My gf is playing the new SH2 (and I when she's scared or sees mannequin rooms or the "leg day" monsters). I know the otherworld and SH is very psychological in nature. That the stuff you see and fight are like... manifestations of James' mind, fears, regrets and such (I think).

Is there in game descriptions or lore that makes this clear? So that way it's more than just creepy bad guys, but really steps into the idea of this being James' personalized hell.

Right now we just got to the part after pyramid head, where we stepped into the otherworld (only know that because the achievement said so).

Also, that part alone is confusing. Why the red door? What does it mean? Why did PH go in there? Why does it take you to the OW?