Avengers: Search for the Winter Soldier
Chapter 36
Soldat: Evaluation Results, Pt. 1
The Soldier's team visits Dr. Golden to learn what she's found so far as a result of Soldat's tests and the varying exercises she's had him participate in over the previous week.
After they'd found the soldier in a fugue state in the bathroom, Dr. Golden went to her office to prepare for a meeting with the soldier's team. She'd gathered Soldat's evaluation results and wanted to share those results with the team before proceeding with the Soldier's evaluation. As she was completing her preparations, she contacted Sam via his earwig and asked him to gather the team in her office and to find someone to sit with the Soldier while Steve and Bruce were otherwise occupied.
Sam found Wanda in the common room and asked her to watch over the soldier while the team gathered with Dr. Golden. Wanda was more than happy to help out. She'd enjoyed her time with Soldat, although her time with him was much more limited than the other Avengers. She found it intriguing to have a chance to spend a little time with the man known as the Winter Soldier. That was all Sam had told her… they believed the Winter Soldier was taking control again. Their plan was to now put him through the same psychological evaluation that Soldat had just completed, but Dr. Golden wanted a chance to give the team information she'd gathered on Soldat before moving forward with the Winter Soldier.
He escorted her to the soldier's room and found Steve sitting in the chair watching the Soldier who was still unconscious.
When everyone had gathered in Dr. Golden's office, she began the meeting.
"Just through observation it was very easy to diagnose him with ASD which has developed into an extreme case of PTSD," Dr. Golden told them. "I honestly don't think the effects of repeated traumas have escaped anyone here who has spent even a few minutes in the same room with him."
"ASD?" Steve asked.
"Acute Stress Disorder," she explained. "The symptoms of ASD usually appear right after a traumatic experience and typically last less than a month but since he is re-traumatized repeatedly, the symptoms never have a chance to dissipate. ASD presents itself through persistent negative moods, as well as symptoms of dissociation, avoidance and arousal. Now, each of us has witnessed at least one of these disturbances outside of a clinical study. In all of the social settings we've presented to him, he's exhibited one or more of these responses.
"The negative mood symptom has been identified, and quite easily I may add, by his persistent inability to experience positive emotions; the blank expression that only changes to show fear or confusion -? He doesn't smile or laugh and actually seems to not understand why we do. His natural response to pleasant experiences has been essentially erased. Basically, he has no understanding of how to respond to positive cues because his handlers… essentially, those inside Hydra have taken all positive experiences away from him along with his ability to identify a positive experience when he is presented with one or even engages in one."
"Yeah," Steve nodded. "It's heartbreaking to watch. As much as Bucky used to love to laugh… he was always smiling and never took things too seriously. It hurts to see. It really does."
"I know, Captain," she replied, "but that's why he's here. So we can help him… we're going to help him find his smile."
Steve looked over at her with a sad smile and nodded. "What were the other symptoms you've identified?"
Dr. Golden looked down at her monitor to the notes she'd made. "The dissociative symptoms are readily apparent. He has a definite altered sense of reality… of his surroundings and of himself. He knows nothing about his world that isn't connected in some way to Hydra or Karpov or Alexander Pierce. The only people in his life that have any true meaning for him are handlers, wranglers and controllers. He has no clue that he's here to be rescued from that horrible life… he can only see and think Hydra. Some of the dissociative symptoms that I've identified have presented as fugue states… we've found him a number of times just staring blindly into space…"
Each member of the team nodded, they'd all seen it at one time or another.
"- even this morning, finding him leaning against the wall in the shower staring at the floor. He had no idea where he was, who was with him… he didn't even know anyone was there. He was easily physically maneuvered and his needs were taken care of without his conscious knowledge."
Steve nodded, thinking back on that moment and finding him in that condition. He had no idea how or if they were going to be able to find Bucky inside all that was happening… all that had happened to him. The tiny flickers of expressions or behaviors he'd identified as belonging to Bucky may simply be wishful thinking on his part and he knew that. His thoughts were interrupted when Dr. Golden continued.
"He's also dissociated by way of a very scary flashback episode… not just scary for him, but for all of us who were involved or witnessed the event. Flashbacks used to be viewed as a vivid memory that intrudes into the present causing the victim to re-live the trauma. Now it is believed to be a dissociative event. Usually dissociation happens when a victim is trying to avoid memories or an external trigger, but a flashback is believed to be a dissociative event that does not allow the victim to escape the memory of the trauma but instead forces them to re-live the trauma in detail by dissociating them from the present reality."
"Geez-us," Clint breathed out, remembering the day the soldier had experienced one of these flashbacks and had to be taken down by Cap. He'd been so out of control that the entire team had to come in to pin him to the floor so Bruce could sedate him. Dr. Golden looked at him for a moment. She watched as Barton re-lived that moment in his own head. She nodded to show she understood before continuing.
"Now the actual act of dissociation can present itself in a few ways," she told them. "It can present as physical sensations… either as pain, discomfort or even numbness. It can present at the level of thinking only, such as remembering that the event happened but the mind has erased or has compartmentalized certain details that are too difficult to face. Amnesia, in varying degrees, is the most common form of dissociation.
"There is a tool psychologists use to look at dissociation called the SIBAM model, which stands for Sensation, Image, Behavior, Affect and Meaning. Sensation refers to physical reactions during the dissociation also called somatic memories. This is when the victim feels the pain or discomfort of the event or goes in the other direction and the body becomes numb to the physical trauma.
"Image refers to the pictures that remain in the victim's head…the images they witnessed of the event itself or of the perpetrators of the event. In the bathroom the other day, when he was caught in a flashback memory… kicking out and punching his assailants… he didn't see Steve… or Bruce or Clint… he saw the men of Hydra who had attacked him and pinned him down as they assaulted him."
Steve lowered his head, threading his fingers together in his lap and clenching them so tightly that his knuckles turned white. Dr. Golden noticed his attempt to quell his emotions. She let him have a moment and then continued.
"Behavior refers to what the victim did during the traumatic event. Some victims freeze in terror and are unable to defend themselves against the threat. Some victims believe that if they comply with whatever the assailant wants they will be spared a worse fate. Usually, those victims end up blaming themselves for allowing the event to happen by "not doing more to prevent it", and that guilt haunts them as much as the crime against them.
"Again, looking back at the flashback event in the shower… he fought them. From the behavioral evidence we witnessed he fought them hard until he was overpowered… most likely in much the same way this team was forced to overpower him… which only added to his sense of reality in that moment. We had no choice but to do it, for his safety and ours… and there was no way of ending it without having to sedate him. His behavioral response to reliving that particular event makes it extremely apparent that that was a violation that did not happen easily. He showed us that. He fought, he yelled, he screamed… he panicked. He showed us so much during that flashback… Sgt. Barnes was not overcome by Hydra easily.
"Affect refers to how the event affected the victim's emotions. Again, that was made vividly clear to us."
"At least he won't be able to blame himself for any of it," Clint said and everyone looked at him. "Well… I mean, he fought them… I was there. He put up a hell of a fight. At least guilt is something he won't have to live with."
"Oh, I guarantee you he will still blame himself at times. Perhaps even all of the time for all that he had to endure," Dr. Golden told him.
"But he fought… hard," Clint said, trying to make sense of it.
"Victims of such violence will always blame themselves," she told them. When Clint's expression shifted to confusion, she added, "They will always believe there was more they could have done. Even when there was no possible way for them to prevent the trauma," she explained.
"Human beings have an innate need to believe they are always in control of themselves and their lives. When that belief is shattered, it is still a very difficult thing to accept and to admit to ourselves. It's that sense of autonomy that makes being human such a beautiful experience… when not tarnished by such evil acts against us."
Clint now understood what she was saying and nodded.
"The final reference; Meaning, pertains to how the victim was able to make sense of the event… if they were able to make any sense of it at all. I believe Sgt. Barnes, Soldat… perhaps even the Soldier himself, has not made sense of any of the traumas they've – he's – endured. How could anyone make any sense out of being tortured and mutilated for someone else's desire for world domination?
"Sgt. Barnes, along with Captain Rogers and the other Howling Commandos, fought against the Nazis and then they were given a focused mission to take down Hydra. That was what the Commandos were charged with… taking down Hydra. Sgt. Barnes fell in that war against Hydra only to have awakened one day to find himself a prisoner of the very organization he'd been charged with stopping. Then he found himself a tortured prisoner who was being conditioned and re-created to serve Hydra's needs.
"Now, the flashback he experienced appeared to have been triggered by Captain Rogers' touch, and often it's something as simple as that. There is no way to predict what will cause a flashback to be triggered, but what you do have to understand is that when a flashback occurs, those traumas he's experienced in the past get re-played with great intensity and he's unable to separate the flashback event from present reality and the issue with that is… the flashback reinforces the impact of the trauma on the victim. In essence, the victim is re-traumatized by every flashback they are forced to re-enact.
"Often it is difficult to make sense of a flashback, especially when there is no explicit event to use as a reference point. Sometimes, we'll see a full event played out during a flashback, like the one we had witnessed downstairs. Other times, we may see a brief glimpse of a flashed memory… we refer to these fragmented memories as intrusive recall episodes. They are not planned and often times cannot be explained by the victim, which makes the intrusive fragment even more frustrating, because they can't make any sense of it.
"This is going to be one of the biggest issues that we're going to have to focus on… not only with Sgt. Barnes whenever he makes an appearance, but right now with Soldat and the Soldier. I'm absolutely certain that what happened in that shower room was triggered by the intrusion of memories into the psyche they all share… and it doesn't matter which soldier experiences the trigger."
The members of the team sat quietly; each one thinking about what they had already seen or experienced to this point with both Soldat and the Winter Soldier. Emily gave them a few moments to follow their own thoughts as she scrolled down the screen in front of her reading her notes.
She paused long enough so that the shift in subject matter wouldn't be too much of a mental shift for them then she continued.
"There is another aspect of the PTSD diagnosis that has been made apparent. Avoidance symptoms have also been identified by both Sam and Natasha during their individual time with him this past week." The others looked to Sam and Natasha and they both nodded in support of that evidence. "They each reported to me that he pulled back from them when they attempted to do something fun with him or what we consider to be a normal activity. Fun for normal people, that is… not fun for him at all."
"What sort of activity?" Steve asked, now curious as to what he'd pulled back from.
"Well, Natasha brought him for a walk in the garden. Each day she found time to bring him out to the gardens even if it was only for a few minutes. She said he seemed to like being out there… fresh air, sunshine, blue skies…" Natasha nodded as Emily consulted her notes before continuing. "On the fifth day, she thought she might let him water the gardens… let him participate in a normal activity that would be an easy challenge to overcome. She was going to let him water the garden. The garden hose was coiled on the hook nearby on a pre-connected pipe."
Steve and the others nodded; they understood the scenario because they'd seen the various hoses discreetly hidden among the gardens for the gardeners to have an easy time of tending to them.
"When Natasha pulled the hose toward him she said he immediately cowered."
"Yeah," Natasha interjected to give the group details. "He dropped to the ground on his knees and covered his head. He was trembling so badly that I couldn't even get his attention to show him that I'd put it away."
Emily gave her a nod and then added, "Apparently, being hosed was a repetitive punishment and I'm guessing it wasn't done with something as harmless as a garden hose."
Steve clenched his teeth together so hard, Emily could see the muscles in his jaw flex. His nostrils flared as he drew in a breath to try to keep his anger impulse at bay.
"The next day, as Natasha was walking him out to the garden he stopped on the path and refused to go further. The garden now held a threat that he hadn't been aware of prior to her actions. That is what is referred to as an aversive response and now, because that detailed memory was introduced into the garden setting, he can no longer find peace or the sense of safety he may have had in that area prior to that action."
Natasha lowered her head with the realization that she'd taken something precious away from Soldat without knowing what effect her actions would have on him. Clint saw her response and reached over to rest his hand on her back to offer her support.
"But he'd been in the gardens before," Steve recounted to her. "He must have seen the hoses stored on the hooks. They're placed discreetly, but anyone can spot them if they're looking around and the way he scans any area he's in… he had to have seen them."
"Having seen them hanging there in a resting, passive state and having someone uncoil one in his direction are two different things," Dr. Golden explained. "He had a marked psychological and physiological reaction in response to an external cue – what we call ia trigger/i - to an action that resembled a traumatic event in his memory. He has been conditioned by those traumatic events to react and respond accordingly… exactly the way Hydra wants him to."
Steve nodded; leaning forward in the chair he kept his hands clasped together as he listened. Emily scrolled down the page from which she was reading.
"Arousal is the final category in the ASD diagnosis," she told him.
"Arousal?" Steve interrupted. "I thought the chemicals he was given were designed to specifically prevent that from happen–"
"I'm sorry, Captain," Dr. Golden stopped his train of thought, raising her hand to signal him to stop talking.
"That's not the kind of arousal she's talking about," Sam informed him. "It's a type of psychological arousal… like being hyper alert all the time."
"Sam is correct," she stated and went on to explain. "The type of arousal to which this refers is a physiological arousal, not a sexual one. It refers to physical and psychological arousal which can manifest in a number of ways; a rise in blood pressure, heart rate, hyper-vigilance, nervousness, irritability or outbursts of anger… sleep disturbances that include difficulty falling asleep or the ability to stay asleep, waking up numerous times through the night… it also includes restless sleep and waking up abruptly due to nightmares or night terrors.
"We've all witnessed his hyper-vigilance as he enters a room or walks outside; that heightened state of awareness… always looking over his shoulder, always on alert for threats or impending danger. He clearly has difficulty concentrating on any task we present to him. Even when he completes the task it is quite clear that he is attentive to his surroundings. That heightened state of arousal also includes an exaggerated startle response, which we all were witness to the other morning at breakfast when you tapped your fork on his plate."
"Oh, geez, yeah," Steve remembered that moment. Soldat had startled so drastically to the sound that he even made Steve jump in surprise. "I felt so bad for doing that to him."
"You had no idea that would happen. ASD is diagnosed when all of these disturbance symptoms are present and can occur at any time up to thirty days after the traumatic event that caused them and they have to significantly impair social functioning or other areas of functioning where other factors can be ruled out, such as drugs or alcohol use."
"It's definitely been longer than thirty days," Steve mentioned, "more like seventy years."
"That's true, for some of those traumas," Emily replied nodding. "But these traumatic events have not ended for him. They are repeated on a daily or weekly basis so those actions continually reinforce his symptoms of conditioning and the affects of the trauma on him."
"How can they be repeated daily?" Steve asked, confused. "The files record clearly that he was in stasis for six months or more at times."
"Yes," Emily nodded, "but the fact that he was put into cryo-stasis immediately upon return to Hydra means that however long he was in stasis, he is oblivious to the passage of time. So, for him, any mistreatments that may have taken place six months prior in real time, took place yesterday for him… and because of these long lengths of time passing while he's asleep, I guarantee he's going to have issues with understanding the passage of real time because his real time has been distorted for decades.
"And… the exam Dr. Banner performed on him after the incident in the shower room… proved to us that that flashback event was in direct response to an assault he'd been victim to just a week or so before we brought him here. "
Natasha looked around the room to see all the men were nodding. "I'm sorry," she said, "but to what exam and what assault are you referring?"
"I'm sorry, Nat," Dr. Golden offered her apology. "I forgot that you weren't present at that time. Has no one filled you in on the details?" Natasha shook her head; she hadn't been let in on the details of this particular event.
"Sorry, Nat," Clint added. "We wanted to tell you, but –,"
"- we didn't know how to say it out loud," Sam finished for him.
"What happened?" she asked, now feeling worry bubbling up inside her.
"The soldier had a severe flashback event the other day that was triggered by Captain Rogers and Dr. Banner as they were tending to his needs.
"He told me 'no', and I didn't listen," Steve added. "I didn't understand that he wasn't saying no to me."
"He had already been triggered by external cues that caused vivid memories of what I believe to have been… a violent rape…" Dr. Golden informed her.
"Oh my god," Natasha whispered.
"He had attempted to escape and found himself cornered in the shower stall… which I can only imagine is where such an assault would take place," Dr. Golden continued. "When Captain Rogers went in to try to talk him down, the soldier became terrorized and fought very hard in his own defense. Steve was able to get him pinned to the floor briefly, after taking a pummeling of his own…"
"So that's where that came from," Natasha commented on the small abrasion on Steve's right cheekbone and he nodded. It had been left behind by a single impact of the metal fist before he was able to get his hands up in front of him. Luckily, the soldier was able to land only the one punch.
"It took all four of us… Clint, Tony, Steve and me to get him under physical control so Bruce could come in to sedate him," Sam added. "That was probably the worst thing I've ever had to take part in while trying to help someone with –."
"You all did a fantastic job that day," Dr. Golden told him when he couldn't finish his thought aloud. "You were able to get the Soldier under control without anyone getting hurt, including him. I know it was a difficult situation to witness, but you all did a phenomenal job."
"You said you've diagnosed him with Acute Stress Disorder and PTSD," Steve mentioned, circling back around to the beginning. "The symptoms you just mentioned related to ASD sound an awful lot like symptoms of Post Traumatic Stress."
"Yes, they would," Emily told him, "because the symptoms of PTSD are the same as the symptoms for ASD."
"Then why are they separate diagnoses?" he asked.
"Because, Captain, the symptoms of ASD are supposed to only last up to three months which is considered brief, short-lived or acute, hence the label of acute stress. PTSD symptoms go further than that; sometimes lasting a lifetime. The biggest difference is that PTSD sufferers have not only been exposed to a traumatic experience, but they have also been exposed to actual death, threatened with death or serious injury, or have experienced sexual violence either through direct experience or exposure to the event, witnessed the event in person or had repeated or extreme exposure to any of those situations," Dr. Golden explained.
"Now, we know for a fact that he's experienced his own death," she reminded them. "Hanging from the side of a speeding train hundreds of feet above the ground would be a traumatic experience in itself, enough to cause post-traumatic stress. Being faced with your own mortality… it's enough to cause the symptoms I've described. But let's go beyond that… Sgt. Barnes actually fell from that speeding train and during that long fall he knew he was about to die… that awareness is traumatic enough to shatter the psyche.
"He died. The Hydra files clearly record that after he was recovered from the ice he was in fact deceased upon thawing. He had to be revived by extreme measures. Then after they brought him back to a living state… they kept him in suspended animation… cryo-stasis, for weeks and months at a time. At one point he was in stasis for over fifteen months. People around him were aging years overnight, by his perspective… except him. I believe he was very much aware of these changes but didn't understand them. I think he would have been very much aware that time was moving on without him… that alone could very easily cause a confusion of reality.
"They amputated his arm and replaced it with a machine… without his knowledge or consent. They mutilated his body and turned him into something else. What he saw and experienced was waking up to having half his arm gone. Another time he wakes up to having no arm at all, and then he wakes up again to having a metal construct attached to him that he didn't understand nor was mentally or physically capable of using. On top of all that, he woke up in the middle of the surgery… I can't even imagine the horror he experienced or the pain he must have felt.
"And while all of this is happening to him, he has no understanding of why it is happening… or when it will stop. Serious injury or actual death… both of these he experienced first-hand. Repeatedly threatened with death, repeatedly tortured in ways that are difficult for us to mentally comprehend and yet he had to physically and mentally endure for decades… and the traumatic personal experience of violent sexual assault… most likely, repeatedly," Dr. Golden paused there when Steve covered his head with both hands. Not only did she feel Captain Rogers needed to take a break from the details, but she did also. "Let's take a break, shall we? Meet me back here in half an hour."
Natasha moved over to sit on the arm of Steve's chair. She leaned over to wrap her arms around his shoulders to offer her support. "I'm so sorry. I had no idea," she told him.
"We didn't know how to tell you," Clint told her. "It was hard enough for us to think about –."
"Let's all take a walk," Sam suggested. Getting them all out of the room would help a great deal to put it all aside before continuing. "Come on," he urged them all up and herded them out of the room.
Once outside, they unconsciously gravitated toward the dock area. Clint was first to speak, "I had no idea there are so many things that factor into PTSD. "
"Neither did I," Nat added. "You hear people talk about it all the time but I never really knew any of the details."
Sam nodded and replied, "I see it all the time and while all cases are different, they are in a sense, all similar in that someone is trying to cope with something horrible they often don't really understand and can't process."
Steve spoke quietly, "If at all possible, I want Bucky back. I miss my friend… I can't speak for you all but I'm going to do anything and everything I can…" his voice trailed off and he looked across the lake.
The others stood around him and nodded in agreement – whatever it takes. They really didn't need to discuss it or hash it out; it was unspoken… a language they all knew well. They all felt the weight of what Barnes was going through and what he had gone through. It was having an effect on all of them, as a team and as individuals.
Natasha had even started having dreams again that woke her up in the middle of the night. Dreams she hadn't had to deal with in years were coming back to the surface; the Red Room, the KGB, her training, her own torture… Dreykov and his daughter. The things she had been made to do against her will… her own subjugation and punishments… and her escape. Sometimes her dreams started off good; remembering the day she first met the Soldier… her training with him and his own defiance to not be subjugated to their will. She'd fallen hard for him… for James. She couldn't tell anyone this though so she kept her secrets close to her chest.
Steve couldn't stop thinking about his childhood friend. All those times that Bucky came to his rescue. Everything he'd shared with Dr. Golden and Natasha about his friendship with Bucky just kept churning in his head. It haunted him. Sometimes he just wanted to grab onto the Soldier and shake him as hard as he could as if that would jar Bucky loose from his moorings deep inside the Soldier… somewhere, just waiting for Steve to free him. Steve lowered his head and shook it slowly. The others noticed and Sam, standing behind him, placed his hand on Steve's shoulder. Natasha stepped up to him and wrapped her arms around his waist. Steve wrapped one arm lightly around her and turned his head to give a nod to Sam; when he turned back, Clint was standing there holding his hand out and Steve reached out to him. The two men grasped the other's forearm in a sign of solidarity. It was done; the pact was complete – 'whatever it takes'.