Other people have already written about James Sunderland's sexual issues, probably more intelligently and articulately than me. But it would seem strange to have a Silent Hill 2 website that doesn't touch on them at all, so I'll give it a go!
The town of Silent Hill tailors itself to the person who sees it, and in James's case it's filled with sexual symbolism. The implication is that, however genuinely James might have loved Mary (and I do believe he genuinely loved Mary), his struggle with her illness had another dimension: he was sexually frustrated.
Did James kill Mary because he couldn't bear to watch her suffer? Did he convince himself he was doing it for her sake? Did he do it because he just desperately wanted it to be over at last, so he could begin to heal? Or did he kill her just so he no longer felt chained to her, so he could leave her dead weight behind, so he could fuck other people?
In the end, it's probably a combination of all of these reasons. Killing someone you love isn't a decision most people are going to make lightly; there are going to be complex factors involved.
Which of these factors holds more weight, though? When you boil James's actions down to their essence, is he a person who acted out of love, or was Mary a replaceable object to him?
That's ultimately what Maria is there to test. If James just wants a replacement for Mary in his bed, here's the perfect replacement: a hotter Mary, a Mary who's sexually available in a way the true Mary wasn't.
What mattered to James, really, in the end? Your actions throughout the game tell the story, and the ending you get is the game's final judgement on James's motives. Are you tempted by Maria, or do you keep your focus on Mary?
To be clear: when I ask whether James acted out of love, I'm not just asking whether he thought he was doing the right thing for Mary. James's actions didn't have to be for Mary's sake to be motivated by love.
Watching the slow death of a loved one is agonising. If James killed his wife because he couldn't handle slowly losing her, his decision was selfish, but his love for Mary is nonetheless at the root of it. That doesn't make it the right decision, and it doesn't make it any less cruel to Mary, but it also doesn't negate the fact that he loved her.
'The symbolism of Silent Hill 2 clearly illustrates that James is an ass man,' I appear to have written in my diary at some point. I regret this.
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