Kill 1 Schism.
The first time you encounter Schisms will be in the Police Station after the first boss battle.
These guys are brutal as they usually attack in groups and are quite quick and unpredictable, making it hard to evade attacks.
The best way to take them out is using the Shotgun combined with a melee weapon.
Let it come in close and blast it with the shotgun, this should knock it down, quickly run over to it with any melee weapon and do a full charge attack, this will kill it regardless of which weapon you are using (knife, pipe, axe).
Once you get the BlueSteel Shotgun, if you let them get close enough, you can kill them in one shot.
Also when you encounter them on the streets of Shepherds Glen or Silent Hill, just run, its not worth wasting your shotgun ammo or health drinks.