Is Sonon Really Dead?

A Clinical Analysis of Cloud's Psychology, Part I - Trauma, Dissociation, and Psychosis

This analysis was originally posted on Reddit, but I decided I wanted to archive it on this old blog too. This topic's been beaten to death already, but in light of the 25th anniversary stream and Rebirth trailer, I want to release my own take on Cloud's psychology using the lens of professional psychology. I'll cover a range of humanistic concepts and criteria from the DSM-5 (basically the bible of clinical psychiatric diagnosis) and tie them in with the lore of FFVII. Although the reasons for Cloud's identity crisis are well-known among OG fans, I'm interested in breaking down exactly why and how those factors resulted in his fabricated ex-SOLDIER persona within the context of real world psychology. I'm going to look into three main areas of exploration: trauma, identity, and reintegration. These areas will conceptualize how Cloud's experiences opened the gateway to pathology, how his understanding of himself is built and then shattered, and how the pieces come back together. This first post will cover the trauma piece, including the topics of dissociation and clinical diagnosis.

Part I - Trauma, Dissociation, and Psychosis [you are here] Part II - Identity, Self-Concept, and Mako Part III - Reintegration and Unconditional Love

One of the most common misperceptions about trauma is that any adverse experience will cause it. While it's true that adversity can cause stress, this belief undermines the remarkable resilience that humans have. The most important thing to consider is that everyone has resilience and the capacity for coping, but this differs from person to person. In the clinical context, traumatic experiences are defined as frightening, dangerous, or violent experiences that elicit strong emotions and physical reactions. People can also experience trauma by witnessing an event that threatens the life or physical security of a loved one (i.e. watching a parent die). When the stressfulness of a traumatic event exceeds a person's ability to cope, the stress becomes pathological and can be classified as trauma. The tragedy of Cloud's life is that his traumatic experiences are deeply stressful and essentially occurred back to back. Each event ticks off multiple boxes for the likelihood of trauma, and then Cloud essentially experienced them in succession, if we assume that his sense of time in Hojo's laboratory was warped due to catatonia.

Dissociation

Different people have different reactions to the same traumatic experiences, and the ex-SOLDIER persona is a unique one. Although we know Cloud's ex-SOLDIER persona is his primary consequence, there's a clinical way to contextualize what purpose it serves. Cloud's headaches are used as a constant indicator that something isn't right with him. His headaches are even described in the FFVII Remake Ultimania within his character profile (translation provided by aitaikimochi):

Cloud suffers from sudden headaches that last for brief moments. This pain is usually accompanied by flashes of his childhood, his fated opponent Sephiroth, or pieces of his past. There are times when visions of the future get mixed up as well. His headaches are filled with mysteries. Perhaps there might be more than one cause of these headaches that plague him...?

Aside from serving as narrative hints, the headaches are also connected to experiences of dissociation. Dissociation is a common consequence of trauma that center around a detachment from reality as a defense mechanism. It has numerous features, some of which open the gateway to psychosis. Let's focus on the specific features that are integrated into Cloud's story.

Memory

Memory is the largest piece of Cloud's dissociation since his ex-SOLDIER persona requires him to ignore key memories. At the start of FFVII, Cloud experienced problems with remembering anything between the Nibelheim incident and his arrival in Midgar. You could argue that Cloud has selective retrograde amnesia, but his memory between the time he left Nibelheim to join SOLDIER and the Nibelheim incident is deeply distorted, rather than unclear or largely missing. This hints to us that Cloud's memory problems are a function of dissociation, which is commonly invoked in trauma victims to protect them from memories of their traumatic experiences. Cloud's case is more complex though, since he also experiences identity problems. Even though sense of identity is also a feature of dissociation, we'll talk about it later in Part II.

Hearing voices 

Hearing voices can be considered a part of dissociation when the voices are internal, or inside the head. It's when they are external and appear to be coming from outside the body that we begin to think of psychosis. This is where fantasy starts to blur how we can interpret Cloud's psychology. Cloud mainly hears two different types of voices during his journey: Sephiroth's voice, and his own voice. Cloud hears Sephiroth's voice taunting him from time to time, and it is an external voice. However, it's important to recognize that Sephiroth is a true external influence with his own agenda. Therefore, we can assume that it really is Sephiroth speaking to Cloud, not just a fabrication of Sephiroth in Cloud's head. We know this because when he experiences a headache, Sephiroth's voice often comes after. Basically, the more unstable Cloud's identity becomes, the more he mentally vulnerable he is and the more he hears Sephiroth's voice.

The other voice, Cloud's own voice, is internal. The problem is, sometimes it's tricky to tell whether it is functioning as dissociation or as a storytelling device. The key to understanding this is recognizing that this internal voice is meant to represent Cloud's real self. Cloud's identity crisis is the core of his pathology and is portrayed as a suppression of his real self. The times when he does hear his real self appear to be moments of clarity. In this case, the voice of Cloud's real self is understood as a sign of deconstructed identity; this voice is a manifestation of dissociation.

Intense Flashbacks

Intense flashbacks are another common feature of dissociation. Again, our perception of this concept in Cloud is somewhat unclear due to the fact that flashbacks are also a storytelling mechanism. However, we can use Cloud's headaches as an indicator of whether he is recalling a memory voluntarily or involuntarily. Cloud's involuntary flashbacks are shown to be disruptive and disorienting. They will initiate sometimes due to triggers in the environment, but might also occur out of the blue. Again, these flashbacks largely tie back to Cloud's identity crisis, so it's safe to say that this is another feature of his dissociation.

Reality Testing

Reality testing refers to a person's ability to understand and distinguish the external and internal world, or reality and fantasy. When someone has problems with reality testing, he experiences hallucinations. For the most part, Cloud is able to grasp his reality and navigate the environment just fine. It's either when something in the environment triggers Cloud's memories or when Sephiroth reaches out to him that he experiences intense hallucinations, which are indeed moments of dissociation. Again though, it's sometimes hard to tell if these are fabrications of Cloud's mind or if they are purposeful illusions created by Sephiroth, especially since other party members can sometimes see Sephiroth as well. But, even though there are moments where Cloud seems to have trouble distinguishing reality from his imagination, these moments are better explained by Sephiroth's influence. Therefore, I wouldn't say that Cloud's hallucinations are a sign of psychosis.

The other complicated piece here is the knowledge that the existence of Cloud's ex-SOLDIER persona is an inherent rejection of reality. Essentially, the ex-SOLDIER persona is like a delusion, a fixed belief that is resistant to change even with the presence of conflicting evidence. Cloud has to reject the reality of who he is, what happened to him, and Zack's existence in order to keep himself grounded. This is maybe subject to change now in Rebirth, but as far as the original story goes, Cloud begins to doubt himself once he is told that his memories actually belong to another person he can't remember. So, should we still talk about psychosis?

Real World Disorders

Before we proceed, a disclaimer. I do have professional training in clinical diagnosis and psychotherapy, but ultimately I'm still playing armchair psychologist. This is just my personal take on Cloud's psychology.

When I talk about psychosis, this refers to a remarkable disconnect from reality (see the NIH). Psychotic episodes can involved disturbed thoughts and difficulty with understanding what is real and what is not. It seems appropriate to discuss psychosis in Cloud's case given that his dissociation does make us question his understanding of reality around him, including what he remembers.

One of the most common things that I've seen people speculate is Dissociative Identity Disorder (DID) due to the implication of the ex-SOLDIER persona as a distinct personality. DID was formerly called Multiple Personalities Disorder, and it's pretty much what it sounds like. The key feature of DID is the presence of two or more distinct personalities that alternate in the conscious. Most of the the time, each personality (or alter, as it's often called) is unaware of what the others are doing when they have control of the conscious. See Marvel's Moon Knight for an excellent recent portrayal of DID. There's a lot of dispute about what causes DID, but the general consensus is that DID results from the combination of childhood trauma, mostly abuse or neglect. To best explain it: "in DID, traumatic memories are decontextualized and processed to retain internal and external balance, which leads to formation of alter personality states each with a sense self and agency, personal history, and a mission" (Şar, 2014).

Despite this, I'd argue we cannot say that Cloud has DID as we understand it in the real world for several reasons. The most important aspect is that Cloud doesn't consistently switch between his ex-SOLDIER persona and his real self - in fact, his real self rarely if ever comes out explicitly. Rather, it looks like as long as the ex-SOLDIER exists, the real self is suppressed. This specifically tells us that Cloud's experiencing an identity issue. Furthermore, people with DID present remarkable problems with reality testing regardless of external influences. The times that Cloud sees and hears Sephiroth are arguably still partly hallucinations, but we already established that Sephiroth is deliberately messing with Cloud's sense of reality and identity in some form. He's purposefully taunting Cloud, especially when others cannot see him. We know that Sephiroth is literally reaching out to Cloud, that this isn't all happening inside Cloud's head. Therefore, Cloud's hallucinations are likely not a sign of psychosis, and it's unclear if we can even call them hallucinations in the first place.

If I had to give an armchair DSM-5 diagnosis to Cloud, I would suggest that he has Delusional Disorder. This disorder shares some features with Schizophrenia, but does not include hallucination as a symptom. More importantly, delusional disorder doesn't feature "bizarre or odd behavior" that's often seen in other psychotic disorders. Outwardly, people with delusional disorder don't appear delusional unless the subject of the delusion is involved. I do still hesitate with this diagnosis though, mainly because Cloud ultimately does respond to information that challenges his delusion. The DSM-V does specify that "individuals with delusional disorder may be able to factually describe that others view their beliefs as irrational but are unable to accept this themselves." When Cloud is explicitly confronted with information that is inconsistent with his delusion, this in fact opens the gate for Sephiroth to convince him that he is essentially not real. If he had delusional disorder, Cloud would have continued to reject reality.

The fact of the matter is that Cloud's ex-SOLDIER persona cannot be fully understood in the context of real world psychosis. The fantasy elements of FFVII complicate diagnosis, especially considering when and how the ex-SOLDIER persona was born. Plus, I wouldn't pathologize Cloud this far given that I don't think real world psychosis best explains what happens to him. While Cloud's ex-SOLDIER persona appears to be a delusion, it doesn't present negative consequences unless he's presented with conflicting information and is vulnerable to change when challenged. Essentially, we can partly understand the ex-SOLDIER persona as an ongoing dissociation that serves to protect Cloud from the memories of traumatic experiences. But, I wouldn't go so far as to give him a DSM-5 diagnosis.

Basically, we can't fully conceptualize Cloud within the realm of psychosis or personality disorders. Rather, his dilemma revolves around the deconstruction of his identity, which I'll discuss in my next post.

I’m not good with Japanese, but these lines sound VERY similar!  

It would be interesting to know if there are others, did you spot any?

FFVII Remake vs Crisis Core comparison

I love how Nibelheim is casually actually buckwild insane in terms of ecology. Harsh mountain landscape where almost no plantlife grows and the air is filled with radiation poisoning and 90% of the random encounters aren't even escaped lab experiments or mutated beasts they're just. Normal wolves except they're 300% stronger than the wolves from the game's starting area and also sometimes you turn the corner and there's. A dragon. Completely normal and unremarkable predator, the fire breathing dragon. Also the locals believe if you climb high enough up the mountain you can get to the land of the dead but why the fuck would you do that so everyone just goes about their lives like a short hike away from the literal afterlife. Truly no other town could have produced the likes of Cloud Strife and Tifa Lockheart.

"I think we're friends in every universe"

Talk about a coincidence!

(Previous post here)

Aerith and Tifa parallel 

Eyes are the window to the soul

Cloud has the so-called Mako-Eyes, due to Mako infusion treatment. This is normally a distinctive mark of SOLDIERS and during the game many characters notice them: President Shinra, Reno, Rude, Elmyra...

Aerith

Aerith commenting about Cloud’s eyes was an important plot point of the OG as it was the first hint about her connection with Zack.

This dialogue takes place when they escape from the church across the rooftops of Sector 5 slums.

The devs decided to change this scene for the Remake and replace it with one that recreates step by step a romantic moment between Aerith and Zack from Crisis Core (for those who don’t know what I’m talking about, 0:13).

When Cloud and Aerith arrive in Evergreen Park, a place that's special for her, she starts talking about Zack and her cheerfulness fades away for the first time.

Zack’s name causes Cloud one of his migraine attacks. When he opens his eyes again she comments about their beauty and when he points out that’s because of the Mako she just sais “...I know”.

Tifa

In Chapter 3 Johnny is arrested by Shinra Public Security and Cloud and Tifa have to intervene to make sure he doesn’t talk about Avalanche. Cloud seems to have no hesitation to kill Johnny but Tifa stops him. 

This is the first time during the game where she openly states how much he’s changed and, coincidentally, she does it commenting about his eyes. Of course she’s not talking about their color. Here too he answers in a similar way, saying it's because of the Mako, to which she replies “I remember...”.

---

To sum up

Aerith:

likes SOLDIER eyes

because they remind her of Zack, the guy she loved.

She gets sad because she misses Zack.

In Crisis Core Mako eyes were described as “color of the sky - but not scary at all”.

Tifa: 

doesn’t like SOLDIER eyes

because they are different from those of the guy she had a crush on.

She gets sad because she misses the Cloud of 7 years ago.

The camera focuses on his eyes while she says that he’s scaring her.

...

WAIT! 

The devs can’t be saying that SOLDIER-Cloud is NOT real-Cloud, that Aerith likes his Zack-side and that real-Cloud doesn’t use to cut civilians in half with a massive sword...

... Right?!

What an unexpected & unexplainable coincidence!

TIFA, AERITH AND BARRET IN-GAME SCHOOL UNIFORM SKINS

Aerith in light of healthcare provider

So, I’ve wanted to write an analysis about Aerith in light of her medical viewpoint for quite a long time but only recently got the chance to complete it. It is well known in the game that Aerith is the healer of the story. She possessed great MP with a limit break to heal and buff people which greatly affect your gameplay. Of course, you can equip others with Healing and Prayer materias to render them useful for healing as well. But story-wise, no one can take away Aerith’s status as the healer. We know in canon that Aerith provided herbs to the Sector 5 slums doctor to create medicine. And if you finished the Corneo Stash side quest in Chapter 14, you can return to the church and see a couple of elderly sitting on the pew praying. And when you come closer to them you’ll hear them talking about how they didn’t see Aerith around and they’re sure she’s alright and probably be around healing people. You know, since the Sector 7 plate just fell. (Even though Aerith is not alright actually coz she was kidnapped by Shinra by this time) Point is, we are fed by the NPCs on how much Aerith had helped around as a healer. She had been doing this for years.

While being in denial about who she actually is, being a healer had always been implanted in her. She is used to it. When you’re used to being a healer, there’s a certain level when you have different reaction compared to others. The way you think is different. Apart from that, she’s also a Cetra. And we knew for a fact Cetra had a certain affinity towards souls who are returning to the Planet. Meaning, as much as she is used to healing others, she’s also used to sensing death.

My whole point is that, being a Cardiac Anaesthesiologist and Intensivist as I am, I can totally relate my position with Aerith, as we both had constantly helped people and encounter death on daily basis. While I’m pretty confident that majority of these might be coincidence (because I’m pretty sure there were no doctors in the SE team), I thought the coincidence is pretty cool to ponder upon and I’m amazed at how the subtle differences between Aerith’s reaction to events from other characters.

I’m gonna ignore the meta part of Aerith, mainly because I’m not discussing about how much Aerith knew, and if there was anything in jeopardy of what she knew whatsoever. So we’re gonna focus on the fact that she is used to healing and feeling people’s death. People who are used to death on daily basis had a certain unique view on life and death. And that affects how we act upon facing them too. While this is evident throughout Remake, I’m gonna focus on the plate drop event to be more concise. I will also use Tifa as comparison to make it easier to see the difference between the reaction of the two. Let’s start!

1) Aerith is quick in emergency situation.

When you are used to people dying, you developed a certain immunity and you are able to have sound mind and composure at sudden change of event. As healthcare providers, we face stable situations turning into critical real fast. And we have a switch in our minds that turn us from standby mode to rescue mode. This is exactly what happened to Aerith when Don Corneo revealed Shinra’s plan to blow up Sector 7’s support pillar. Tifa is part of Sector 7. It is her home. Which was why her reaction showed how she was super devastated, she slowly stood up and muttered “They wouldn’t…” because she couldn’t believe it. Aerith? She had that switch in her mind, and she immediately turned and say “Come on, guys! We gotta go!”. She switched into that critical mode in a second. It helps that she’s also not personally connected to Sector 7, and thus her judgement was not as impaired. Of course, they both switched into critical mode in the sewer, but it was at the moment of reveal that made it different. Just like how healthcare providers switched at the moment of reveal that their patients are at the brink of death—you immediately jumped into rescue mode.

2) She plans for the worst.

Remember after they defeated Abzu and Tifa started to question Corneo’s information? She didn’t want to believe it, because it didn’t make sense to destroy your years of efforts building the plate just to get back to a small group like AVALANCHE. Think about the money they put in to build it, they’re gonna have to put them all again. In fact, along their way out of the sewer, Tifa voiced out multiple times how this had been bothering her. But I’m intrigued with Aerith’s reply “If he’s telling the truth, then we should go. And if it turns out he was lying, then so what?”. This here is exactly what doctors do. We plan and prepare for the worst. And if the worst didn’t happen, then so what? If you have ever had a life saving surgery, your doctors would tell you “You need this surgery coz you might die. But if you do the surgery, there’s a high chance you’ll survive, but there’s a small chance you’ll die too”. And we prepare for that small chance that our patients die. No, we don’t let our preparations lacking because we hope they’ll survive. We prepare to the worst outcome possible and get all the equipments ready in case they’ll die. If they didn’t, then so what? It doesn’t mean our preparations were futile efforts. It only means we were prepared. And that line of Aerith seriously hits home to me.

3) She hopes for the best.

Before they crossed the water sewer, Tifa once again voiced out how she couldn’t stop thinking about what Corneo said, and she was still hoping that he was lying. And then Aerith said “The future isn’t set in stone”. (Again, I’m gonna ignore the meta part of Aerith) And then she proceeded to set up that small date with Tifa. Believe it or not, this is actually what we do during bad calls. We’d talk about what we would do after all this ends; we’d go out dining, or playing games/darts, or go drinking, or whatever it is that makes us happy. Just to keep our minds calm and to allow us to hope for the future, even if it’s just a few hours away. It gives us hope and courage to go on. We plan for the worst, but we hope for the best. The more critical the situation is, the more you need to be level headed. And needless to say, after this point onwards, Tifa is much more calmed down from her struggle to keep herself focus.

4) She follows orders.

This might sound weird to some, but the ability to cast away your worry and focus on what you can do, instead of what you should do, is important in emergency situations. You need to know what you don’t know. You don’t get in the way of your comrades. If you’re not good in intubating, you don’t insist to intubate in emergency situations just because you wanna help. Seriously, you’ll just make things worse. When Cloud, Tifa and Aerith were attacked before climbing up and out of the sewer, Cloud asked both Tifa and Aerith to keep going. Aerith immediately answers “Okay” and left—without a single but. This is significant, because it shows that Aerith knew she’d be better off leave. She doesn’t need to offer help, coz her help was not needed. This is not the place where she could help. The ability to recognise this is very important for healthcare professionals. Tifa was a bit more reluctant to leave, but that’s probably because she is a martial artist in game. Also, the fact that Aerith could still joke “We’re not delicious” is just so real lol! Yup, we joke sometimes when we’re facing deaths—doesn’t mean we lose focus in saving the dying person in front of us, don’t worry. And then it happens again when they reached Sector 7 when Cloud asked them to stay with Wedge as he goes up, and Aerith immediately answered “sure"—because she can “patch” Wedge up, it’s where her abilities lie. This is even more accentuated when an injured Wedge argued that he can still fight, when he clearly can't—making this point even more obvious. Aerith is someone with the healthcare mind, Wedge was not.

5) She supports her comrades emotionally even when she’s worried too.

When they reached the surface, they spotted Shinra helicopter. Cloud assured them they’re only on patrol. Aerith turned to Tifa and said “Don’t worry, we’ll make it in time”. This moment is also very iconic to me. As I mentioned, I’m an anaesthesiologist. We are the support doctors to surgeons and physicians. Those moments when we’re operating on a AAA surgeries and the patient is losing litres of blood and literally dying, we’re pumping bloods in with our hands and get those Level 1 machines operating, and the surgeons would be panicking because it keeps bleeding? Yep, I did say it before. “We’ll make it. Just concentrate with the surgery and don’t worry about the bleeding”, even though I’m sweating and dying here trying to keep the patient alive. But I pretended to be calm in front of my team and cheered them on. Because the whole team need to keep calm. If one of the team lose hope, then bid your chance farewell. As an anaesthesiologist, we’re almost like the anchor in the room. People look at us to know if everything’s alright. I need to tell them it’s alright, so they need not worry. Aerith knew Tifa is worried. And she tried to keep Tifa calm with reassurance.

6) She doesn’t discriminate.

After they defeated the ghost at the haunted maintainance facility, Cloud tried to kill it, and Aerith didn’t let him. When Cloud said that thing was dangerous, Aerith said she knows and added “but even so…” she didn’t feel right about killing it. (Let’s ignore the fact that the Ghoul was a lonely creature for now) It then goes to drop the train wreck which almost killed them had it not been for Cloud. Now this would have been avoided had Aerith let Cloud killed it—maybe. But here’s the thing. When you’re hyper aware that people are dying left and right, you value life more. No one deserve to die, even the worst criminal in the world. You’re a law-abiding citizen? You’re a criminal? It doesn’t make a difference to us. I know this is something super hard to comprehend. But technically only when the law subject the criminal to death sentence that a person should be left to die. I’ve been a doctor for eleven years, I was a prison doctor for two. I had first hand experience of dealing with criminals. It’s not my job to determine whether they deserved to die or not. It’s not my call whether they will turn a new leaf or not had they lived. I know this is something others find difficult to relate and agree—happens to my non-medical family and friends. The verdict to us is simple. It’s a life. It’s worth saving. Period. (Technically the ghosts are dead though but my point still stands)

7) She tries in her best abilities and lets go of what is out of her control.

Tifa’s emotions are tampered again when they confirmed Shinra was going to drop the plate when they overheard the Turks conversation. Her voice shook, we can literally hear it. Aerith’s response was “all we can do now is keep moving”. And she’s right. When they reached Sector 7 and the Whispers were preventing them, she said “we have to get past whatever it takes”. And later on Tifa left to help Cloud and Barret, and Aerith agreed to get to Seventh Heaven to ensure Marlene’s safety. Wedge had a short mental breakdown when he realised he was no good to anyone up or down the crime scene. And Aerith told him “We can still save a lot of lives”, “That’s no excuse to give up”, “I need to know I did everything I could”. Her encouragement helped Wedge save more people. Some argued, did she not care about the lives that already died? Now here’s my point; no, we don’t. Sorry if this sounds harsh, but really. What can we do for people who are already dead? Nothing. What can we do to people who are still alive? Everything. And this is the core of being a healthcare provider—we prioritise. Yes, we’re also humans. We can get emotional when our own friends and relatives die. (Aerith might not be as calm had it happened at Sector 5) But when we put the healthcare provider cap on, we meant business. That is why when disasters happened, and we triage people with black tag? That’s when we know we couldn’t do anything for them. We don’t mourn at the black tags. We move on to the other tags instead. So that we know we already did everything in our power to help. And yes, it doesn’t matter even if we lost more lives than we saved. It’s worth it, even if we only saved one person out of thousands deaths. Just like how Aerith saved Betty in Sector 7, that one life is worth it.

#no one can resist the puppy