "Bad" ending, Travis awakens strapped to a gurney and is injected with an unknown substance: he starts convulsing and has a series of visions in which he kills two people and his form is briefly replaced by that of the Butcher. The joke ending sees Travis leave with a grey alien and a dog in an unidentified flying object.