In the first cutscene of the game, Simon is hit by a car as he asks a man who is crawling on the ground what had happened to him. This car crash crippled Simon, leaving him in a wheelchair and unable to use his legs. It caused him to feel depressed and isolated, especially after losing his friends post-accident.
Simon’s mentor and therapist, Doctor Purnell, plays a HUGE role in Cry of Fear's story. He is portrayed as the villain, but cutscenes reveal that he’s actually trying to help Simon. When you kill Dr. Purnell in the attic, a flashback shows him asking Simon to write a book about how he feels. When Simon writes that book, Cry of Fear begins.
Simon says his life is a never-ending loop of anxiety and despair. The car crash was the final push into insanity, driven mainly by his anxiety. That’s why the game begins there — because that’s when the book starts to be written.
After the crash, Simon wakes up in an alley, symbolizing how lost he feels every day in his depression. All the monsters in the game are either crippled, deformed, or disembodied — they represent Simon’s fear, trauma, and pain. These monsters are Simon’s own creations. Every monster, every boss fight, every second, every experience you had in the game was all happening inside Simon’s book.
For example, the Sawer boss has nails and cuts on his neck, symbolizing self-harm — a reflection of Simon’s own feelings. After defeating Sawer, the boss cuts its own head off, representing Simon’s suicidal thoughts.
Another detail: if the monsters are Simon’s creations, then killing them represents Simon’s recovery. If you die in-game, it symbolizes Simon committing suicide in real life. Take the Croucher monster, for instance: its low posture might represent Simon’s diminished status or perspective after the accident. The Croucher attacks Simon’s legs — attacking what he lost in the crash.
The Mace boss is slow and wrapped in bandages, which may symbolize Simon’s injuries. The bandages over its eyes could reflect how Simon feels blind and lost in his depression.
In the Carcass boss cutscene, Simon and Sophie have an emotional conversation, and Simon realizes that Sophie doesn’t want to be in a relationship or even remain friends. This devastates him. Simon loves Sophie, and seeing her leave and commit suicide makes his life even worse. The Carcass boss — a lump of meat with amputated limbs in a chair — represents Simon’s own words: that he feels like a piece of meat sitting in a chair.
If you flee from the Carcass boss, it means Simon never came to terms with Sophie’s rejection, leading him to kill her and take her with him into an alternate life — this triggers a bad ending. If you fight the Carcass, Sophie stays alive, leading to a better outcome.
In the asylum, giving the doctor a gun shows trust, but results in him shooting you — an illusion of betrayal. If you keep the gun and kill him in the attic, then in the "real" world, Simon has killed him in his apartment.
Everything that happens in the game is Simon writing that book. In Doctor Mode, your objective is to find Simon’s book and destroy it. Why? Because all the events in the campaign are making Simon worse, and the doctor is trying to save him.
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