Bucky's ECT
Hello, I'm here to ruin your day. Stop reading if your heart is not in the mood for Bucky angst.
I decided to read up on ECT (electroconvulsive therapy) because... meta things.
(Before I start, there is good evidence for ECT in the conditions it is prescribed for, so please...this post is about Hydra being barbaric, not ECT itself)
1) I don't know if the film makers actually did their research or just got lucky, but there are 3 common ECT electrode placements, and bitemporal placement (literally as it says - on both temples) is the one most likely to cause cognitive side effects, including retrograde memory loss (memory of events prior to the ECT). This memory loss can go as far as autobiographical memory, which is a combination of all the memory parts I talk about in #2, but also includes self identity. Now in real life this is what you want to avoid with ECT, but in Bucky's case, this is what they want to achieve, so the bitemporal placement is selected for this purpose. Also common is anterograde memory issues but this doesn't seem to come up in Bucky's case so I won't talk more about it.
2) Memory is a complex thing and at close to midnight I'm really not into researching this, but there is explicit memory, which consists of episodic memory (events) and semantic memory (names and things). Then there is implicit memory, consisting of all that cannot be spoken, i.e. procedural (muscle) memory and emotional memory and other reflexive pathways. These are stored in different parts of the brain but communicate tightly with each other. Bucky not recognising Steve's face or knowing his own name - semantic memory; Bucky not remembering his early years with Steve - episodic memory. But Bucky still has all the experience and knowledge to operate a machine gun and fling a knife - procedural memory/reflex pathways. But he definitely also needs explicit memory so maybe they just retrain him each time he becomes operational. There is (some) evidence that you can reduce the amnesiac effects of ECT by reorienting quickly after an ECT session, so maybe by rehashing all the weapon-based knowledge each time, it reinforces specific explicit memories to the point where he doesn't lose them.
3) But let's talk about the implicit memory. Apart from procedural memory, there's also emotional memory. This is why even though Bucky could not put a name to Steve's face, could not recognise his own name, something about Steve's face and voice and physical presence triggers such a strong emotional memory in Bucky that it almost breaks him out of his brain-wipe. (I'm going to stop using brainwashing so people can stop blaming him for his lack of control, thanks Skogland.) That's why when he asks about "the man on the bridge" and Pierce says "you met him earlier this week on another assignment", he couldn't be convinced because the immense emotional response he has just does not match what Pierce is saying.
4) This is where it starts hurting you. The retrograde memory problem can be temporary or permanent, but in most people it gets better with time (i.e. you start to recall what you have forgotten). Now, assuming Bucky's super soldier serum also helps him recover faster, the protocol they use for wiping him will have to be at a much higher dosage and frequency than your usual ECT. When the scientist says "He's been out of cryo-freeze for too long", it's likely that the cryo slows down his healing, i.e. prevent him from regaining his memories too quickly. They use the ECT to wipe, but then they have to re-prep him for missions, so cryo is used to reduce the number of times they have to wipe him.
5) ECT also causes a lot of non-memory cognitive side effects, particularly when used over a long time, at high doses, with high frequency, and with bitemporal placement. All of which, unfortunately, Bucky was submitted to. These effects include: reduced intellect, poor attention, slowed thinking speed, and this wonderful thing we call "executive function". I mean, maybe we can blame the terrible TFATWS writing decisions he makes on this, because that's all your insight, judgement, problem-solving, impulse control, emotional regulation stuff. This also explains why Pierce talks to him almost like to a child, because in this wiped state, he depends on his experience and muscle memory to function. Give him anything more complex or abstract and his mind doesn't have the capacity to deal with it. This also helps them keep him under control.
6) ECT is done under general anaesthetic. It's done with a muscle paralytic (you know, to stop your muscles actually seizing up cos sustained whole body tetany HURTS LIKE HELL and yes that's why you need to get your tetanus shots). If you look closely at the top GIF he had a drip in, but they clearly didn't give him near enough to a) relax muscles b) reduce his level of consciousness or c) reduce pain. Why? I mean it could be that Hydra are all sadistic bastards, but it could also be that there is a need for it. Maybe his super soldier status means that the usual way of working out dose (via EEG) did not work with him, or using anaesthetics made it less effective. Or it could be that they needed him in that post-ictal confusion but awake in order to move onto the next step - the hypnosis with the code words.
7) And just briefly on dosing (because tumblr ate my long paragraph): the aim of ECT is to get to suprathreshold, i.e. at a dose of electrical impulse 1.5-3 times higher than what would be expected to cause a seizure. Now remember this is for treatment, and that we need higher doses to achieve amnesia. And in Bucky's case, with his faster healing and higher resistance, they will need to really dial up the dose and frequency in order to get the effect they need. Ouch.
8) Erm I didn't expect to get this far so let's be brief about hypnotherapy. I haven't had time to look at the evidence (or the method), but there is some out there that it works for pain. Now we talked about what ECT can do for memory - that just makes you vulnerable but doesn't overcome intrinsic personality traits. I suspect how they get the Winter Soldier to operate (and override Bucky's innate goodness) is through hypnosis with the code words, which would be in keeping with what Marvel said about him entering "a trance state". As the Winter Soldier, one of the things that makes him come across as unstoppable is his lack of reaction to what should be painful. I can't find right GIF but immediately after this, he just rolls onto his knees and jumps up even though he should have been hurt and winded.
8) Now because the Winter Soldier operates during a hypnotic trance, this is why Steve can break him out (rather than him breaking out of the effects of ECT which is much longer lasting). What this means is that on the Helicarrier, because Bucky was under both the effects of ECT and hypnosis, when Steve breaks the hypnosis, Bucky emotionally connects with Steve but still has no memory of him. This is why he left Steve and went to the Smithsonian to look at the exhibit, then disappeared for 2 years. He's still in a state of amnesia, which slowly recovers. But when Steve breaks Bucky's hypnosis in CACW, Bucky has not had ECT for some time, so after he wakes up he immediately knows Steve's history.
So there you go, this is the nitty-gritty of how they mind-broke Bucky.
buckybarnesevents