Avengers: Search for the Winter Soldier
Chapter 37
Soldat: Evaluation Results, Pt. 2
Dr. Golden continues the meeting, explaining the results of Soldat's evaluation to his team once they've returned from their walk in order to absorb all that they'd learned so far.
Before the team returned to Golden's office to hear the rest of the results from Soldat's evaluation process, Steve stopped in to check on Wanda and the Soldier. He was still asleep and Steve made note that the IV drug therapy was below half. He'd let Dr. Banner know that when he returned to Golden's office.
"How are you doing?" Steve asked and Wanda smiled at him.
"I'm fine. No need to worry, Captain. It's under control," she told him.
"It's always under control when he's asleep," he told her and that got him another smile.
"I can handle him, Steve. Trust me," she said.
"Oh, I do," he told her. "You wouldn't be in here if I didn't. I'm on radio; call me if he wakes up."
"I will," she assured him and he left her to her duty.
The rest of the team members were already there and enjoying some casual conversation near the bar when Steve reached the office. Sam had poured a cold drink for each of them; non-alcoholic, of course. Clint was facing the door when Steve entered and he nudged Sam, lifting his chin toward the door to indicate that Rogers had arrived. Everyone went back to their seats and Bruce joined them to listen in on what Emily had to tell them. She'd already gone over the evaluation results with him as it was customary to consult with other physicians in such cases. Between the two of them they had both the physical and psychological issues covered.
As Banner took a seat with the team, Steve turned to him. "I stopped in to check on Wanda," he told him. "The fluids bag is about a quarter full."
Bruce nodded and checked his watch. "Thanks. I'll take care of it as soon as we're done here." Steve nodded and looked up as Emily walked by them.
Dr. Golden returned to her seat after retrieving another file folder from her desk. She looked at the group in front of her and gave a nod. Everyone was in attendance so it was time to finish this part so she could get started on the Winter Soldier's evaluation. She had his copies of the testing procedure all set and ready to go as soon as he was ready to participate.
"One of the exercises I had him complete is a drawing exercise," she told them as she picked up a folder from the table beside her. There were a number of pieces of paper sticking out of the folder. "This drawing exercise consists of five drawings total. I gave him a blank piece of paper and told him I wanted him to draw himself. Step one is called 'This is me' and it is supposed to depict how the patient sees himself or thinks about himself and who he is –," she explained to the group and slid the top page out of the folder and handed it to Steve.
Steve stared into her eyes as he took the page from her hand. He really didn't know if he wanted to see the drawing… especially after he heard Natasha gasp softly and Sam's tongue made a clicking sound behind him. He dropped his eyes to the page to see that it was covered with scribbles in black crayon. The entire piece of paper was nearly completely colored in by what looked to be wild, uncontrolled strokes that went in every direction.
His heart was pounding now and he tried to control his breathing by inhaling slowly through his nose and letting it back out the same way. Each member of the team could see the picture Steve was holding. Natasha reached over and carefully took the page from Steve's fingers and that prompted Dr. Golden to continue.
"The second step in the exercise is called 'This is my space' and is supposed to depict how he sees his world… how he sees his place in the world."
She handed Steve the second page that had a large awkward circle taking up as much of the paper as it could without going off the edge. He'd drawn the continents of the world almost perfectly and there was a tiny red dot at the bottom of the page just outside the circle. Steve looked up at Emily, confused about what he was looking at.
"The circle," she explained, "is obviously supposed to be the earth… the world as a whole… that tiny red dot at the bottom of the page he sees as his space. A tiny bloody dot not a part of the world as we know it… he sees his space as if he exists outside of our world… literally."
Steve held the page in one hand and covered his mouth with the other. He stared at that bloody looking dot hovering outside the circle until Natasha reached over his shoulder and slid it gently from his grasp.
"This one… is called 'This is my past', and is supposed to show how he sees his life's progression up to this point." She handed the page to Steve. He took it from her fingers and flipped it over to look at both sides then looked at her confused.
"It's blank," he pointed out.
"Yes, it is," Dr. Golden replied. "To Soldat, he has no history… no life before." She thought about that for a moment and shook her head. "I don't know if that is an insanely brilliant way of telling me that he knows the life he's living isn't worth being counted as a past… or if he is telling me he only focuses day to day… no past, no future…"
"Maybe it just means he doesn't remember what came before," Clint suggested.
"That's possible," Dr. Golden agreed, "but, considering his terrified behavior, I'd say he remembers enough."
Steve handed the page to Natasha to keep with the other two as Emily slowly pulled the next one from the folder.
"This one is called 'This is my family and me'. Dr. Golden hesitated a moment and then turned the page over for the group to see as she handed it to Captain Rogers.
Steve gasped, but was able to slam his mouth shut to contain the expletive that was to follow. He raised his hand to his forehead and stared down at the drawing of a blonde boy holding a round object with a star in the center. Sam put his hand on Steve's shoulder as a supportive gesture and Natasha draped her arm around him. They all stared at the little boy holding Cap's shield and then Steve frowned.
"Where is he?" he asked. He looked up at Dr. Golden. "You said 'my family and me'… he sees me as his family… but where is he? He's not in the drawing…"
"No, he's not," she answered. "He's not there. That's what it means. Take from it what you will…" she told him and then sighed softly. "It could mean a number of things… all of which are sad." She then pulled out the last of the pages and handed it to Steve. "This one is called 'This is me'… it's supposed to be a repeat of the first step and is supposed to develop from how the patient sees themselves at the beginning of the exercise and then, after drawing their family and their space and their history… they realize how good, or how bad, they've had it…. And in the end show me the new image they have of themselves…"
Steve took the page and covered his mouth with a hand as he looked at the black and red crayon scribbles on the page. He assumed the red was supposed to be blood… and the black represented the darkness he felt surrounded him.
Darkness and blood.
Darkness and death.
That's how he saw himself… Steve's head twitched to the side as if he'd been punched and he stood up, dropping the paper in Emily's lap as he walked to the windows to look out at something else. She regarded him for a moment and then continued.
"I've had him take part in a number of different tests; some were targeted psychological tests, most of them focus on memory retention and other cognitive abilities. I don't intend to go through the results of each one with you… we'd be here all night. His ability to remember things he's told… whether it be a list of words or asking him to repeat a short story that was read to him as best he can… he scored extremely low.
"I also presented two behavioral tests that focus on a scale of independent behavior and one for adaptive behavior. These tests assess functional independence and adaptive functioning across different social settings. As you all can guess, he scored very low on the independent behavior test. We've witnessed for ourselves that he shows no ability to act independently from a controller or handler telling him what to do. That being said, he scored extremely low on the adaptive behavior scale as well."
"What exactly is adaptive behavior?" Clint asked.
"Adaptive behavior encompasses real-life skills such as self-grooming, getting dressed, following the rules, money management, identifying and avoiding dangerous situations, safe food handling, house cleaning, and making friends… among other things. It also includes the ability to work, practice social skills and taking personal responsibility. He's only recently learned how to wash and dress himself… but he still does not understand that he's allowed to choose what clothes he wears or what food he eats. He has no understanding of finances or personal organization… why would he?"
"I then had him complete two psychological and emotional exams. One was a social anxiety scale which I know I don't even have to detail for you, but there were two others that I found extremely interesting. One is called Draw-A-Person and it's a score rating system. It's scored by giving a rating to each detail that is drawn… for example, did the subject draw hands on the person and if so, did he draw five fingers on each hand or did he draw them in the shape of mittens… or just a circle at the end of the arms, that sort of thing. Did he give the person eyes and hair and clothes? That type of thing. I asked him to draw a picture of a person in general, not a specific person, just a human being in general… this is what he drew."
She pulled a sheet of paper out of the file folder and handed it to Steve. The drawing was a recognizable facsimile of a human being; it had a head and body, two arms and two legs. The face was left blank with no attempt to give the drawing facial features and the head had no hair; it was just a blank circle. The two feet were drawn as military style boots and the hands were drawn as circles which looked like fists… and in one hand he'd drawn a pistol and in the other hand was an object that looked like a stick.
Dr. Golden sat quietly as the team looked at the drawing. After a few moments Steve looked at her and said, "Maybe he just can't draw."
"You would think that would be the obvious conclusion," Dr. Golden told him and pulled another sheet of paper from the file folder. "I asked him to draw a person who was important to him… perhaps someone with whom he enjoyed spending time with." She held up the drawing so the whole team could see it before she handed it to Steve.
Steve held his breath as he reached out to take the sheet of paper that had a beautifully sketched portrait of what obviously could be assessed as… himself. It was hardly a professionally rendered portrait but it was clear to all of them; the shape of his face, the light colored hair styled pretty much the same way as his… there were two perfectly shaped eyes well spaced to either side of the nose and the mouth was curved into a soft smile and he'd drawn lips, on top of that he'd even included a small dot on the left cheek to represent the single freckle on Steve's cheek that his mom used to call a 'beauty mark' … and beneath the face, he had drawn an almost perfect star. Steve took a deep breath and let it out then raised his eyes to Emily. She smiled at him.
"I think it's safe to say he can draw when the subject matter he's drawing has meaning for him," she told them. "Having seen that sketch portrait which I think we can all agree is supposed to be Captain Rogers… it makes this one," she said, holding up the generic sketch of a humanoid being, "even more concerning. He didn't draw a person the way a person looks because he can't draw… he drew a person without detail because that's the way his mind sees other people. It's the way Hydra wants him to see other people… as unidentifiable objects. It makes it easier for a brainwashed assassin to complete his missions if he doesn't identify with other people at all.
"The other test I gave him is called Sentence Completion… I give him a sentence and he is supposed to fill in the missing words either in the middle of the sentence or at the end. I gave him five sentences… it was supposed to be ten, but when he made no attempt whatsoever to complete the first five, I ended that exam."
"Well, he can't speak," Steve reminded her.
"I was in the room as his translator," Clint told him. "He… simply didn't seem to know how to complete the sentences."
"Why do you think he didn't respond?" Natasha asked Dr. Golden. "Did he not understand what he was expected to do? Or did he not know how to fill in the blanks?"
"I really don't know," Dr. Golden told her. "I gave him the instructions and asked him if he understood what I was asking him to do and he nodded, but then made no attempt to offer any words at all."
"Yeah, a lot of the time I just sat there waiting for him to sign words and he just … didn't," Clint told them.
"I don't understand what these evaluations are supposed to tell us," Steve told her. "We already know that he appears to be… impaired. We've seen evidence of that."
"Yes, you're right," Emily replied, "but if I'm going to have anything to present as official findings I have to put him through the battery of testing. He needs to be scored and rated according to the scales of each test. These evaluations and the results of them are admissible in a court of law," she told him and Steve looked at her over his shoulder. "If his crimes ever go to trial… we're going to need these as part of his defense."
"Crimes, Steve spat out. "Hydra is responsible for whatever crimes he committed."
"Well, that would be what we would have to prove," she told him. "The battery of neuropsychological tests I had him engage in was the most significant and the most interesting."
"Neuro-psychological?" Steve echoed, looking confused.
"It's the study of the relationship between brain functions and behavior. Over the past week I presented him with a dozen or so different tests. Some showed amazing results while others resulted in scores much lower than I would have expected."
"Such as?" Sam asked. "What kind of tests exactly?"
"One of the tests is called Judgment of Line Orientation, in which I show him a diagram that has a dozen lines fanned out creating an arch of 180 degrees. Then I show him a flash card that has a single line on it and he's to look at the line on the card and choose the one in the arch diagram that matches the orientation of the one on the flash card. He did exceptionally well with that test. He scored 10 out of 10.
"Then I moved to the Stroop Color Word test… in which I show him a list of color words, such as green, blue, red and orange… but the word orange may be printed in blue type… the word blue is written in green type and so on… the object of it is to get him to tell me the color in which the word is printed and not the color the word states. So if the word 'green' is printed in red ink, he's to say red and not green. He excelled in that test also, which still amazes me, but he completed it so quickly it was as if all he could see was the color of the type and not the word itself."
"Can he read?" Sam asked. "Perhaps the printed word didn't confuse him because he can only see the color."
"I thought that too, so I tested him on that as well. After he completed the color test, I asked him to show me the words for certain colors and he chose the correct words. The word Green is printed in orange type and I asked him to point out the word Green and he did so.
"I then went into a number of word association tests, which are commonly used to measure verbal fluency. The first one is referred to as FAS, in which the subject is tasked with producing as many words as he can think of that begin with the letters F, A and S given to him one at a time. It is a timed test to see how many words can be given in a one minute time period. He didn't do well with that one.
"The next one is called the Boston Naming Test, in which the subject is shown 60 images on flash cards one at a time and he has to tell me what the image is – such as a dog, plane, apple, fish, things like that. He did really well on that one. I showed Soldat the flash cards and Clint couldn't see them from behind me, but he translated the words correctly as Soldat signed what he was seeing."
Clint nodded in agreement.
"What does that mean?" Steve asked.
"From what I can take away from these first few tests is that he has difficulty coming up with words on his own… out of thin air. Asking him to give me as many words as he can think of that begin with the letter A was pretty much a no-go, but showing him images of an object and telling me what he is seeing he could easily come up with the word for it. Immediately after showing him the sixty flash cards with the pictures on them I then asked him to name as many animals he could think of in one minute and then as many fruits and then vegetables. He named only animals, fruits and vegetables that were shown on the flash cards moments before. He uses visual cues to access the information he needs. Without the visual cue, he's lost. I read him a short story which is used to test logical thinking… as soon as I'm done reading the story to him he's then asked to explain the story back to me in his own words and he couldn't.
"So he has a problem with comprehension, is that what that means?" Clint asked. Everyone looked at him so he added, "My youngest son is in a special education class for reading comprehension. He reads very well, but when asked what it was that he just read he can't explain it."
"Exactly, he can read the words or hear the words as I told him the story and he was probably visualizing the story as it unfolded. But as soon as the story was over, his short-term memory simply couldn't hold onto it," Dr. Golden explained, concurring with Clint's assessment
"The next tests are called Trails… Trail A consists of showing him a piece of paper covered in numbers situated haphazardly on the page. Some of the numbers are circled and some are not. His task was to draw a line that connects all the circled numbers together starting with the number 1 and moving to the next consecutive number. The test includes the numbers 1 to 20. He did that one without much effort at all. He flew right through it, so he knows how to count.
"The second Trails test is called Trails B and this one consists of circled numbers and letters. His task was to draw a line in consecutive order while alternating between numbers and letters… so he would draw a line as follows 1 – A – 2 – B – 3 – C and so on… he made it to 5 – E and then stared at the paper."
"Which means?" Steve asked, looking more stressed with each piece of information.
"I think it means the jumbled images on the paper in front of him simply overwhelmed his thought processes. I tested that theory by creating my own Trails C using only letters and he accomplished the entire alphabet in consecutive order correctly. So he knows his numbers and the English alphabet.
"During each of his evaluation sessions I also observed behavioral indicators that signaled stress or anxiety during key moments of testing. For instance, his tendency to rock back and forth as the subject matter deepened or if the session went on too long and he became tired or anxious; I terminated the sessions as soon as I identified this behavior as a stress indicator."
"I noticed him doing that a few times as well," Steve mentioned, turning from the window. "He did that just yesterday after I got him back in his room from the gym. He huddled in the corner and I went to him. I wrapped my arms around him to try to make him feel safe and he began rocking. Isn't that a sign of autism?" Steve asked.
Dr. Golden gave him a compassionate smile. "Although people diagnosed with autism do often engage in what is termed body rocking, it isn't a symptom related to only autism diagnoses. A person with autism rocks for completely different reasons.
"In Soldat's case, the act of rocking the body back and forth, either from side to side or forward and back; is a self-soothing action for those dealing with extreme or chronic stress. There have been noted cases where the person rocks back and forth in order to stimulate an under active nervous system which is referred to as Hyposensitivity," she explained.
"In Soldat's case, it is more aptly due to Hypersensitivity where he shows evidence of being overwhelmed by input from his surroundings… he rocks to find relief from sensory overload. He may also rock in times of extreme stress because the motion is known to release endorphins that help quiet the mind so this is an action he's more than likely habituated to due to the chronic stress he's lived with for such a long time. As human beings, rocking is a motion that we've learned through millennia will soothe a crying infant. The repetitive action of rocking is soothing and calms the mind. Adults will even embrace each other and unconsciously rock back and forth when comforting a bereaved widow or during other times of extreme stress or sorrow."
"Is there anything we can do to help him stop?" Steve asked and Emily looked at him with curiosity then she smiled at him.
"If it brings him a sense of comfort, if it helps to soothe his mind… why would you want to stop it?" she asked.
Steve thought about it for a moment. "I guess… I'd rather he find comfort from me... instead of himself."
"Himself is all he's had for seventy-five years, Captain. No one else would have shown him any comfort… he hasn't been held or comforted or shown compassion for nearly a century. Any repetitive motion is considered a self-soothing or self-comforting action – some people bounce their leg, others crack their knuckles… some people tap their heel or their toe on the floor… some people snap their gum… he rocks. Some of those behaviors are more socially acceptable than others, but they all have one thing in common… it's a way of relieving pent up stress, whether the person doing it realizes it or not."
She paused for a moment, thinking, and then added, "Perhaps, when you see him beginning to rock… try offering him a hug or even just your hand, whichever you're more comfortable with. It may not stop the rocking motion immediately, or ever, but with repetition he might be able to learn to seek out comfort from others… and even if he still rocks while you embrace him, it would still be a very good thing. The rocking shouldn't be the action we focus on while he's attempting to deal with stress, Our focus should be in teaching him that he can seek out comfort or support from others. He will probably always rock during times of stress or anxiety… he's been doing that for so long now that it's become a tic… but if he comes to you seeking out support or comfort… that's our big win."
Steve nodded and then, after a thought, he asked, "So what does all this mean?"
Emily looked at him for a moment. "I believe Soldat is suffering from a form of aphasia. It's a common abnormality of cognitive functioning after a traumatic brain injury. I believe he also suffers from multi-domain amnestic Mild Cognitive Impairment."
"What does that mean?" Clint asked.
"It means he has cognitive impairment based in traumatic amnesia… a single-domain MCI affects memory only. Multi-domain includes memory issues along with at least one other cognitive impairment. In Soldat's case he also has issues with problem solving, abstract thinking, complex idea comprehension and reasoning.
"Is it permanent?" Steve asked and when Dr. Golden smiled at him, he looked at her confusedly. "What?"
"Apparently not, Captain," she answered. "Since the Winter Soldier is the final step in their transformation and he seems more than capable in many of these areas where Soldat is lacking in ability. Soldat is the one who has been broken down to his base functions so the KGB and Hydra could re-create him into the assassin we all know. I do, however, want to put the Soldier through the same evaluation process to have a complete picture of their capabilities."
"Do you think the Soldier would participate willingly?" Clint asked.
"I don't know if I'd call it 'willingly'," Dr. Golden told him. "I do believe he's taken part in numerous evaluations conducted on him during his time with Hydra. I think these evaluations are seen by both of them as simply a part of their existence. They participate because it's what is expected of them. Soldat is wounded… he clearly displays the psychological injuries Hydra perpetrated on Sgt. Barnes. The Soldier is the final product and he does as he's told because he's a good soldier. He serves his master unquestioningly, not sure I'd say willingly… I don't think that word can be applied to their existence at all."
She let the team think about that for a few moments before saying, "That's all I have for you at this time, but I'm always available if you have any further questions or concerns."
"Thank you, Doctor," Steve said as he turned away from the window and to the others he said. "I'm going back with Dr. Banner to check on the Soldier. I'll see you guys at dinner."
"Okay," Nat replied. "Are you okay?"
"Yeah, I'm good," he assured her. Bruce stopped alongside them and Steve gave her a nod and the two men exited.