As scary as Silent Hill! There, I said it!
You play the role of James Earl Cash, a prisoner on death row who's about to pay the piper at the end of a lethal needle. After getting injected, he doesn't die and instead is manipulated into murdering dozens of gang members for the twisted desires of a fallen-from-grace Hollywood director (hopefully I'm not spoiling anything). That's what makes this game interesting, the human element. I can see this actually happening in real life, a Hollywood director fails to repeat his past success and in an attempt to gain even an iota of respect from anyone he can, directs snuff films in his basement, regardless of who gets hurt in the process. No freaky otherworlds, no mist or fog, no secret corporation creating viruses to turn people into zombies (uh oh, ruined the first RE, sorry guys), no monsters (well...except maybe Piggsy...he's a bit...weird...)...just plain, old, ordinary human sickness...human ego blown out of proportion to the point of committing terrible acts on others...
And now, you get to allow yourself to be pulled into that world...and fight your way out, ;-)