Psychiatric
Solitary Confinementt
Confinement t
Psychiatric Effects of Solitary
Stuart Grassian·
Grassian*
TABLE OF CONTENTS
CONTENTS

PRE FA CE
.......................................................................................
PREFACE
.......................................................................................
327
I. O
VERV
IEW
.......................................................................................
327
OVERVIEW .......................................................................................327
II. SOLITARY
SOLITARY CONFINEMENT
CONFINEMENT CAN CAUSE SEVERE PSYCHIATRIC
PSYCHIATRIC
H AR M
.......................................................................................
HARM
.......................................................................................
333
A. Solitary
Solitary Confinement
Confinement Can
Can Cause
Cause a Specific Psychiatric
Psychiatric
Syndrom e .........................................................................
333
Syndrome
......................................................................... 333
1. The Specific Psychiatric
1.
Psychiatric Syndrome
Syndrome Associated with
Solitary
Confinem ent .................................................
.................................................
335
Solitary Confinement
2. This Syndrome has the Characteristics of an Acute
Organic Brain Syndrome-A
Syndrome-A Delirium .....................
..................... 337
337
B. The Historical
Confinement:
Historical Experience
Experience with Solitary
Solitary Confinement:
The Nineteenth Century
338
Century Experience
Experience ................................
................................ 338
1. The Origin of the American
1.
American Penitentiary: The
The
Experience ...................
................... 338
338
Nineteenth Century
Century German
German Experience
.................. 341
2. Psychological
Psychological Effects of Severe
Severe Isolation ..................
C. The Twentieth Century
Century Experience:
Experience: Prisoners
War,
C.
Prisoners of War,
"Brain Washing,
Washing, "and
Research..............
.............. 343
"Brain
" and Experimental
Experimental Research
1. Prisoners of War and "Brain Washing"
Washing" ................
1.
..................... 343
343
2. Experimental
........ 345
Experimental Research on Sensory Deprivation ........
D.
FactorsEffecting Response to Sensory Restriction
D. Factors
Restriction and
Confinem ent.......................................................
.......................................................
346
Solitary
Solitary Confinement
346
1. Differing Conditions ofIsolation
of Isolation ...............................
1.
............................... 346
346
2. The Perceived
...... 347
Perceived Intent of the Isolation Experience
Experience ......
347
3. Individual Differences
in
Response
...........................
Differences Response ........................... 347

t This article was prepared from a statement
statement given to the Commission on Safety
Safety and
and
Abuse
Abuse in America's
America's Prisons. As the article is an overview of the psychiatric
psychiatric effects of
of
confinement
confinement throughout
throughout history it is not fully footnoted
(617) 244-2792;
•* M.D. Phone: (617)
(617) 244-3315; Fax: (617)
244-2792; 401 Beacon Street, Chestnut Hill,
Hill,
Mass. 02467-3976;
02467-3976; e-mail: stgrassian@aol.com.
stgrassian@aol.com.

325

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[Vol.

a.
b.

Findings at Pelican
Pelican Bay State
State Prison ...............
Findings
............... 349
Attention
Attention Deficit and Antisocial
Antisocial Personality
Personality
D
isorders ..........................................................
..........................................................
350
Disorders
350
c.
Coughlin.........................................
......................................... 351
Langley v. Coughlin
d. Effects
Effects on Psychologically
Psychologically More Resilient
Inmates:
Baraldini v. Meese and Hameed
Hameed v.
Inmates: Baraldini
Coughlin ..........................................................
..........................................................
Coughlin
352
E.
and Small Group
Group
E. Long Term Effects of Solitary
Solitary and
C
onfinem ent ....................................................................
....................................................................
353
Confinement
CON CLU SION S ..................................................................................
III. CONCLUSIONS
.................................................................................. 354
354
APPENDIX
REPORTS OF PSYCHIATRIC
IN
APPENDIX A: REpORTS
PSYCHIATRIC DISTURBANCES
DISTURBANCES IN
OTHER
CONDITIONS OF RESTRICTED
ENVIRONMENTAL
OTHER CONDITIONS
RESTRICTED ENVIRONMENTAL
STIM
ULATION
.................................................................................
STIMULATION ................................................................................. 356
356
I. AVIATION
AVIA TION
.......................................................................................
356
.......................................................................................
356
II.
II. SMALL
SMALL GROUP
GROUP CONFINEMENT..........................................................
.......................................................... 357
357
III. POLAR HABITATION
HABITATION .........................................................................
.........................................................................
358
358
IV. EXPLORERS:
EXPLORERS: SOLO VOYAGES
VOyAGES ..........................................................
.......................................................... 361
V. MEDICAL CONDITIONS
......................................................................
CONDITIONS ......................................................................
362

A. Eye Patched
..........................................................
362
Patched Patients
Patients ..........................................................
B. P
oliomyelitis .......................................................................
B.
Poliomyelitis
.. ..................................................................... 363
C
CardiacPatients
P atients.................................................................
C.. Cardiac
................................................................. 363
D. Hearing-Impaired
............................................ 364
D.
Hearing-Impaired Individuals
Individuals ............................................
E. Other
Other Medical
Medical Patients
Patients.......................................................
E.
....................................................... 365
SITUATIONS ..........................................................
..........................................................
VI. OCCUPATIONAL
OCCUPATIONAL SITUATIONS
365
VII. ANIMAL STUDIES ............................................................................
............................................................................
365
GERMAN EXPERIENCE
APPENDIX B: THE NINETEENTH
NINETEENTH CENTURY
CENTURY GERMAN
WITH SOLITARY
SOLITARY CONFINEMENT
WITH
CONFINEMENT ....................................................
.................................................... 367
APPENDIX C: EXPERIMENTAL
PSYCHIATRIC
APPENDIX
EXPERIMENTAL RESEARCH ON THE
THE PSYCHIATRIC
EFFECT OF PROFOUND
SENSORY DEPRIVATION:
DEPRIVATION: FACTORS
EFFECT
PROFOUND SENSORY
INFLUENCING VULNERABILITY
............ 373
INFLUENCING
VULNERABILITY TO PSYCHIATRIC
PSYCHIATRIC HARM ............
I.
THE
INFLUENCE
OF
EXPECTATION
.....................................................
I.
EXPECTATION ..................................................... 373
II.
INDIVIDUAL
DIFFERENCES
IN RESPONSE
......................................... 374
II.lNDNIDUAL
IN
RESPONSE .........................................
A. Effects of Sensory
Sensory Deprivation
Deprivationon Antisocial
Personality
A.
Antisocial Personality
D
isorder ..........................................................................
Disorder
.......................................................................... 376
1. Aversive
1.
Aversive Conditioning ...............................................
............................................... 376
Considerations .....................................
..................................... 378
a. Ethical Considerations
Incarceration is not Aversive
b. SHU
SHU Incarceration
C
onditioning ....................................................
378
Conditioning
.................................................... 378

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379
(i) The
The behavior
behavior being
being changed:
changed: ...........................
........................... 379
379
(ii) The
ent": ...........................................
The "punishm
"punishment":
........................................... 379
APPENDIX D:
APPENDIX
D: REPORTS
REpORTS OF
OF THE LONG-TERM
LONG-TERM EFFECTS OF
OF
SOLITARY CONFINEMENT
CONFINEMENT IN FORMER
FORMER POLITICAL
POLITICAL PRISONERS
PRISONERS
SOLITARY
AND
AND IN
IN PRISONERS
PRISONERS OF WAR:
WAR: SOLITARY
SOLITARY CONFINEMENT
CONFINEMENT AS
AS A
.......... 380
MEANS OF "BRAIN
"BRAIN WASHING"
WASHING" AND "INDOCTRINATING".
"INDOCTRINATING" ...........
380

PREFACE
PREFACE

Psychiatrist who was on the
Dr. Grassian
Grassian is a Board Certified
Certified Psychiatrist
Harvard Medical
Medical School for over twenty-five
twenty-five years. He
faculty of the Harvard
evaluating the psychiatric
has had extensive
extensive experience
of
experience in evaluating
psychiatric effects
effects of
solitary confinement,
confinement, and in the course
course of his professional
involvement, has been involved as an expert regarding
regarding the psychiatric
psychiatric
segregation and disciplinary
impact of federal and state segregation
disciplinary units in many
observations and conclusions regarding
settings. His observations
regarding this issue have
decisions. The following
been cited
cited in a number of federal court decisions.
been
statement
statement is largely
largely a redacted, non-institution
non-institution and non-inmate
declaration which was submitted in September
September
specific, version of a declaration
1993 in Madrid
Madrid v. Gomez.1l To enhance
enhance the readability of this
described in
statement, much of the supporting medical literature is described
the appendices
appendices to the statement.
OVERVIEW
I. OVERVIEW

confinement of a prisoner
Solitary confinement-that
confinement-that is the confinement
prisoner alone
environmental
in a cell for all, or nearly all, of the day with minimal environmental
stimulation and minimal opportunity for social interaction--can
interaction--can
cause severe psychiatric
psychiatric harm. It has indeed long been known that
severe restriction of environmental and social stimulation has a
profoundly
profoundly deleterious effect on mental functioning; this issue has
been a major concern for many groups of patients including, for
example, patients in intensive care units, spinal patients immobilized
immobilized
of
impairment of
by the need for prolonged traction, and patients
patients with impairment
remanded, 150 F.3d 1030 (9th Cir.
Cal. 1995), rev'd and remanded,
1. 889 F. Supp. 1146 (N.D. Cal.
I.
1998).
1998).

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eye-patched or hearing-impaired
their sensory
sensory apparatus (such as eye-patched
patients). This issue has also been a very significant concern in
military situations, polar and submarine
submarine expeditions, and in
preparations for space travel.
preparations
The United States was actually the world leader in introducing
of
prolonged incarceration,
incarceration, and solitary confinement, as a means of
dealing with criminal behavior. The "penitentiary
"penitentiary system" began in
the United States, first in Philadelphia, in the early nineteenth
century, a product of a spirit of great social optimism about the
possibility
rehabilitation of individuals
individuals with socially deviant
deviant
possibility of rehabilitation
Americans were quite proud of their "penitentiary
"penitentiary
behavior.22 The Americans
system" and they invited and encouraged
encouraged important
important visitors from
abroad to observe them.33 This system, originally
originally labeled
labeled as the
"Philadelphia System,"
System," involved
"Philadelphia
involved almost an exclusive
exclusive reliance upon
confinement as a means of incarceration
solitary confinement
incarceration and also became the
predominant
incarceration, both for post conviction and also
predominant mode of incarceration,
for pretrial
pretrial detainees,
detainees, in the several European prison
prison systems which
4
emulated
the
American
model.
emulated
The results were, in fact, catastrophic. The incidence
incidence of mental
disturbances
such
disturbances among prisoners
prisoners so detained, and the severity
severity of such
disturbances,
disturbances, was so great that the system fell into disfavor
disfavor and was
ultimately abandoned. During this process a major body
body of clinical
literature
developed which
literature developed
which documented
documented the psychiatric disturbances
disturbances
created
created by such stringent
stringent conditions of confinement.55
The paradigmatic
disturbance was an agitated
paradigmatic psychiatric
psychiatric disturbance
agitated
confusional
characteristics
confusional state which, in more severe cases, had the characteristics
of a florid delirium,
characterized by severe
delirium, characterized
severe confusional,
confusional, paranoid,
paranoid,
and hallucinatory
hallucinatory features, and also by intense agitation and random,
impulsive,
disturbances were
impulsive, often self-directed
self-directed violence. Such disturbances
were often
often
2.
2. An
An excellent
excellent history
history of
of the
the Philadelphia
Philadelphia System is
is found in NORMAN
NORMAN JOHNSTON
JOHNSTON ET
ET
AL.,
AL., EASTERN
EASTERN STATE
STATE PENITENTIARY:
PENITENTIARY: CRUCIBLE
CRUCIBLE OF
OF GOOD
GOOD INTENTIONS
INTENTIONS (1994).
(I 994}.
3.
3. See
See DAVID
DAVID ROTHMAN,
ROTHMAN, THE
THE DISCOVERY
DISCOVERY OF
OF THE
THE ASYLUM
ASYLUM 81 (1971);
(1971); see
see also
also
GUSTAVE
IN THE
GUSTAVE DE
DE BEAUMONT
BEAUMONT & ALEXIS
ALEXIS DE
DE TOCQUEVILLE,
TOCQUEVILLE, ON
ON THE
THE PENITENTIARY
PENITENTIARY SYSTEM
SYSTEM IN
THE
UNITED
STATES AND
UNITED STATES
AND ITS
ITS APPLICATION
ApPLICATION IN FRANCE,
FRANCE, http://www.law.du.edu/sterling/Content/
http://www.law.du.edulsterling/Contenti
ALH/Tocqueville
Pen.pdf; CHARLES
AMERICAN NOTES
CHARLES DICKENS,
DICKENS, AMERICAN
NOTES AND
AND PICTURES
PICTURES FROM
FROM ITALY
ITALY
ALHlTocqueville]en.pdf;

(Leonee
(1842).
(Leonee Ormond ed.,
ed., Everymans
Everymans Library
Library 1997)
1997) (1842).
4.
96-101.
4. ROTHMAN,
ROTHMAN, supra note
note 3,
3, at
at 96-101.
5.
5. See
See Appendix
Appendix D
D (describing
(describing this literature).
literature).

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observed
observed in individuals who had no prior history
history of any mental
illness. In addition, solitary confinement
confinement often resulted in severe
exacerbation
previously existing mental condition. Even
Even among
exacerbation of a previously
of
inmates who did not develop overt psychiatric
psychiatric illness
illness as a result of
solitary confinement,
confinement almost inevitably
confinement, such confinement
inevitably imposed
imposed
significant
significant psychological
psychological pain during the period of isolated
confinement
confinement and often significantly impaired the inmate's capacity
capacity to
adapt successfully
successfully to the broader prison environment.
It is both tragic and highly disturbing that the lessons of the
nineteenth century
experience with solitary confinement
century experience
confinement are today
being so completely
completely ignored by those responsible for addressing the
housing and the mental health needs in the prison setting. For, indeed,
the psychiatric hann
harm caused
caused by solitary confinement had become
exceedingly apparent
exceedingly
apparent well over one hundred
hundred years ago. Indeed, by
66 the United States Supreme Court explicitly
1890,
with
In
re
Medley,
Supreme
explicitly
1890,
recognized
harm caused by solitary
recognized the massive psychiatric hann
confinement:
This matter of solitary confinement
confinement is not ...
... a mere
unimportant regulation
regulation as to the safe-keeping
safe-keeping of the prisoner
prisoner
unimportant
[E]xperience [with the penitentiary
..... . [E]xperience
penitentiary system of solitary
confinement]
demonstrated
that
there were serious objections
confinement] demonstrated
to it. A considerable
number
of
the
prisoners
considerable number
prisoners fell, after even a
short confinement,
confinement, into a semi-fatuous condition, from which it
was next to impossible
impossible to arouse them, and others
others became
became
violently
violently insane;
insane; others, still, committed
committed suicide; while those
who stood the ordeal better were not generally
generally reformed,
refonned, and
of
in most cases did not recover
recover sufficient mental activity to be of
any subsequent
subsequent service to the community. 77
The consequences
consequences of the Supreme Court's holding were quite
dramatic for Mr. Medley. Mr. Medley had been convicted of having
murdered
murdered his wife. Under the Colorado
Colorado statute
statute in force at the time of
of
the murder
he
would
have
been
executed
after
about
one
additional
murder
(1890).
6. 134 U.S.
U.s. 160 (1890).
Id. at 167-68.
7. Id.

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month of incarceration
incarceration in the county jail. But in the interim between
between
Mr. Medley's
legislature had passed
Medley's crime and his trial the Colorado
Colorado legislature
passed
a new statute which called for the convicted murderer
murderer to be, instead,
incarcerated in solitary
solitary confinement in the state
state prison during the
month prior to his execution. 8 Unhappily, when the legislature
legislature passed
passed
the new law it simultaneously
simultaneously rescinded
rescinded the older law without
allowing
allowing for a bridging clause which would
have allowed for Mr.
9
older statute.
under the
Medley's sentencing
sentencing under
the older
statute. 9
Mr. Medley appealed his sentencing
sentencing under the new statute,
statute,
arguing that punishment under this new law was so substantially
substantially
more burdensome
burdensome than punishment under the old law as to render its
10 The Supreme
post facto.
Supreme Court agreed with
facto. 10
application to him ex post
Medley
him, even though it simultaneously
simultaneously recognized
recognized that if Mr. Medley
sentenced at
was not sentenced
sentenced under the new law, he could not be sentenced
all."11 Despite this, the Court held that this additional
additional punishment
punishment of
all.
of
one month of solitary confinement was simply too egregious
egregious to
and
ordered
ignore; the Court declared
Mr.
Medley
a
free
man,
ordered his
12
.
12
prison.
release
re
Iease from
from pnson.
Dramatic
psychiatric effects of
Dramatic concerns
concerns about the profound psychiatric
of
confinement have continued
continued into the twentieth century, both
solitary confinement
in the medical literature
literature and in the news. The alarm raised about the
washing" of political
of
"brain washing"
political prisoners
prisoners of the Soviet Union and of
Communist China-and
China-and especially
especially of American
American prisoners
prisoners of war
War-gave rise to a major body of medical and
during the Korean War-gave
literature concerning
deprivation and
and
scientific literature
concerning the effects
effects of sensory deprivation
experimental
social isolation, including a substantial body of experimental
research. 13
13
This literature, as well as my own observations,
observations, has demonstrated
demonstrated
that, deprived of a sufficient
level
of
environmental
sufficient
environmental and social
stimulation, individuals will soon become
become incapable of maintaining
an adequate
attention to the environment.
adequate state of alertness and attention
8.
9.
10.

Id. at 162--63.
162-63.
[d.
Id. at 166.
166.
/d.
Id. at 162.
[d.
11. [d.
Id. at 166.
11.
Id. at 174.
12. [d.
MANIPULATION OF HUMAN
BEHAVIOR 2-3, 35 (Albert D. Biderman
13. THE MANiPULATION
HUMAN BEHAVIOR
Biderman & Herbert
Herbert
1961).
Zimmer eds.,
eds., 1961).

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confinement will predictably
predictably shift
Indeed, even a few days of solitary confinement
the electroencephalogram
electroencephalogram (EEG) pattern
pattern toward
toward an abnormal pattern
characteristic
characteristic of stupor and delirium.
This fact is not surprising. Most individuals
individuals have at one time or
or
another
another experienced,
experienced, at least briefly,
briefly, the effects of intense monotony
and inadequate
environmental stimulation. After even a relatively
relatively
inadequate environmental
brief period
individual is likely to
period of time in such a situation an individual
descend into a mental torpor or "fog,"
"fog," in which alertness, attention,
and concentration
concentration all become impaired. In such a state, after a time,
the individual becomes increasingly
processing external
external
increasingly incapable of processing
stimuli, and often becomes "hyperresponsive"
"hyperresponsive" to such stimulation.
For example, a sudden
sudden noise or the flashing of a light jars the
individual
individual from his stupor and becomes intensely unpleasant. Over
Over
time the very absence of stimulation causes whatever
whatever stimulation
stimulation is
available
become noxious and irritating. Individuals in such a
available to become
stupor tend to avoid any stimulation, and withdraw progressively
progressively into
themselves
themselves and their own mental fog.
An adequate state of responsiveness
responsiveness to the environment requires
both the ability
ability to achieve
achieve and maintain an attentional
attentional set and the
ability to shift attention. The impairment of alertness and
concentration in solitary
related
concentration
solitary confinement leads to two related
abnormalities:
shift
abnormalities: the inability to focus, and the inability
inability to shift
attention. The inability to focus (to achieve and maintain
maintain attention)
attention) is
experienced
"fog" in
dissociative stupor-a
stupor-a mental "fog"
experienced as a kind of dissociative
which the individual
individual cannot focus attention, and cannot, for example,
example,
grasp or recall when
when he attempts to read or to think.
"tunnel vision"
The inability to shift attention results in a kind of "tunnel
in which the individual's attention becomes
becomes stuck, almost always on
on
something
intensely
unpleasant,
and
in
which
he
cannot
stop
thinking
something
cannot
about that matter; instead, he becomes
becomes obsessively fixated upon it.
These obsessional preoccupations
preoccupations are especially
especially troubling.
Individuals in solitary
solitary confinement
confinement easily become
become preoccupied
preoccupied with
some thought, some perceived slight or irritation, some sound or
or
smell coming from a neighboring cell, or, perhaps most commonly,
individuals are unable
by some bodily sensation. Tortured by it, such individuals
to stop dwelling on it. In solitary
solitary confinement ordinary
ordinary stimuli
become intensely unpleasant and small irritations become
become
confinement brood upon normally
maddening. Individuals in such confinement

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unimportant
of
unimportant stimuli and minor irritations become the focus of
increasing
increasing agitation and paranoia. I have examined
examined countless
individuals
confinement who have become obsessively
individuals in solitary
solitary confinement
obsessively
preoccupied with some minor, almost imperceptible
preoccupied
imperceptible bodily sensation,
a sensation which grows over time into a worry, and finally into an
all-consuming,
all-consuming, life-threatening
life-threatening illness.
experiencing such environmental
Individuals experiencing
environmental restriction
restriction find it
daytime alertness and
difficult to maintain a normal pattern of daytime
nighttime sleep. They often find themselves incapable of resisting
day-incapable of resisting the paralyzing
paralyzing effect
their bed during the day-incapable
of their stupor-and
stupor-and yet incapable of any restful sleep at night. The
meaningful activity is further compounded
compounded by the effect of
of
lack of meaningful
continual exposure to artificial light and diminished
diminished opportunity to
experience natural daylight. And the individual's difficulty
experience
difficulty in
maintaining
maintaining a normal day-night sleep cycle is often far worsened by
constant intrusions on nighttime dark and quiet, such as steel doors
slamming shut, flashlights shining in their face, and so forth.
There are substantial
differences in the effects
substantial differences
effects of solitary
confinement upon different individuals. Those most severely
severely affected
confinement
are often individuals
individuals with evidence of subtle neurological
neurological or attention
deficit
deficit disorder, or with some other vulnerability. These individuals
suffer from states of florid psychotic delirium, marked by severe
hallucinatory
hallucinatory confusion, disorientation, and even incoherence,
incoherence, and by
intense
agitation
and
paranoia.
intense agitation
These psychotic disturbances often
have a dissociative
dissociative character, and individuals so affected often do not
recall events
confusional
events which
which occurred during the course of the confusional
psychosis. Generally, individuals with more stable personalities
personalities and
greater ability to modulate their emotional expression and behavior
behavior
and individuals
individuals with stronger cognitive functioning are less severely
severely
affected. However,
experience a
However, all of these individuals will still experience
concentration,
degree of stupor, difficulties with thinking and concentration,
obsessional thinking, agitation, irritability,
obsessional
irritability, and difficulty tolerating
external stimuli (especially noxious stimuli).
Moreover,
suffered by
Moreover, although many of the acute symptoms suffered
these inmates are likely to subside upon termination of solitary
confinement, many-including
many-including some who did not become overtly
psychiatrically ill during their confinement
solitary-will likely
confinement in solitary-will
suffer permanent
permanent harm as a result of such confinement. This harm is

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social
most commonly
commonly manifested
manifested by
by a continued
continued intolerance
intolerance of social
interaction, a handicap which
which often
often prevents the inmate
inmate from
from
interaction,
successfully readjusting
readjusting to the broader
broader social
social environment
environment of general
general
successfully
population in
in prison and, perhaps
perhaps more
more significantly,
significantly, often
often severely
severely
population
impairs the inmate's capacity
capacity to reintegrate
reintegrate into the broader
broader
impairs
community upon release
release from imprisonment.
community
Many inmates housed in such stringent
stringent conditions
conditions are extremely
extremely
Many
they are
harm
or
fearful of acknowledging
the
psychological
stress
are
psychological
acknowledging
experiencing as a result of such
such confinement.
confinement. This reluctance
reluctance of
of
experiencing
inmates in solitary confinement
confinement is a response
response to the perception
perception that
"break them
authorities to "break
such confinement
overt attempt by authorities
them
confinement is an overt
down" psychologically,
psychologically, and in my experience,
experience, tends to be more
more
severe when
when the inmate experiences
stringencies of his
experiences the stringencies
confinement as being the product of an arbitrary exercise of power,
confinement
rather
rather than the fair result of an inherently
inherently reasonable
reasonable process.
process.
mental
settings,
confinement
Furthermore, in solitary confinement
mental health
health
screening interviews
screening
interviews are often conducted
conducted at the cell
cell front, rather than
in a private
private setting, and inmates
inmates are generally
generally quite
quite reluctant
reluctant to
interview
disclose psychological
psychological distress in the context
context of such an interview
since such conversation
conversation would inevitably be heard by other inmates
inmates
in adjacent cells, exposing them to possible stigma and humiliation in
front of their fellow inmates.
PSYCHIATRIC
II. SOLITARY
CONFINEMENT CAN CAUSE SEVERE PSYCHIATRIC
SOLITARY CONFINEMENT
HARM

Can Cause
A. Solitary
Solitary Confinement Can
Cause a Specific Psychiatric
Psychiatric Syndrome
During the course of my involvement as an expert I have had the
confinement
opportunity to evaluate the psychiatric effects of solitary confinement
in well over two hundred prisoners in various state and federal
so
penitentiaries. I have observed
observed that, for many of the inmates so
housed, incarceration
incarceration in solitary caused either severe exacerbation
exacerbation or
appearance of an acute mental
preexisting illness, or the appearance
recurrence of preexisting
recurrence
illness in individuals who had previously
previously been free of any such
illness.
I became aware of the particular toxicity of solitary confinement
evaluate prisoners in solitary
when I first had the opportunity to evaluate

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confinement
confinement as a result of my involvement in a class action lawsuit in
confinement
Massachusetts,
Massachusetts, which challenged conditions in solitary confinement
at the maximum
security state penitentiary
maximum security
penitentiary in Walpole,
Massachusetts. 1144 The clinical observations I made in the course of my
involvement
coupled with my research
research into the
involvement in that lawsuit, coupled
medical literature concerning
concerning this issue, have formed the basis of two
peer-reviewed
articles I have since published
published on this topic in peer-reviewed
journals. 1515 My subsequent professional experience
experience has included
observations
phenomena in many other solitary
observations of similar phenomena
confinement settings.
confinement
When I initially agreed to evaluate the Walpole prisoners I had not
yet reviewed the literature on the psychiatric effects
effects of solitary
confinement and I was somewhat skeptical; I expected
confinement
expected that inmates
psychiatric
exaggerate whatever
would feign illness and exaggerate
whatever psychiatric
symptomatology
symptomatology they suffered. I discovered, however, something
very different. Contrary to my expectations,
expectations, the prisoners appeared
appeared to
be extremely defensive about the psychiatric
psychiatric problems they were
suffering in Special Housing Unit (SHU);
(SHU); they tended to rationalize
away their symptoms, avoid talking about them, or deny or distort
apparent effort to minimize
their existence all in an apparent
minimize the significance
significance
Numerous
interviews
to
isolation.
of their reactions
reactions
interviews began with
"some of the guys
"solitary doesn't bother me" or "some
statements such as "solitary
me," or even with the mention of a symptom
symptom and a
can't take it-not me,"
started
significance: "As
"As soon as I got in I started
simultaneous denial of its significance:
here."
cutting my wrists. I figured it was the only way to get out of here."
As these interviews
interviews progressed the facile accounts gave way to
experiences that were very worrisome. For example,
descriptions
of
experiences
descriptions
one inmate was unable to describe the events of the several days
surrounding
surrounding his wrist-slashing, nor could he describe his thoughts or
feelings at the time. Similarly, the prisoner who said he could "take
eventually came
it" eventually
and
came to describe panic, fears of suffocation, and
paranoid distortions which he suffered
suffered while in isolation. Moreover,
1982).
Comm'r of
Corr., 432 N.E.2d 486 (Mass.
14. Libby v. Comrn'r
ofCorr.,
(Mass. 1982).
of Sensory Deprivation
Deprivationin Psychiatric
Stuart Grassian &
15. See Stuart
& Nancy Friedman, Effects o/Sensory
Psychiatric
(1986); Stuart Grassian,
& PSYCHIATRY
and Solitary
Solitary Confinement,
Confinement, 88 INT'L J.L. &
Seclusion and
Seclusion
PSYCHIATRY 49 (1986);
(1983).
PSYCHIATRY 1450 (1983).
of Solitary Confinement,
Confinement, 140
PsychopathologicalEffects a/Solitary
Psychopathological
140 AM. J. PSYCHIATRY

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the specific psychiatric symptoms reported
reported were strikingly consistent
consistent
among the inmates:

1. The Specific Psychiatric Syndrome Associated
1.
Associated with Solitary
Confinement
Confinement
a. Hyperresponsivity
Hyperresponsivity to External Stimuli: More than half the
progressive inability to tolerate ordinary
prisoners
prisoners reported a progressive
ordinary stimuli.
"You get sensitive to noise, the plumbing system.
For example, "You
... It's
It's
Someone in the tier above me pushes the button on the faucet ...
too loud, gets on your nerves. I can't stand it. I start to holler."
Hallucinations: Almost
b. Perceptual
Perceptual Distortions, Illusions, and Hallucinations:
Almost a
third of the prisoners described hearing voices, often in whispers and
of
often saying frightening things to them. There were also reports of
noises taking on increasing meaning and frightening significance.
significance. For
For
example, "I hear noises, can't identify them-starts to sound like
I'm
... I'm
sticks beating men, but I'm pretty sure no one is being beaten ...
not sure."
sure." These
These perceptual
perceptual changes at times became more complex
complex
and personalized:
personalized:
They come by with four trays; the first has big pancakes. I
think I am going to get them. Then someone
someone comes up and
gives me tiny ones-they get real small, like silver dollars. I
seem to see movements, real fast motions in front of me. Then
seems like they are doing things behind your back, can't quite
see them. Did someone just hit me? I dwell on it for hours.
c. Panic Attacks: Well over half the inmates interviewed
interviewed described
severe panic
panic attacks while in SHU.
d. Difficulties with Thinking, Concentration, and Memory: Many
reported
concentration and memory. One
reported symptoms of difficulty in concentration
...
described his experience,
"I can't concentrate,
prisoner
concentrate, can't read ...
prisoner described
experience, "I
Your mind's narcotized. Sometimes I can't
can't grasp words in my mind
Memory's
that I know. Get stuck, have to think of another word. Memory's
going. You feel like you are losing something you might not get
get
back."
back." In some cases this problem
problem was far more severe, leading
leading to
acute
acute psychotic,
psychotic, confusional
confusional states. One prisoner had slashed his
wrists during such a state and his confusion and disorientation
disorientation had
actually
actually been noted in his medical record.

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Thoughts: Emergence of Primitive
e. Intrusive Obsessional Thoughts:
Aggressive Ruminations: Almost half the prisoners
Aggressive
prisoners reported
reported the
emergence of primitive
aggressive fantasies of revenge, torture, and
emergence
primitive aggressive
mutilation of the prison guards. In each case the fantasies were
described as entirely unwelcome,
unwelcome, frightening, and uncontrollable. For
example, one prisoner recounted
recounted
I try to sleep sixteen
sixteen hours a day, block out my thoughts;
muscles tense, think of torturing and killing the guards; lasts a
couple of hours. I can't stop it. Bothers me. Have
Have to keep
... I get
control. This makes me think I'm flipping my mind ...
back-pictured throwing a guard in
panicky, thoughts
thoughts come back-pictured
lime-eats away at his skin, his flesh-torture him-try to
block it out, but I can't.
f.f. Overt Paranoia:
Paranoia: Almost half the prisoners interviewed
interviewed reported
reported
persecutory fears. Some of these persecutory
persecutory fears were
paranoid and persecutory
prisoner
short of overt psychotic disorganization. For example, one prisoner
"sometimes I get paranoid-think
paranoid-think they meant something
recalled "sometimes
else. Like a remark about Italians. Dwell on it for hours. Get frantic.
Like when they push buttons on the sink. Think they did it just to
annoy me."
me." In other cases
cases this paranoia deteriorated
deteriorated into overt
psychosis:
Spaced out. Hear singing, people's voices, 'Cut
'Cut your wrists
tonight.' I
and go to Bridgewater
Bridgewater and the Celtics
Celtics are playing tonight.'
... I suspect they are putting drugs in
doubt myself. Is it real? ...
... The Reverend,
my food, they are putting drugs in my cell ...
Reverend,
Scared
the priest, even you, you're all in cahoots in the Scared
Straight Program.
g. Problems
Problems with Impulse
Impulse Control:
Control: Slightly less than half of the
prisoners
random
prisoners reported
reported episodes of loss of impulse control with random
violence:
"I snap off the handle over absolutely
violence: "I
absolutely nothing. Have torn
tom up
mail and pictures,
pictures, throw things around. Try to control it. Know it
impulsive
only hurts myself."
myself." Several of these prisoners
prisoners reported impUlsive
self-mutilation;
self-mutilation; "I
"I cut my wrists many times in isolation. Now it
seems crazy. But every time I did it, I wasn't thinking-lost
control--cut
control--cut myself without knowing what I was doing."

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2. This Syndrome
Syndrome has the Characteristics
Characteristics of an Acute
Acute Organic
Organic
2.
Syndrome-A Delirium
Delirium
Brain Syndrome-A
Brain
Clearly, these
these symptoms
were very
very dramatic.
dramatic. Moreover, they
they
symptoms were
of
form aa discreet syndrome-that
syndrome-that is, a constellation
constellation of
appeared to form
appeared
over
symptoms
symptoms occurring
occurring together and with a characteristic
characteristic course
course over
illness. Moreover, this syndrome
syndrome
thus suggestive
suggestive of a discreet illness.
time, thus
symptoms described above
above are
strikingly unique;
unique; some of the symptoms
was strikingly
virtually no other psychiatric
psychiatric illness. The characteristic
characteristic acute
found in virtually
dissociative, confusional
confusional psychoses
psychoses are a rare phenomenon
phenomenon in
dissociative,
Similarly, cases of random, impulsive violence
psychiatry.
violence in the
psychiatry. Similarly,
exceedingly rare. But the most
context of such confusional state is exceedingly
cluster are the striking and dramatically
dramatically
unique symptoms in this cluster
by
the
isolated
person.
extensive
extensive perceptual
perceptual disturbances experienced
experienced
Indeed,
Indeed, these disturbances
disturbances are almost pathognomonic
pathognomonic of the
they are symptoms
symptoms virtually
virtually found nowhere
nowhere else.
syndrome, meaning they
larger
For example, loss of perceptual
perceptual constancy
constancy (objects becoming larger
and smaller, seeming to "melt"
"melt" or change
change form, sounds becoming
becoming
louder and softer, etc.) is very rare
rare and, when found, is far more
commonly associated
associated with neurological illness (especially
(especially seizure
commonly
affecting sensory integration
integration areas of the
disorders and brain tumors affecting
16
illness.
psychiatric
primary
with
brain) than
primary psychiatric illness. 16
In addition, functional psychiatric
psychiatric illness very rarely presents
presents with
severe and florid perceptual
perceptual distortions, illusions, and
such severe
hallucinations simultaneously
hallucinations
simultaneously affecting
affecting multiple perceptual
perceptual
17
kinesthetic. 17
tactile, and
modalities-auditory,
modalities-auditory, visual, olfactory,
olfactory, tactile,
and kinesthetic.
Similarly, hyperresponsivity
hyperresponsivity to external
external stimuli with a dysesthetic
to
such stimuli, is likewise rare. In
response
(subjectively
painful)
(subjectively
appearance of this symptom
fact, it is exceedingly
exceedingly rare; so rare that appearance
symptom
brain
dysfunction
etiology.'188
also might suggest an organic
etiology.
16. When seen in primary psychiatric illness, it is basically
16.
basically only seen in especially severe,
schizophrenic illness which has always been
been
insidious, early onset schizophrenia-the
schizophrenia-the kind of schizophrenic
biological/neurologic disease.
"feel" like a fundamentally
thought to clinically "feel"
fundamentally biologicaUneurologic
17. In fact, in the more common psychotic illnesses such as schizophrenia
schizophrenia and psychotic
depression, auditory hallucinations are by far the most common type; visual hallucinations
come a distant second; and hallucinations
hallucinations in all other modalities are actually very uncommon.
Moreover, combined modality hallucinations (other than the combination of auditory with
visual) are exceedingly rare.
18. This symptom is similar, for example, to the experience many people have during a

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Thus, the fact that all of these quite unusual symptoms
symptoms ran
together in the same syndrome was itself a clear confirmation
confirmation of the
distinct nature of this syndrome. While this syndrome is strikingly
strikingly
atypical for the functional
functional psychiatric illnesses,
illnesses, it is quite
characteristic
acute organic
organic brain syndrome:
syndrome: delirium, a
characteristic of an acute
syndrome
characterized
by
a
decreased
level
of alertness and EEG
EEG
syndrome characterized
abnormalities;
abnormalities; by the same perceptual
perceptual and cognitive
cognitive disturbances,
disturbances,
fearfulness, paranoia,
selfparanoia, and agitation; and random, impulsive, and selfdestructive behavior
behavior which I observed in the Walpole
Walpole population.
Moreover, delirium is a syndrome
syndrome which is known to result from
environmental stimulation,
the type of conditions, including restricted environmental
which are characteristic
characteristic of solitary confmement.
confinement. Even the EEG
EEG
abnormalities
characteristic
abnormalities characteristic of delirium have been observed in
individuals exposed to conditions
conditions of sensory deprivation. By now the
individuals
potentially catastrophic
catastrophic effects of restricted
restricted environmental
environmental
voluminous medical literature;
stimulation have been the subject of a voluminous
international symposia are being held on the subject, and the
annual international
issue has even found its way into the popular
popular media. The literature is
summarized in the appendices
summarized
appendices to this statement.
B. The Historical
Experience with Solitary
Confinement: The
Historical Experience
Solitary Corifinement:
The
Nineteenth
Experience
Nineteenth Century Experience
1. The Origin
Penitentiary: The Nineteenth
Nineteenth
1.
Origin of the American
American Penitentiary:
Century German
German Experience
Experience
Preindustrial
Preindustrial societies had often not made any fundamental
"criminal
distinction between deviant behavior seen as the product of "criminal
stemming from "mental
intent" as opposed to behavior seen as stemming
19 For
illness."' 19
behavior-whatever its
such societies, deviant
deviant behavior-whatever
illness."
origins-was
origins-was a social evil that was deeply feared and cruelly
cruelly
punished.
febrile illness of finding any touching of their body exceedingly
exceedingly unpleasant, or the inability
inability of a
patient with a headache
headache to tolerate an even ordinary
ordinary volume of sound, or the inability of some
becoming nauseated.
pregnant women to tolerate even ordinary
ordinary smells without becoming
19. ROTHMAN, supra
supra note 3, at 4-5, 62-65.

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In Colonial America the Salem witch trials were but one example
"demonic
of a continuing tendency to equate "lunacy"
"lunacy" with "demonic
possession"
Deviant behavior
behavior was
possession" and, ultimately, with "evil.,,20
"evil.", 20 Deviant
naturally feared and hated; the instinctive
instinctive response
response was to punish it
cruelly, lock it away, banish it, or kill its perpetrator. Thus, in
behavior
Colonial America
America generally, the social response to deviant behavior
protection of the larger society was
was relatively simple:
simple: the protection
"illness" and "evil"
"evil" was far
paramount, while the distinction between
between "illness"
less critical. Indeed, the social response
response to deviance largely stemmed
deserved
from the severe
severe puritanical
puritanical belief in innate human evil that deserved
whipping, pillories,
pillories, stockades, brandings,
violent retaliation such as whipping,
and, ultimately, the gallows. At times, when there was a more
"humane" response to persons viewed as suffering from lunacy this
"humane"
keeping the individual caged under lock
response consisted simply of keeping
and key, often for the rest of his life.
But in the early nineteenth century,
century, a surge of great social
optimism swept over America, and along with this grew a belief
belief in
the possibility
optimistic faith in
possibility of social reform, perhaps an overly optimistic
the possibility of rehabilitation
rehabilitation of persons whose
whose behavior
behavior was
deviant. 2121 Not coincidentally,
coincidentally, this spirit gave rise virtually
simultaneously
United
simultaneously to two great social reform movements in the United
States: the development of large mental hospitals and the
construction of the first large penitentiaries.
construction
premiseBoth of these institutions were founded upon a similar premisepsychological and social deviance
namely, that psychological
deviance was largely a result of
of
the evils and stresses of "modem
society,"
and
both
held
a
"modem society,"
fundamental belief that healing
healing would naturally occur if the deviant
individual was removed from the evils
of the larger
larger society, and thus
22
nature. 22
true nature.
enabled to know his own
own true
In the case of the mental hospital this belief gave rise to the
community. 23 But, in the
concept of a healing, pastoral, therapeutic community.23
safeguard was obviously
penitentiary, an additional safeguard
obviously
case of the penitentiary,
20. GEORGE IVES, A HISTORY
CRIMINALS, WITCHES,
58HISTORY OF PENAL METHODS: CRIMINALS,
WITCHES, LUNATICS
LUNATICS 5859, 68-73 (reprint 1970)
59,68-73
1970) (1914).
(1914).
21. ROTHMAN,
ROTHMAN, supra note 3, at 57-58, 79.
21.
22. Id.
/d. at 82.
23.
23. Id.
Id. at 133.

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required: the inmates clearly had to be protected, not only from the
evil influences
influences of the broader society, but also from the evil
24
influences of each
each other.24
proper approach thus appeared
appeared to be
influences
The proper
to give each inmate the opportunity to live a life alone, like a penitent
monk in his own monastic cell.
Thus, the earliest American
American penitentiaries
penitentiaries were, generally,
systems of rigid solitary confinement.
confinement.2255 Extravagant
Extravagant attention was
paid to the design of these institutions, to ensure the absolute and
offender from any evil and corrupting
total isolation of the offender
26
completed in 1829,
1829, was
influences.26
The Philadelphia Prison, completed
particularly conscientious
conscientious in this regard:
particularly

arrangements ...
The arrangements
... guaranteed
guaranteed that convicts would avoid all
remained
contamination and follow a path to reform. Inmates remained
.... No
in solitary cells for eating, sleeping, and working ....
precaution
precaution against contamination was excessive. Officials
placed
placed hoods over the head of a new prisoner when marching
marching
him to his cell so he would not see or be seen by other inmates
inmates..
...
. . . Thrown upon his own innate sentiments, with no evil
. . . the criminal would start his
example
example to lead him astray, ...
rehabilitation. Then, after a period of total isolation, without
companions,
companions, books, or tools, ...
... [h]e would return to the
community
community cured of vice and idleness, to take his place as a
27
responsible
responsible citizen.27
The American
American penitentiary,
penitentiary, and the Philadelphia System, became
world-famous; no important visitor to the United States neglected
neglected to
world-famous;
principles for emulation
tour its penitentiaries
penitentiaries and to bring back their principles
Tocqueville of France and
in Europe. Some such as Alexis de Tocqueville
specifically for that purpose.2288
Nicholas
Nicholas Julius from Prussia came
came specifically
"perfect" desolation of the American
American
Tocqueville wrote of the utter, "perfect"
24.
25.
26.
27.
28.

Id. at 83.
Id.
Id.
Id.
Id. at 82-83.
Id.
Id.
Id. at 85-86.
Id. at 81.
81.
Id.

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penitentiary,
penitentiary, of the "profound
"profound silence"
silence" within its "vast walls,"
walls,"
29
likening it to the silence of death.
likening
death.29
2.
Psychological Effects of Severe
2. Psychological
Severe Isolation
Isolation
The openness with which
which these institutions were held up to public
scrutiny
scrutiny led in time to open concern
concern about the psychological
psychological effects
1842,
of such confinement. During a tour of the United
United States in 1842,
Charles Dickens wrote with pathos of the Philadelphia Prison:
The system here is rigid, strict, and hopeless solitary
confinement....
confinement. ... Over the head and face of every prisoner who
comes into the melancholy
melancholy house, a black hood is drawn, and
in this dark shroud, ...
. . . he is led to the cell from which he
imprisonment
never again comes forth, until his whole term of imprisonment
.... dead to everything
has expired. He is a man buried alive ....
but torturing anxieties and horrible despair.
... answered ...
... always with a strange
The first man I saw ...
kind of pause ....
.... He gazed about him and in the act of doing
so fell into a strange stare as if he had forgotten something.
... a more dejected, brokenIn another cell was a German, ...
creature, it would be difficult
hearted, wretched creature,
difficult to imagine....
imagine ....
.... [w
[w]hy
There was a sailor ....
]hy does he stare at his hands and
pick the flesh open, upon the fingers, and raise his eyes for an
an
?30
walls...
instant..,
instant ... to those bare
bare walls
... ?30
American concern about the effects
effects of rigid solitary
solitary confinement
confinement
began as early as the 1830s.
1830s. 3311 Statistical comparisons
comparisons began
began to be
made between
Philadelphia system and its chief competitor: the
between the Philadelphia
Auburn system prevailing
prevailing in New York State at the Auburn and Sing32 The latter system also utilized solitary
Sing penitentiaries. 32
29. Id.
/d. at 97.

30. P. Herbert
Liederman, Man Alone: Sensory Deprivation
Behavioral Change,
Change, 8
Herbert Liedennan,
Deprivation and Behavioral
CORRECTIONAL
(1962).
CORRECTIONAL PSYCHIATRY
PSYCHIATRY & J. SOC. THERAPY 64, 66 (1962).
31. ROTHMAN,
ROTHMAN, supra
31.
supra note 3,
3, at 87-88.

32. Id.
Id. at 88.

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confinement,
confinement, but less rigidly; inmates
inmates left their cells to work together
common courtyard,
courtyard, although
although here,
in workshops
workshops and exercise
exercise in a common
33
times. 33
all times.
too, absolute and strict silence was
was maintained
maintained at
at all
Statistical
Statistical comparisons
comparisons began to generate evidence that "[i]t
"[i]t was
... to leave men in solitary, day after day, year after year;
unnatural ...
insanity. 34 The Philadelphia
indeed, it was so unnatural that it bred insanity.,,34
Philadelphia
Prison system appeared to have a higher incidence
incidence not only of
of
insanity but also of physical disease
disease and death than its New York
35
State system counterpart.35
Meanwhile,
the
American
system had been emulated in many
Meanwhile,
36
major European
European prisons, such as at Halle, Germany.
Germany.36
Although the
Americans had been the world leaders in instituting rigid solitary
confinement in their penitentiary
confinement
penitentiary system, German
German clinicians
eventually assumed the task of documenting
documenting its demise. Between
eventually
1909, thirty-seven articles appeared in German scientific
1854 and 1909,
journals
journals on the subject
subject of psychotic disturbances among prisoners,
summarizing years
summarizing
years of work and hundreds of cases. A major review of
of
37
this literature
literature was published
1912. 37
published in 1912.
A summary and synthesis of
of
this rather large body of work appears as an appendix
38
appendix to this article. 38
But it should be noted that interest in the problem was not purely
academic;
such
academic; psychotic disturbances among prisoners were of such
frequency in these prisons that they attracted
administrative
as
well
as
attracted administrative
clinical
clinical concern, and great effort was made to explain this disturbing
incidence.
incidence. Thus, the literature
literature covered a variety of issues:
speculation,
degeneracy" of the prison
prison
speculation, for example,
example, on the "moral degeneracy"
psychopathology of those who
population; comparison
comparison of the psychopathology
"crimes of passion" with those who committed "crimes
"crimes
committed "crimes
documentation of the incidence
incidence of the major
against property";
property"; or documentation
major
diagnostic categories of the time (for example, "circular
"circular insanity,"
insanity,"
diagnostic
"alcoholic psychoses,"
general paresis) among the
"alcoholic
psychoses," epilepsy,
epilepsy, and
and general
prison population.
33. Jd.
Id.at 95, 97.
33.
Id. at 87.
34. Jd.
35. !d.
Id. at 87-88.
35.
36. See PAUL NITSCHE
& KARL WILMANNS,
WILMANNS, THE HISTORY OF THE PRISON
PRISON PSYCHOSES
NITSCHE &
PSYCHOSES
(Francis M. Barnes, Jr. &
& Bernard
Bernard Glueck trans., 1912).
1912).
37. See id.
id.
SeeAppendixB.
Appendix B.
38. See

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343

observation
However, multiple reports based on careful clinical observation
suggested that a substantial majority of these prison psychoses were
suggested
itself. Gradually,
Gradually, a
direct reactions to the conditions of imprisonment itself.
clinically distinguishable
distinguishable syndrome of acute reactive prison
clinically
considered in
psychoses began to be defined. Different variables were considered
attempting
attempting to explain the etiology
etiology of these reactive prison psychoses,
or
including
including long versus short durations of imprisonment,
imprisonment, or
imprisonment
imprisonment of those already
already convicted
convicted versus imprisonment while
while
awaiting trial. However, the most consistent factor described,
reported in over half the total literature, was solitary confinement.
C. The Twentieth Century Experience: Prisonersof War, "Brain
C. The Twentieth Century Experience: Prisoners of War, "Brain
Washing,
Washing,""and
and Experimental
Experimental Research
Research
1. Prisoners of War and "Brain
"Brain Washing"
1.
Washing"
Unfortunately, other than some anecdotal reports, there was little
Unfortunately,
discussion of the psychological
effects of solitary confinement
confinement in the
psychological effects
medical literature
literature during the first half of the twentieth
twentieth century.
earlier
consequence of the disastrous earlier
Undoubtedly, this was in part a consequence
experience with such confinement. As statistical
experience
statistical evidence
evidence
accumulated during the nineteenth
accumulated
nineteenth century
century that solitary confinement
confinement
produced a very disturbing incidence
incidence of insanity, physical
physical disease,
changed
and death the system fell into disrepute
disrepute and, with this, it had changed
experiment in social refonn
reform into a hidden,
from an open, optimistic experiment
secretive place
secretive
place of punishment and control.
psychological impact, however, did not change, a
Its devastating psychological
1950s
fact which became suddenly
suddenly and very painfully evident
evident in the 1950s
dramatic
as the American
American public began
began hearing
hearing the frightening and dramatic
washing" of American
reports of "brain washing"
American prisoners of war in KoreaKoreareports that alterations
alterations in the sensory environment
environment were being
being
intentionally imposed upon these prisoners in a seemingly Orwellian
Orwellian
3
attempt to profoundly
profoundly disrupt their psychological
psychological equilibrium. 39
1950s,
reports
had
already
appeared
of
major
psychiatric
By the
confinement in
disturbances among survivors of prolonged
disturbances
prolonged solitary confinement
as It
39. Lawrence E. Hinkle,
InterrogationSubject as
Hinkle, Jr., The Physiological
Physiological State of the Interrogation
supra note 13,
13, at 35.
Affects
BrainFunction,
MANIPULATION OF HUMAN
HUMAN BEHAVIOR,
BEHAVIOR, supra
Affects Brain
Function, in THE MANIPULATION

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40
war,40
but during the decade of the Korean War major attention was
war,
riveted on the occurrence
occurrence of these disturbances
disturbances not only in war but in
1956 the Group for the
a variety of other settings as well. In 1956
"Factors Used
Advancement
Psychiatry (GAP) held a symposium, "Factors
Advancement of Psychiatry
of
Individuals
to Increase the Susceptibility
Susceptibility
Individuals to Forceful
Indoctrination," to study methods used by the Chinese
Chinese and Russian
Indoctrination,"
Communists
"indoctrinate" and "break the will" of political
Communists to "indoctrinate"
Chief
prisoners and prisoners of war. 441' Dr. Milton Meltzer, former Chief
contributed his
Medical
Medical Officer at Alcatraz Federal Penitentiary,
Penitentiary, contributed
observations
disturbances among prisoners
prisoners exposed to
observations of psychiatric disturbances
42
42
prisoners were
punitive solitary
solitary confinement
confinement at Alcatraz. These prisoners
rarely confined
confined for periods
periods beyond one week.43
43 Despite this, Dr.
Meltzer
Meltzer described acute psychotic breakdowns
breakdowns among prisoners
prisoners so
confined; his descriptions
descriptions closely paralleled
paralleled the observations
observations at
confined;
Walpole:

The motor
motor effects
effects ranged from occasional tense pacing,
restlessness and sense of inner tension with noise making,
of
yelling, banging and assaultiveness at one extreme, to a kind of
regressed, dissociated, withdrawn, hypnoid and reverie-like
state at the other....
other. ...

self, the ego and ego boundary
...... [T]he sense of self,
phenomena
44
phenomena are profoundly
profoundly affected by the isolation.44
of
In the same symposium
symposium Dr. John Lilly of the National
National Institute of
Mental Health noted that despite the importance
importance of other factors
"weaken personalities and make them more
which tended to "weaken
susceptible to [forced indoctrination]"-such
indoctrination],,-such as semi-starvation,
semi-starvation,
physical
pain
and
injury,
and sleep deprivation-social
physical
deprivation-social and sensory
45
isolation was still the central pathogenic factor in such confinement.45
CONFINEMENT (1952).
40. See,
See, e.g.,
e.g., CHRISTOPHER
CHRISTOPHER BURNEY, SOLITARY CONFINEMENT
(1952).
ADVANCEMENT OF PSYCHIATRY,
41.
41. See GROUP
GROUP FOR
FOR THE ADVANCEMENT
PSYCHIATRY, FACTORS USED TO
TO INCREASE
INCREASE
(1956).
THE
INDIVIDUALS TO FORCEFUL INDOCTRINATION
INDOCTRINATION (1956).
THE SUSCEPTIBILITY
SUSCEPTIBILITY OF INDIVIDUALS

42.
43.
43.
44.
45.
45.

Id. at 96-103.
96-103.
[d.
Id.
[d. at 98.
Id.
Id.
Id.
Id. at 89.

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Experimental Research
2. Experimental
Research on Sensory Deprivation
Deprivation

An experimental model
model was therefore
therefore designed to study the effect
effect
of such sensory deprivation;
deprivation; this research, conducted during the
the
1950s and early 1960s, primarily at Harvard
Harvard and McGill University
Medical Centers, was in fact funded in large part by the United States
government-and especially
government-and
especially by the Department of Defense and the
Intelligence Agency. This research
Central Intelligence
research is described
described in an
an
46 Its relevant conclusions can, however, be
appendix
appendix to this article.46
described relatively
relatively briefly:
In these studies subjects
subjects were placed
placed in a situation designed for
maximum reduction perceptually
informative
perceptually informative external
external stimuli (light(lightproof, sound-proof rooms; cardboard
proof,
cardboard tubes surrounding
surrounding the arms and
hands to reduce
on).47
reduce proprioceptive
proprioceptive and tactile sensation;
sensation; and so on).47
The research revealed that characteristic
characteristic symptoms generally
generally
developed in .such
such settings. These symptoms
developed
symptoms included perceptual
perceptual
distortions and illusions
illusions in multiple spheres (visual, auditory,
auditory, tactile,
olfactory); vivid fantasies, often accompanied
accompanied by strikingly
strikingly vivid
hallucinations in multiple
experiences; and
hallucinations
multiple spheres;
spheres; derealization
derealization experiences;
hyperresponsivity to external
external stimuli. What was also clear, however,
hyperresponsivity
experiences well, many
was that while some
some subjects tolerated such experiences
characteristic syndromes
syndromes were observed, including the
did not, and characteristic
above symptoms and cognitive impairment;
impairment; massive free-floating
free-floating
emergence of primitive
anxiety; extreme
extreme motor restlessness;
restlessness; emergence
aggressive fantasies which were often accompanied
accompanied by fearful
hallucinations;
and
a
decreased
capacity
to
maintain
hallucinations;
decreased capacity
maintain an observing,
observing,
reality-testing ego function. In some cases an overt psychosis
psychosis
supervened with persecutory
persecutory delusions and, in other cases, a marked
supervened
catatonic-like stupor
dissociative, catatonic-like
stupor (delirium) with mutism developed.
of
EEG recordings
recordings confirmed
confirmed the presence of abnormalities typical of
stupor and delirium.
These
These findings clearly
clearly demonstrated that this experimental
experimental model
did reproduce
the
findings
in
the
non-experimental
reproduce
non-experimental situations,
46. See Appendix C.
C.
EXPERIMENTAL
47. See,
See. e.g.,
e.g., CHARLES
CHARLES A. BROWNFIELD, ISOLATION:
ISOLATION: CLINICAL AND EXPERIMENTAL
APPROACHES (1965);
(1965); SENSORY
SENSORY DEPRIVATION:
SYMPOSIUM HELD AT HARVARD
HARVARD MEDICAL
ApPROACHES
DEPRIVATION: A SYMPOSIUM
1961) [hereinafter
SENSORY DEPRIVATION-HARVARD].
SCHOOL (Philip Solomon
Solomon et al. eds.,
eds., 1961)
[hereinafter SENSORY
DEPRIVATION-HARVARD].

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prisoners of war held III
in solitary
including the findings among pnsoners
confinement.
D. Factors
FactorsEffecting Response to Sensory Restriction
and Solitary
Solitary
Restriction and
Confinement
Much of the subsequent research in this area attempted
attempted to
delineate variables which might explain these differing outcomes.
i) differences
differences
These variables can be divided into two categories:
categories: i)
among various conditions of perceptual
perceptual deprivation, and ii)
differences in preexisting personality
personality functioning among individuals
differences
experiencing such conditions.
experiencing

1. Differing Conditions of Isolation
1.
One of the factors that was commonly cited in the research was
the intensity and duration of the sensory deprivation. More
More severe
longer
sensory restriction, the presence of noxious stimulation, and longer
duration
experience have all been
duration of the sensory deprivation
deprivation experience
associated
adverse psychiatric
psychiatric
associated with an increased risk of adverse
consequences.
consequences.
In my experience,
experienced by inmates
experience, conditions
conditions experienced
inmates in various
prison solitary confinement
confinement settings generally
generally bear some similarities
similarities
(a
eighty square
square feet; approximately
approximately twentytwenty(a cell of roughly fifty to eighty
two and one-half
one-half hours per day locked in the cell; about one hour per
per
day of yard exercise, five out of the seven
seven days each
each week),
week), in other
other
respects
respects the conditions
conditions are fairly variable. For example, some cells
cells
have barred
doors,
which
allow
better
ventilation,
sound
barred
sound
transmission, and visual connection
connection with the outside environment
environment
than do mesh steel doors; solid
restrictivesolid steel doors are
are the most restrictiveespecially
especially when they are either
either hinged or
or slide shut
shut with almost
almost no air
air
gap from the
the wall. Moreover,
Moreover, administrative
administrative conditions
conditions regarding
regarding the
amount and circumstances
availability of
of reading
reading
circumstances of visitation, the availability
and
material
television,
and
so
forth
are
all
factors
which
vary
from
material
television, and
are
from
institution to institution,
and
even
from time
institution, and
time to time within a given
given
institution.

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Experience
2. The Perceived
Perceived Intent of the Isolation Experience
In addition to the factors described above, another
another critical factor in
determining the effect of isolation appears to be the perceived intent
demonstrated that an
of the isolation. Experimental
Experimental research has demonstrated
an
experience the
individual who receives clues which cause
cause him to experience
isolation situation as potentially threatening
threatening is far more likely to
develop
psychiatric reactions to the isolation experience.
develop adverse psychiatric
experience.4848
Conversely, if the subject has reason to believe the situation is likely
49
it.
even enjoy
to be benign he will be far more
more likely
likely to
to tolerate
tolerate or
or even
enjoy it.
49
Among the latter group of subjects who tolerated isolation well,
many reported pleasant
pleasant or at least non-threatening
non-threatening visual imagery,
50 "His mind may begin to
hallucinatory experiences. 50
fantasy, and hallucinatory
wander, engage in daydreams, slip off into hypnogogic reveries with
their attendant vivid pictorial images
...he may be quietly having
images ...
5
sexual or other pleasurable
thoughts.,,51
pleasurable thoughts."
This finding is perhaps
perhaps not surprising. It appears
appears that sensory
restriction produces
perceptual
disturbances
and
illusions which are
produces
disturbances
analogous
clearly,
analogous to those produced
produced by hallucinogenic
hallucinogenic drugs, and clearly,
while there are some individuals who could be said to have
volunteered
volunteered to undergo
undergo such hallucinatory, psychotic-like
experiences
experiences it must be almost uniformly terrifying to be forced to
experience similar to that induced by hallucinogenic
undergo an experience
hallucinogenic
drugs.

3. Individual
Individual Differences
Differences in Response
3.
Response
Many
Many studies have demonstrated
demonstrated that there is great variability
among
given
among individuals in regard to their capacity to tolerate a given
condition of sensory restriction. This variability helps to provide
further insight into the nature of the toxic effect
effect of such isolation
conditions, and provides striking corroboration of the fact that such
& David S.
Perceptual Deprivation
48. See Nancy
Nancy A. Wright &
S. Abbey, Perceptual
Deprivation Tolerance
Tolerance and
Adequacy of Defenses, 20 PERCEPTUAL
PERCEPTUAL &
& MOTOR
SKILLS 35
35 (1965).
MOTOR SKILLS
(1965).
49. Leo Goldberger,
ExperimentalIsolation: An
Goldberger, Experimentallso/ation:
An Overview, 122 AM. J.J. PSYCHIATRY
PSYCHIATRY 774,
777
(1966).
777 (1966).
50. Id.
Id.
SO.
Id.
551.
I. ld.

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deprivation of environmental
environmental stimulation, especially when of
of
deprivation
prolonged duration, is toxic to brain functioning and causes
characteristic of stupor and delirium.
symptoms characteristic
Generally, individuals with mature, healthy personality
functioning and of at least average intelligence are most able to
tolerate the regressive pull and perceptual intrusions of such isolation
isolation
situations. On the other hand, individuals with primitive or
psychopathic
psychopathic functioning or borderline
borderline cognitive capacities,
capacities, impulseridden individuals, and individuals whose internal emotional life is
at risk for severe psychopathologic
psychopathologic
chaotic or fearful are especially
especially
52
reactions
reactions to such
such isolation.
isolation. 52
Moreover, there is clear evidence that, in a situation
situation of restricted
environmental
environmental stimulation, preexisting
preexisting central nervous
nervous system
dysfunction
of
dysfunction is a major predisposing factor to the development
development of
adverse
adverse psychiatric reactions and of overt delirium. For example,
example, in
one study of patients suffering visual deprivation
deprivation following eye
surgery
(eye-patched patients), those patients
surgery (eye-patched
patients with preexisting central
nervous system dysfunction were found to be at especially
especially high risk
to develop symptoms of delirium.5533 Further, the presence of a
preexisting personality
personality disorder
psychosocial
preexisting
disorder or impairment of psychosocial
functioning
functioning was associated
associated with increased risk of incapacitating
fearfulness,
paranoia,
fearfulness,
paranoia, agitation, and irrational
irrational aggression
aggression toward
toward
54
staff. 54
In addition, individuals
individuals may at times be exposed to situations
which
cause
impairment
central nervous system functioning. Such
Such
which cause impairment of central
situations-especially if they impair the individual's
situations--especially
individual's state of alertness
alertness
deprivation, abnormal
(for example,
example, sleep
sleep deprivation,
abnormal sleep-wake
sleep-wake cycles, or the
use of sedating medication)
medication) will substantially increase
increase the
individual's
development of delirium. Delirium
Delirium
individual's vulnerability
vulnerability to the
the development
among
post-surgical
patients
and
the
so-called
"ICU
psychoses"
among post-surgical patients
so-called "leu psychoses" are
55 One of the characteristic
examples
of
this
phenomenon.
examples
phenomenon. 55 One
characteristic difficulties
difficulties
52.
52. See
See Appendix
Appendix CC (describing
(describing these studies
studies in more detail).
detail).
53.
and Mental Illness, 168
53. Eugene
Eugene Ziskind,
Ziskind, Isolation
Isolation Stress
Stress in Medical
Medical and
168 J.
1. AM.
AM. MED.
ASS'N
ASS'N 1427,
1427, 1428 (1958).
(1958).
54.
& Rafael
Rafael Moses,
Moses, Psychological
Psychological Reaction to Sensory Deprivation
Deprivation in
54. Hillel
Hillel Klein
Klein &
Patients
PSYCHOTHERAPY &
Patients with Ablatio
Ablatio Retinae,
Retinae, 24 PSYCHOTHERAPY
& PSYCHOSOMATICS
PSYCHOSOMATICS 41,
41, 49-51
49-51 (1974).
(1974). A
A
more
of this literature
literature is contained
contained in
in Appendix
Appendix A to this
this declaration.
declaration.
more extensive
extensive review
review of
55.
55. Appendix
Appendix A discusses
discusses this
this issue
issue in more
more detail.
detail.

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349

experienced
inmates in solitary
solitary confinement
confinement is abnormal
abnormal sleepsleepexperienced by inmates
wake cycles and
and impaired
impaired sleep.
wake
a. Findings
Findings at Pelican
Pelican Bay State Prison
Prison
These findings
findings received
received further corroboration
corroboration in my observations
observations
These
1991-1992, as
of inmates at Pelican
Pelican Bay
Bay State
State Prison, California. In 1991-1992,
of
part of my
my participation
participation in
in Madrid
Madrid v. Gomez-a class-action
class-action lawsuit
lawsuit
part
a
new
challenging conditions at Pelican
Pelican Bay State Prison,
Prison,
new
challenging
"supermax"
facility
in
California
56-I
evaluated
forty-nine
inmates
"supermax" facility in California 56_1 evaluated
housed in the SHU at the institution
institution and prepared a lengthy
lengthy report to
housed
the federal court
court of my findings.57
57 Many of the inmates II evaluated
evaluated
there suffered severe
severe psychiatric
disturbances while housed in Pelican
Pelican
psychiatric disturbances
there
Bay SHU, either springing up de novo while so incarcerated
or
incarcerated or
exacerbation of preexisting
recurrence or severe
representing
representing a recurrence
severe exacerbation
preexisting
illness. Of
Of the forty-nine inmates II evaluated, at least
least seventeen
seventeen were
of
actively psychotic
psychotic and/or acutely
acutely suicidal and urgently
urgently in need of
acute hospital treatment,
treatment, and twenty-three
twenty-three others suffered
suffered serious
psychopathological reactions
reactions to solitary
solitary confinement,
confinement, including (in
psychopathological
several cases) periods
periods of psychotic
psychotic disorganization.
The clinical
clinical data at Pelican
Pelican Bay also added striking corroboration
corroboration
of
to the conclusion
conclusion that the severe and prolonged
prolonged restriction
restriction of
brain
is
toxic
to
confinement
in
solitary
stimulation
environmental
environmental
confinement
florid
demonstrated that the most severe,
functioning. The data demonstrated
severe, florid
confinement tend to be
psychiatric illnesses resulting from solitary
solitary confinement
psychiatric
suffered by those individuals with preexisting
suffered
preexisting brain dysfunction. As
noted before, I have observed
observed a high incidence
incidence of preexisting central
nervous system dysfunction
dysfunction among the inmates I evaluated in solitary
solitary
confinement settings. This was also the case at Pelican
confinement
Pelican Bay, and
dramatically
statistical analysis of the Pelican Bay data quite dramatically
were
vulnerability
preexisting
with
such
that
inmates
demonstrated
demonstrated
the most likely to develop
develop overt confusional, agitated, hallucinatory
hallucinatory
psychoses as a result of SHU confinement.
remanded, ISO
150 F.3d
rev'd and
andremanded,
1146 (N.D. Cal. 1995), rev'd
56. Madrid v. Gomez, 889 F. Supp. 1146
1998).
1030 (9th Cir. \998).
57. Much of the literature review and historical material in the present declaration is taken
Madriddeclaration.
from my Madrid

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b. Attention Deficit and Antisocial Personality Disorders

research regarding Attention Deficit Hyperactivity
In addition, research
Disorder and Antisocial Personality
Personality Disorder demonstrated that these
conditions are similarly associated with a particular
particular inability to
environmental stimulation. There is increasing
tolerate restricted environmental
evidence that childhood impulsivity and Attention Deficit
Deficit
Hyperactivity
Hyperactivity Disorder bear some relationship to Antisocial
Personality
characterized by impulsivity
Personality Disorder, in that both are characterized
and stimulation-seeking
stimulation-seeking behavior, and both involve biologically
based abnormalities in central nervous system functioning. Moreover,
the clinical literature demonstrates
demonstrates that individuals
individuals with Antisocial
Personality
Disorder
are
especially
intolerant of restricted
restricted
Personality
environmental
environmental stimulation. For example, the psychopathic
psychopathic individual
has been
been characterized
characterized as pathologically
pathologically "stimulation
"stimulation 58seeking,"
seeking,"
and boredom.,
routine and
tolerate routine
"impulsive," and "unable to
to tolerate
boredom.,,58
"impulsive,"
conducting clinical
observations of
of
Given the exigencies
exigencies of conducting
clinical observations
inmates in solitary confinement
confinement it is not surprising that little
systematic
systematic attempt
attempt has been made to elucidate the underlying
underlying
psychological
characteristics
of
those
most at risk for developing
developing
psychological characteristics
severe
severe psychopathological
psychopathological reactions
reactions to such isolation. However,
Syndrome, a related
among the clinical reports on Ganser's Syndrome,
related
condition, in non-prison
non-prison populations
populations are several studies
studies of patients in
psychiatric
available for
psychiatric hospitals. 59
59 These
These patients were,
were, of course, available
extensive psychological
psychological assessment
assessment and observation, and these
reports
suffering longreports described
described the majority of these patients as suffering
standing hysterical
character
hysterical character disorders, having problems with severe
impulsivity,
impulsivity, childhood truancy, and
and antisocial
antisocial behavior patterns.660°
demonstrates that individuals
Thus, the
the medical literature
literature demonstrates
individuals whose
whose
internal
internal emotional
emotional life is chaotic and impulse-ridden
impulse-ridden and individuals
individuals
with central
dysfunction may be especially
central nervous system dysfunction
especially prone
prone to
58.
C. Quay,
58. Herbert
Herbert C.
Quay, Psychopathic
Psychopathic Personality
Personality as Pathological
Pathological Stimulation-Seeking,
Stimulation-Seeking, 122
122
AM.
AM. J.
J. PSYCHIATRY
PSYCHIATRY 180,
180, 180
180 (1965).
(1965). Appendix
Appendix B contains
contains a more
more detailed
detailed discussion.
discussion.

59. See,
Contribution to the
See, e.g., Merle R. Ingraham
Ingraham &
& David M. Moriarty, A
A Contribution
Understanding
Understanding of
of the Ganser
Ganser Syndrome, 8 COMPREHENSIVE
COMPREHENSIVE PSYCHIATRY
PSYCHIATRY 35
35 (1967);
(1967); Rupert
Rupert H.
May et
al., The Ganser
Ganser Syndrome: A Report of
Cases, 130
et aI.,
of Three Cases,
130 J. NERVOUS
NERVOUS &
& MENTAL
MENTAL
DISEASES
DISEASES 331 (1960).
(1960).
60. May
May et
et al.,
aI., supra
supra note 59, at 331-36.
331-36.

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psychopathologic reactions to restricted
restricted environmental
environmental stimulation in
psychopathologic
a variety of settings. Yet, among the prison
prison population,
population, it is quite
likely that these are the very individuals who are especially prone to
committing infractions
infractions that result in stricter incarceration,
incarceration, including
committing
severe isolation and solitary confinement.
61

Coughlin6J
v. Coughlin
c. Langley v.

In the late 1980s I interviewed and reviewed
reviewed the medical records
of several dozen
dozen inmates
inmates confined
confined in maximum security
security prisons in
incarcerated at
New York State, including a large group of women incarcerated
the maximum security women's
women's prison for the state of New York at
Bedford
Bedford Hills. During the process of these evaluations it became
became
of
clear that a very high percentage of these women had a history of
serious emotional or organic mental difficulties. Many had severe
cognitive
cognitive limitations,
limitations, were
were highly emotionally
emotionally labile, impulse ridden,
and prone to psychotic disorganization. In many cases the infraction
which led to their original
original incarceration was an act which had been
of
committed
committed impulsively and chaotically. Under the stress of
imprisonment these inmates became even more unable to conform
their behavior
behavior to the requirements of their situation.
Inevitably, this resulted in their being sentenced
sentenced to terms in the
SHU, and once in the SHU their subsequent
subsequent course was often
often a
nightmare.
nightmare. Many became grossly disorganized and psychotic,
psychotic,
smearing themselves with feces, mumbling and screaming
screaming
of
incoherently all day and night, some even descending to the horror of
eating parts of their own bodies.
The resulting lawsuit was ultimately
ultimately settled by consent decree.
The settlement provided injunctive relief as well as monetary
condition
damages
emotional condition
damages both for the mentally ill inmates whose emotional
had deteriorated
deteriorated during their incarceration
incarceration in the SHU, and also for
of
subjected to the bedlam of
the non-mentally
non-mentally ill women who had been subjected
relief
mental illness created in their SHU environment.
environment. The injunctive
injunctive relief
required the prison
prison to begin to reframe the meaning it gave to
Coughlin, 715 F. Supp. 522 (S.D.N.Y.
61. There are two companion
61.
companion cases: Langley v.v. Coughlin,
(S.D.N.Y.
affid, 888 F.2d 252 (2d Cir.
1989); and Langley v. Coughlin,
Coughlin, 709 F. Supp. 482 (S.D.N.Y. 1989),
1989), ajJ'd,
1989).

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behavioral disturbances
disturbances which they had
had previously
previously responded
responded to by
behavioral
62
Under
further
further SHU
SHU time. 62
Under the settlement
settlement the prison
prison began to actively
actively
consider whether
whether such
such disturbances
disturbances were the result of organic
consider
of
personality disturbances,
disturbances, affective
affective or impulse disorders,
disorders, or
or even
even of
personality
schizophreniform illness. The result
result of these changes was apparently
apparently
schizophreniform
quite dramatic.
prisoners who had been in SHU began
began to be
be treated
treated
Many of the prisoners
residential psychiatric
psychiatric unit within the prison. This
This unit had
in a residential
previously refused to treat such inmates,
inmates, claiming that
that their security
previously
When
pressed
handled.
could
be
greater
than
needs were
could
When pressed to provide
discover
settlement not only did the unit discover
services as a result of the settlement
services
provide those services, but moreover discovered
discovered
that it was able to provide
dramatically
custodial and security
security needs
needs of these inmates dramatically
that the custodial
decreased when their behavioral
behavioral disturbances
disturbances were framed as
decreased
psychiatric problems rather than as a security
security issue. Thus, as a result
result
psychiatric
benefitedto
the
suit
all
parties
parties
benefitedof the settlement of the lawsuit,
prisoners
prisoners and the officers
officers of the correctional
correctional facility alike. I followed
followed
the result of the litigation
litigation in my capacity
capacity as an expert member of the
settlement.

Psychologically More Resilient Inmates:
d. Effects on Psychologically
63 and Hameed v. Coughlin64
Baraldiniv. Meese 63 and
Baraldini
Hameed v. Coughlin 64
Meese, a
Baraldiniv. Meese,
involvement in Baraldini
In 1988 in the course
course of my involvement
confinement of a small group of women
women
class-action challenging
challenging the confinement
class-action
in a subterranean
subterranean security
security housing unit at the Federal Penitentiary in
Lexington, Kentucky, I had the opportunity to interview
interview several
Lexington,
These
women had
this
facility.
in
in
confinement
women who were
confinement
politically motivated crimes,
been convicted of having committed politically
were all highly educated, and had a history of relatively strong
psychological functioning prior to their confinement. None of these
earlier
women developed the florid confusional psychosis described earlier
in this affidavit, yet each of them demonstrated
demonstrated significant
62. Langley, 709 F. Supp. 482.
Thomburgh, 884 F.2d
rev'd sub
sub nom., Baraldini v. Thornburgh,
63. 691 F. Supp. 432 (D.D.C. 1988), rev'd
615 (D.C. Cir. 1989).
1995).
57 F.3d 217 (2d Cir. 1995).
64. 57F.3d

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psychopathological reactions to their prolonged confinement in a
psychopathological
setting of severe environmental
environmental and social isolation. These included
included
perceptual
perceptual disturbances, free-floating anxiety, and panic attacks.
These inmates also uniformly described severe difficulties in
thinking, concentration, and memory; for example, one inmate
reported that she was able to perform
perform tasks requiring some mental
effort-such
effort-such as reading or writing-only for about the first three
hours of the morning after she awoke; by then, her mind had become
so slowed down, so much "in a fog," that she was entirely unable to
maintain any meaningful
meaningful attention or expend any meaningful
meaningful mental
effort.
evidenced
I have since evaluated a number
number of individuals who evidenced
strong psychological
psychological adjustment prior to imprisonment. For example,
in 1993 I evaluated
evaluated Bashir Hameed, an inmate who had been
incarcerated
Shawangunk Correctional Facility and
incarcerated in the SHU at Shawangunk
who had brought suit concerning his incarceration
incarceration there. As I
described in my testimony
testimony in that case, Mr. Hameed is an individual
evidences strong prior psychological adjustment and no prior
prior
who evidences
SHU
psychiatric history, yet became
became significantly ill as a result of his SHU
confinement.
confinement.
E.
and Small Group
Group Confinement
E. Long Term Effects of Solitary
Solitary and
Long-term
Long-term studies of veterans
veterans of prisoner
prisoner of war camps, and of
of
kidnapping
kidnapping and hostage situations
situations have demonstrated that while
while
many of the acute
acute symptoms
symptoms I outlined
outlined above
above tend to subside after
after
release
release from confinement, there are
are also long-term effects
effects which may
65
persist
These
These not only include persistent
persistent symptoms of
of
persist for decades.
decades.65
post traumatic
stress
(such
as
flashbacks,
chronic
traumatic
(such flashbacks, chronic hypervigilance,
hypervigilance, and
and
a pervasive
hopelessness), but also lasting personality
personality
pervasive sense
sense of hopelessness),
changes--especially
intolerance of
of
changes---especially including
including a continuing
continuing pattern
pattern of intolerance
social
social interaction,
interaction, leaving
leaving the individual
individual socially
socially impoverished
impoverished and
and
withdrawn, 66 subtly angry
angry and fearful when forced
forced into
into social
interaction. 66
interaction.
65. See
See LAWRENCE
LAWRENCE E. HINKLE,
HINKLE, JR. &
& HAROLD
HAROLD G.
G. WOLFF, COMMUNIST
COMMUNIST INTERROGATION
INTERROGATION
AND
STATES" (1956).
AND INDOCTRINATION
INDOCTRINATION OF
OF "ENEMIES
"ENEMIES OF
OF THE STATES"
(1956).
66.
66. This
This literature
literature is reviewed
reviewed in Appendix
Appendix D to
to this
this declaration.
declaration.

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In addition, from time to time I have had the opportunity
opportunity to
incarcerated in solitary
evaluate individuals
individuals who had been incarcerated
confinement several years previously. I have found the same pattern
confinement
of personality
personality change
change described above: these individuals had become
impoverished and experienced
strikingly socially impoverished
experienced intense irritation
irritation
with social interaction, patterns
dramatically different
patterns dramatically
different from their
functioning prior to solitary confinement.
III. CONCLUSIONS

The restriction
restriction of environmental
environmental stimulation and social isolation
associated
associated with confinement
confinement in solitary are strikingly
strikingly toxic to mental
functioning, producing a stuporous
stuporous condition associated with
perceptual and cognitive impairment
perceptual
impairment and affective
affective disturbances. In
more severe
severe cases, inmates so confined have developed
developed florid
florid
delirium-a
confusional
psychosis
with
intense
agitation,
fearfulness,
delirium-a confusional
and disorganization. But even those inmate
inmate who are more
psychologically resilient inevitably suffer severe psychological
psychological pain
psychologically
as a result of such confinement, especially
especially when the confinement is
especially when the individual experiences
experiences this
prolonged, and especially
confinement as being the product of an arbitrary
arbitrary exercise of power
confinement
and intimidation. Moreover, the harm caused
caused by such confinement
confinement
may result in prolonged
or
permanent
psychiatric
disability,
including
prolonged permanent
impairments which may seriously
impairments
seriously reduce the inmate's capacity to
reintegrate
community upon release from prison.
reintegrate into the broader community
Many of the prisoners who are housed in long-term solitary
confinement are undoubtedly a danger to the community and a
confinement
danger
danger to the corrections officers charged with their custody. But for
many they are a danger not because they are coldly ruthless, but
because
because they are volatile, impulse-ridden, and internally
disorganized.
As noted earlier in this statement, modem societies made a
fundamental
fundamental moral division between socially deviant behavior
behavior that
behavior that was seen
was seen as a product of evil intent, and such behavior
as a product of illness. Yet this bifurcation
bifurcation has never been as simple
as might at first glance appear. Socially
Socially deviant behavior can in fact
be described
described along a spectrum
spectrum of intent. At one end are those whose
behavior
"instrumental"-ruthless, carefully planned, and
behavior is entirely
entirely "instrumental"-ruthless,

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355

other are individuals
individuals whose
whose socially
socially deviant
deviant behavior
behavior
rational; at the other
the product
product of unchecked
unchecked emotional impulse, internal chaos,
chaos, and
and
is the
of psychiatric
psychiatric or neurological
neurological illness.
often of
It
It is aa great
great irony that as one passes through
through the levels of
of
maximum
to
the
to
the
moderate
minimum
incarceration-from
incarceration-from the minimum
moderate
maximum
security institutions,
institutions, and then to the solitary
solitary confinement
confinement section
section of
of
security
institutions--one does not pass
pass deeper
deeper and
and deeper into a
these institutions-one
subpopulation of the
the most ruthlessly
ruthlessly calculating
calculating criminals. Instead,
subpopulation
ironically
ironically and tragically,
tragically, one comes
comes full circle
circle back to those who are
emotionally
emotionally fragile and, often, severely mentally ill. The laws and
practices
practices that have established
established and perpetuated
perpetuated this tragedy
tragedy deeply
deeply
offend any sense of common human decency.

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APPENDIX A:
APPENDIX

REPORTS OF PSYCHIATRIC
PSYCHIATRIC DISTURBANCES
REpORTS
DISTURBANCES IN OTHER
OTHER CONDITIONS OF
RESTRICTED ENVIRONMENTAL
STIMULATION
ENVIRONMENTAL STIMULATION

The psychopathologic
psychopathologic syndrome which I have described in the
body of this article
article is found in other settings besides isolation in civil
prisons. Some of these settings involve small group, rather than
solitary isolation, and the studies have demonstrated
demonstrated that isolated
groups comprising two individuals may be the most pathogenic
pathogenic of all.
These studies also suggest that those individuals with below average
intelligence and poor psychosocial adjustment prior to isolation
isolation
In
developed more severe psychiatric
psychiatric difficulties during isolation. In
disturbances persisted at a one year follow-up
some studies, such disturbances
follow-up
after reentry.
I.1. AVIATION

One particular
particular study, by Bennett, has described psychiatric
disturbances
disturbances among pilots of the British Royal Air Force who had
been exposed in-flight to periods of restricted auditory and visual
described became
became significantly
significantly
stimulation. 6677 All of the groups he described
anxious;
anxious; many suffered full-blown panic attacks, and many
experienced
experienced unusual sensations which they were very reluctant to
describe. The most severely disturbed groups refused
refused to expose
expose
themselves
themselves further to the isolation conditions of these flights. At all
levels of impairment, however, anxiety was common (both panic and
free-floating
free-floating anxiety). Pilots reported anxiety
anxiety symptoms
symptoms such as
afraid., 68
"nervous and
powerless" and
feeling "hot and tense and powerless"
and "nervous
and afraid.,,68
Feelings of derealization,
derealization, feelings of detachment
detachment from reality, and
perceptual distortions were described. Some of these perceptual
distortions were dangerous-such
dangerous-such as having the impression that the
aircraft was turning when it was not-and resulted in serious
serious errors in
in Aviation,
67. A.M. Hastin Bennett, Sensory Deprivation
Deprivation in
Aviation, in SENSORY
SENSORY DEPRIVATIONDEPRIVATIONHARVARD, supra
161-73.
HARVARD,
supra note 47, at 161-73.

68. Id.
ld. at 164.
164.

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judgment like making the aircraft spiral dangerously
after
dangerously downward after
attempting
"correct" for what was incorrectly
attempting to "correct"
incorrectly perceived as a
turning aircraft.
Another study described strikingly similar
similar symptoms among
among
69
isolation. 69
in-flight isolation.
to periods
of in-flight
United States Navy pilots exposed to
periods of
Among pilots who flew alone at high altitude (meaning in a situation
situation
of monotonous visual and sensory stimulation) and flying with a
minimum of pilot activity, over one third experienced
frightening
experienced
70
7o
anxious.
severely
became
and
unreality
of
feelings
and became severely anxious.
II. SMALL GROUP CONFINEMENT
CONFINEMENT

studies-both anecdotal and experimental-have
experimental-have been
been
Many studies-both
made of individuals confined together
in
small
groups.
Groups
thus
together
approximately sixty
described have ranged in size from two to approximately
individuals,
isolated on a
individuals, the larger
larger groups include
include reports of men isolated
Pacific island, in submarines, and on Antarctic expeditions. 7711 The
of
dramatically increased levels of
most consistent finding was of dramatically
exposed
hostility, interpersonal conflict, and paranoia.7722 Individuals
Individuals exposed
irrationally territorial, staking
to such conditions also tend to become
become irrationally
out "areas
of
exclusive
or
special
use,
[and] acting with hostility to
special
"areas
73
others.,,73
trespasses by others.
Confined groups comprising
comprising just two individuals may be the most
especially high rates of mutual
pathogenic of all, associated with especially
paranoia
paranoia and violent hostility. Admiral
Admiral Byrd believed
believed it to be
extremely unsafe to staff an Antarctic
Antarctic base unit with just two men:
& Ashton Graybiel, The Break-off Phenomenon,
Phenomenon, 28 J. AVIATION
69. Brant
Brant Clark &
AVIATION MED.
(1957).
121 (1957).
122.
70. Id.
Id. at 122.
71. See Seward
Studies of Small Groups
Groups in Confinement,
Confinement, in
in SENSORY
71.
Seward Smith, Studies
SENSORY
374-76 (John Peter Zubek ed.,
1969) [hereinafter
[hereinafter
DEPRIVATION: FIFTEEN
FIFTEEN YEARS OF RESEARCH
RESEARCH 374--76
ed., 1969)
SENSORY DEPRIVATION: FIFTEEN YEARS]. For articles
articles reporting
reporting effects in arctic environments,
environments,
see
J. Cochrane & S.J.J.
Conditions:
see Jeanette 1.
S.J.1. Freeman, Working in Arctic and
and Sub-Arctic Conditions:
Mental Health
Health Issues, 34 CAN. J. PSYCHIATRY 884 (1989);
(1989); Eric Gunderson &
& Paul D. Nelson,
Adaptation
Groups to Extreme Environments,
1111;
Adaptation of Small Groups
Environments, AEROSPACE MED., Dec.
Dec. 1963, at 1111;
Charles
& H.1.M.
H.J.M. Connery,
PsychologicalStudy at an
an Antarctic
Antarctic IGY Station,
Charles S. Mullin
Mullin &
Connery, Psychological
Station, 10 U.S.
ARMED
(1959).
ARMED FORCES MED. J. 290 (1959).
71, at 377.
72. Smith, supra
supra note 71,
73.
Id. at 380.
73. Id.

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[T]he
[I]t doesn't take two men long to find each other out....
out. ... [T]he
unformed
... when even his [campmate's]
[campmate's] unformed
time comes ...
thoughts can be anticipated, his pet ideas become a
meaningless
meaningless drool, and the way he blows out a pressure
pressure lamp
or drops his boots on the floor or eats his food becomes a
Men who have lived in the Canadian
Canadian
annoyance .... Men
rasping annoyance....
bush know well what happens to trappers paired off this way
...
... During my first winter at Little America
America I walked for
hours with a man who was on the verge of murder or suicide
over imaginary
imaginary persecutions by another man who had been his
74
devoted friend.74
POLAR HABITATION
III. POLAR
HABITATION

described in Arctic and
Psychiatric disturbances have been described
Psychiatric
Antarctic
Antarctic inhabitants
inhabitants (explorers,
(explorers, researchers, and their support staff),
spending varying periods in winter isolation. In these regions, winters
last for up to nine months with weather conditions so cold (-100F)
(-1 OOOP)
75
Typically,
leaving the confines
confines of the indoors is dangerous. 75
that leaving
teams of work groups have fewer than fifty members
members who spend up
76 Small group isolation
to two years working in small quarters. 76
compared to life in prisons by
conditions
conditions at these stations have been compared
"[T]he isolation imposed by the harsh
at least one researcher: "[T]he
experienced outside penal
environment
environment' 77[of the Antarctic] is rarely experienced
conditions.
conditions." 77
A review
review of the literature on the psychological
psychological adjustment
adjustment to
Antarctic
Antarctic living described a staff wintering over at a British Antarctic
Antarctic
to
be
socially
best
tended
station; those of the staff who adjusted
adjusted
socially
78
78
mature, intelligent, reserved, and trusting individuals. Similarly,
74. Id.at381.
!d. at 381.
& Nelson, supra note
71, at 1111.
1111.
75. Gunderson &
note 71,
76. Id.
!d.
Isolated
PersonalityCorrelates
CorrelatesofAdjustment in Isolated
77. Robert J. Biersner &
& Robert Hogan,
Hogan, Personality
(1989).
PERSONALITY 491,
491,491
RESEARCH IN
Work Groups,
Groups, 18
18 J. RESEARCH
IN PERSONALITY
491 (1989).
Factors in
in the Antarctic,
78. See Esther D. Rothblum,
Rothblum, Psychological
Psychological Factors
Antarctic, 124 J. PSYCH.
PSYCH. 253
(1990).
(1990).

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359

United States, and Australian
Australian studies revealed that
that
French, United
intelligence
intelligence and
and previous
previous social
social adjustment
adjustment predicted
predicted a decreased
decreased risk
risk
psychiatric disturbance
disturbance among workers
workers at Antarctic
Antarctic stations.
stations.7799 On
On
for psychiatric
the other
other hand, lack of respect
respect for authority
authority and
and aggression
aggression were
80
poor isolation adjustment.
adjustment.80
important markers for poor
Similarly, another
another study
study correlated
correlated outcome measures
measures with
Similarly,
81
to work
work station
station assignment.
assignment. 81
psychological testing obtained
obtained prior
prior to
psychological
specifically that persons
These researchers
researchers found specifically
persons with antisocial
antisocial and
and
in
functioning
risks
for
efficient
psychotic
psychotic tendencies
tendencies were poor risks
efficient
in
82
isolation.
of
isolation. 82
conditions
conditions
As a result
result of these disturbing
disturbing findings among Antarctic
Antarctic workers,
psychological screening
systematic
systematic efforts have
have been
been made to provide psychological
screening
of potential
potential station employees
employees and to ameliorate the isolation
isolation
83 Despite these
these efforts,
conditions prevailing
prevailing in such stations. 83
84
significant psychiatric
psychiatric disturbances
disturbances have continued to be observed. 84
significant
rather
in
small
groups
The fact that these individuals were confined
confined
than alone was not found to prevent these disturbances;
disturbances; indeed,
indeed, one
one
central pathogenic
pathogenic factors cited in this literature
literature has been the
of the central
interpersonal
interpersonal tension and hostility
hostility generated
generated by small
small group
confinement. 85
85
syndrome" including
"winter-over syndrome"
Studies have described
described a "winter-over
progressively worsening
progressively
worsening depression, hostility, sleep disturbance,
impaired cognitive functioning, and paranoia during small group
86
Strikingly similar findings
confinement in the Antarctic.86
winter confinement
were reported
reported by the United States Navy Medical
Medical Neuropsychiatric
Neuropsychiatric
Research Unit, which found high incidences of sleep disturbance,
Research
depression, anxiety,
anxiety, aggression, somatic complaints, and a
71, at 393-95.
also Smith, supra
supra note 71,
79. Id.
Id. at 256; see also
79.
71, at 292.
supranote 71,
& Connery, supra
80. Mullin &
Civilians for
Factors in the Selection
Selection of Civilians
et a!.,
al., Personality
Personality Factors
W. Wright et
81. See Morgan W.
(1967).
IsolatedNorthern
NorthernStations,
Isolated
Stations, 8 CAN. PSYCHOLOGIST 23 (1967).
Id. at 29.
82. Id.
71, at 889.
supra note 71,
Cochrane &
83. Cochrane
& Freeman, supra
South Pole
Pole
& 1.
J. Shurley, Sociopsychological
Sociopsychological Aspects of a Winter Vigil at South
84. K. Natani &
Gunderson
ADAPTABILITY TO ANTARCTIC CONDITIONS
HUMAN ADAPTABILITY
Station, in HUMAN
Station,
CONDITIONS 89-114 (Eugene Gunderson
Geophysical Union 1974).
ed., Am. Geophysical
& Hogan, supra
85. See Biersner
Biersner &
supra note 77, at 491-96.
Winterand Social Adjustment of Recent WinterEmotionaland
86. See, e.g., R. Strange &
& W. Klein, Emotional
(1974).
Stations, 7 ANTARCTIC
IsolatedAntarctic
Antarctic Stations,
ANTARCTIC BIBLIOGRAPHY
BIBLIOGRAPHY 229 (1974).
Over in Isolated

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progressive
impoverishment of social relationships as the winter
progressive impoverishment
progressed.8877 Psychiatric problems worsened as the length of time in
increased; in one study of a group of Japanese
this confinement increased;
winter-stationed in the Antarctic, periodic
winter-stationed
periodic psychological
psychological testing
revealed increasing levels of anxiety and depression
revealed
depression as the winter
88
Similar findings have been described
described among a group of
of
progressed.88
Americans
89
Americans stationed in the Antarctic. 89
A review of the literature on the psychological
psychological adjustment to
Arctic life described a syndrome which parallels the Antarctic
literature:
disturbances, apathy, irritability,
literature: sleep disturbances,
irritability, cognitive
dysfunction, hallucinations, depression, and anxiety were widely
endured by
reported as a result of the small group isolation endured
9o
inhabitants. 90
"depression, irritability, [and] easily
They also reported "depression,
provoked anger
anger which may escalate into dramatic
dramatic and florid acting
out and, not surprisingly, a breakdown
breakdown in relationships with other
.... [I]nsomnia,
[I]nsomnia, pallor, loss of appetite, loss of
of
members of the group ....
paranoidal ideation,
interest, psychomotor
psychomotor retardation, paranoidal
ideation, [and]
nonspecific hallucinations
hallucinations of light flashes and sudden movements
91 Even when
[were
experienced].",,91
[were also experienced].
Arctic workers were
adequately preselected
adequately
preselected by psychological
psychological screening,
screening, trained, and
supported sleep difficulties, apathy, and irritability persisted.
Studies on reintegration into the home environment
environment after Antarctic
Antarctic
living found persisting problems
problems and symptoms including
including sleep
cognitive slowing, emotional
emotional withdrawal,
of
disturbances, cognitive
withdrawal, resentment of
indecisiveness,
communication
even
one
authority, indecisiveness,
and
poor
communication
year
92
after reintegration. 92
Robert J. Biersner and Robert Hogan summarized
summarized the findings
related
to
personality
variables
in
the
Arctic
related
Arctic and Antarctic workers:
"Individuals with high needs for novelty and new sensations, ...
... who
"Individuals
are emotionally
emotionally unstable, or who are unconcerned
unconcerned with social
87. See E.K. Eric Gunderson, Emotional
Groups, 9
Emotional Symptoms
Symptoms in Extremely Isolated
Isolated Groups,
ARCHIVES
PSYCHIATRY 362 (1963);
& Nelson, supra
supra note 71,
1111-15.
ARCHIVES GEN. PSYCHIATRY
(1963); Gunderson
Gunderson &
71, at 1111-15.
supra note 78, at 253-73.
88. Rothblum, supra
89. Gunderson
Gunderson &
71, at 1114.
& Nelson, supra
supra note 71,
& Freeman,
90. See Cochrane
Cochrane &
Freeman, supra
supra note
note 71, at 889.
91. Id.
91.
Id. at 887.
supranote 78, at 267.
92. Rothblum, supra

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approval
for..,
environments ....
.... The opposite
approval seem unsuited for
... such environments
93
well.,,93
[traits are found in] those who adjust well.
IV. EXPLORERS:
EXPLORERS: SOLO VOYAGES
VOYAGES

Anecdotal reports of shipwrecked
Anecdotal
shipwrecked sailors and individuals
accomplishing
generally described
accomplishing long solo sea voyages have generally
described
"disturbances
"disturbances in attention and in organization
organization of thought, labile and
94 Dramatic
Dramatic anecdotal
extreme affect, hallucinations and delusions. ,,94
extreme
reports
have
appeared
from
time
to
time.
Some
of these were
reports
appeared
summarized in a review article
article by Dr. Philip Solomon, one of the
lead scientists in the Harvard Medical SchoollBoston
School/Boston City Hospital
group:
Christine Ritter in her very sensitive document A Woman in the
Polar
Night, reported that at times she saw a monster
monster...... [and]
Polar Night,
experienced depersonalization
depersonalization to the extent that she thought
experienced
she and her companions
companions were dissolving in moonlight 'as
'as
up' ...
... The Spitzbergen hunters use
though it were eating us up'
.... 95
these experiences
to describe
95
the term ran (strangeness) to
describe these
experiences ....
Tales of the sea have provided
provided many accounts of hallucinatory
phenomena. John Slocum sailed alone around the world...
world. . . [In the
South Atlantic] he suddenly saw a man, who at first he thought to be
a pirate, take over the tiller ....
....
Walter Gibson, a soldier
soldier in the British Indian Army, was on a ship
ship
torpedoed
....
Japanese in World
World War II ....
torpedoed in the Indian Ocean by the Japanese
shipwrecked survivors] reported that "all
"all of us at various stages
[The shipwrecked
stages
in that first week became
hallucinations" ...
. . . [As the weeks
became a prey to hallucinations"
comradeship disappeared
passed] the feeling of <;omradeship
disappeared and the men began to
suspiciously." 96
and suspiciously.,,96
covertly and
our fellows
find themselves
themselves "watching
"watching our
fellows covertly
93.
& Hogan, supra
93. Biersner
Biersner &
supra note 77, at 495.
495.
94. Peter Suedfeld, Introduction
Introduction and Historical
HistoricalBackground,
DEPRIVATION:
Background, in SENSORY
SENSORY DEPRIVATION:
FIFTEEN YEARS, supra
71, at 7.
supra note 71,
al., Sensory Deprivation:
Deprivation:AA Review, 114 AM. J.
J. PSYCHIATRY 357,
95. Philip Solomon
Solomon et ai.,
357,
357-58
(1957).
357-58 (1957).
Id.
96. Id.

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Murder, suicide,
and cannibalism followed as social controls
97
dissolved. 97
V. MEDICAL
MEDICAL CONDITIONS
CONDITIONS

PatchedPatients
A. Eye Patched
Patients
Restricted
Restricted environmental stimulation conditions also occur postoperatively and in certain medical conditions. In a study of one
hundred American
American patients
patients with macular
macular degeneration
degeneration of the retina, a
percentage of such patients experienced
experienced disturbing visual
high percentage
98
cognitively
Those patients who were relatively cognitively
hallucinations. 98
limited, those who were socially
isolated,
and
those
with
socially
simultaneous sensory
impairment in another modality (for example,
simultaneous
sensory impainnent
example,
99
hearing-impaired patients) fared worst. 99
But other factors, including
hearing-impaired
concomitant medical illness, did not appear to affect
affect
the presence
presence of concomitant
incidence of hallucinations. 100
100
the incidence
In an especially
especially relevant study of eye patched patients,
patients, it was
determined
that
psychologically
well-adjusted
patients
detennined
psychologically well-adjusted patients (as assessed
prior to surgery)
surgery) tended not to develop
develop visual hallucinations
hallucinations during
the period when their eyes
eyes were
were patched, whereas those suffering
suffering
preexisting
preexisting personality
personality disturbances
disturbances did tend to develop
develop such
such
hallucinations. 101
101 Among
Among those patients
patients who did develop
develop
hallucinations,
hallucinations, almost
almost half developed
developed complex hallucinations
hallucinations
involving
involving human figures and with content
content suggesting
suggesting serious
preoccupations
anxiety. 10 2 Moreover,
Moreover,
preoccupations with themes
themes of depression and anxiety.102
among those patients who had both preexisting
preexisting personality
personality
disturbances
disturbances and difficulty
difficulty with their premorbid psychosocial
psychosocial
adjustment,
eye
patching
produced
severe
psychiatric
eye
patching
produced
severe
psychiatric
symptomatology,
symptomatology, including:
including: paranoid thoughts about being poisoned,
physically
physically harmed
hanned or attacked;
attacked; psychomotor
psychomotor agitation;
agitation; interpersonal
interpersonal
97.
97. Id.
Id.
98.
98. See Suzanne
Suzanne Holroyd
Holroyd et
et al.,
aI., Visual Hallucinations
Hallucinations in Patients
Patients with Macular
Macular
Degeneration,
(1992).
Degeneration, 149 AM.
AM. J. PSYCHIATRY
PSYCHIATRY 1701,
1701, 1703
1703 (1992).
99. Id.
at 1703-04.
Id.at
1703-04.
100. Id.
Id.
101.
101. Klein &
& Moses,
Moses, supra
supra note
note 54,
54, at
at 49.
102.
102. Id.
Id.

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aggressiveness;
aggressiveness; inability to comply with staff directives; fearful
visual hallucinations;
incapacitating anxiety. 103 In this most
hallucinations; and incapacitating
disturbed group, symptoms had not remitted when observed one
patches were removed. 104
week after their eye patches
Other studies have also found patients to suffer from perceptual
perceptual
distortions, thinking disturbances,
disturbances, and mood changes following the
visual deprivation
postoperative recovery in eye
deprivation that is part of postoperative
05 Furthermore,
Furthermore, it was noted that "[i]n
... brain
surgery. 105
"[i]n patients with
with..,
brain
damage, there were also delirioid symptoms, e.g., confusion,
disorientation, memory impairment, vivid hallucinations
hallucinations [and
[and
disorganized] hyperkinetic
hyperkinetic activity ....
....
,'06 Finally, in C. Wesley
disorganized]
,,106
Jackson's extensive
extensive literature review of hospitalized eye patched
patched
10 7
These
These
patients, psychiatric disturbance was commonly
commonly found. l07
patients suffered
suffered from unusual emotional,
emotional, cognitive, and sensorysensoryperceptual disturbances similar to those previously
previously described.
B. Poliomyelitis
Poliomyelitis
Polio patients
become
patients confined
confined to tank-type
tank-type respirators have become
confinement; moreover, they
psychotic as a direct result of such confinement;
became
hallucinations and delusions, at
became more ill, with more florid hallucinations
108 The same
night when sensory input was diminished. 108
same florid
hallucinatory, delusional
hallucinatory,
delusional psychosis
psychosis has been found in other patients
109
similarly confined
confined in
in tank
tank respirators.
respirators. 109
C. Cardiac
CardiacPatients
Patients
C.
Patients
decompensated heart disease are at times placed on
Patients with decompensated
on
developed acute
very strict bed rest; some of these patients have developed
103.
Id.at
at 50.
103. Id.
104. Id.
105. See.
See, e.g., Eugene Ziskind et aI.,
al., Observations
Observations on Mental
Patched
Mental Symptoms in Eye Patched
105.
Patients:
Hypnagogic Symptoms in Sensory
Sensory Deprivation,
J. PSYCHIATRY
Patients: Hypnagogic
Deprivation, 116 AM. 1.
PSYCHIATRY 893 (1960);
(\960);
Ziskind,
supranote 53.
Ziskind, supra
53.
106. Ziskind et al.,
supranote 105,
aI., supra
\05, at 894.
107. See C. Wesley
\07.
Wesley Jackson, Jr., Clinical
Clinical Sensory Deprivation:
Deprivation: AA Review of
of Hospitalized
Hospitalized
Eye-Surgery Patients,
Patients,in SENSORY
71, at 337-43.
SENSORY DEPRIVATION: FIFTEEN
FIFTEEN YEARS,
YEARS, supra
supra note 71,
al., supra
supra note 95, at 361.
361.
108. Solomon et aI.,
109. Id.
Id. at 362.
362.

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confusional, paranoid, hallucinatory psychoses, especially
especially at night
during periods of decreased
decreased sensory input.
Studies of postoperative open heart surgery patients who were bed
confined-their
confined-their visual stimulation restricted to looking up at a whitetiled hospital room ceiling-revealed
ceiling-revealed a high rate of disordered
10
disorientation.'llo
thinking, visual and auditory hallucinations, and disorientation.
There is an extremely disturbing incidence of psychosis following
open heart surgery, ranging in various studies from 14%
14% to 30%.111
30%. 11
Upon recovery
recovery these patients described their postoperative
environment
environment as a major pathogenic factor in producing their
psychiatric illness. "1122 Perceptual
Perceptual disturbances
disturbances and emotional
emotional liability,
as well as paranoia, depression, and obsessive-compulsive
obsessive-compulsive reactions
to the restrictive
restrictive postoperative environment have been documented in
113
as well.
studies
other
as
well. 113
D. Hearing-Impaired
Hearing-Impaired Individuals
Individuals
Another condition of restricted
environmental stimulation leading
restricted environmental
to psychiatric
disturbance
of
psychiatric disturbance involves the hearing
hearing impaired. Studies of
the deaf consistently
consistently find significantly
significantly higher rates of paranoia
paranoia in
14
High
High rates of paranoia have been reported in
these individuals.'
individuals. 114
both
developmentally hearing impaired as well as those who
both the developmentally
110.
& J.H. Kay, Psychological
DisturbancesAssociated with Open
110. See, e.g.,
e.g., N. Egerton
Egerton &
Psychological Disturbances
Heart
Surgery, 110 BRIT. J. PSYCHIATRY
(1964); Donald S. Kornfeld et al.,
PSYCHIATRY 433 (1964);
aI., Psychiatric
Psychiatric
Heart Surgery,
Complicationsof
Open-Heart Surgery,
273 NEw
NEW ENG.
ENG. J. MED. 287 (1965);
(1965); Herbert R. Lazarus
Lazarus
Complications
o/Open-Heart
Surgery, 273
&
of Psychosis
J.
Jerome H. Hagens,
Hagens, Prevention
Prevention 0/
Psychosis Following
Following Open-Heart
Open-Heart Surgery,
Surgery, 124
124 AM.
AM. J.
& Jerome
PSYCHIATRY
PSYCHIATRY 1190 (1968);
(1968); Larkin M. Wilson,
Wilson, Intensive Care
Care Delirium,
Delirium, 130 ARCHIVES
ARCHIVES
INTERNAL
MED. 225 (1972).
(1972).
INTERNAL MED.
111.
& Patricia
Coronary
Ill. Robert
Robert E.
E. Lee
Lee &
Patricia A.
A. Ball, Some Thoughts on the Psychology of
0/ the Coronary
Care Unit Patient,
J. NURSING
1498, 1501
Patient, 75 AM.
AM. J.
NURSING 1498,
1501 (1975).
(1975).
112.
supra note
note 110,
110, at
at 290.
112. Komfeld
Kornfeld et
et al.,
aI., supra
113.
Unusual Sensory and Thought Disturbances
Cardiac
113. See, e.g.,
e.g., Rosemary
Rosemary Ellis,
Ellis, Unusual
Disturbances After
After Cardiac
Surgery,
AM. J.
J. NURSING
NURSING 2021
2021 (1972);
(1972); Alvin G. Goldstein, Hallucinatory
Hallucinatory Experience:
Experience: A
Surgery, 72 AM.
Personal
Personal Account, 85 J.
J. ABNORMAL
ABNORMAL PSYCHOL.
PSYCHOL. 423
423 (1976);
(1976); Linda
Linda Reckhow
Reckhow Thomson,
Thomson, Sensory
Deprivation:
73 AM.
AM. J.
J. NURSING
NURSING 266 (1973);
(1973); Lee &
& Ball,
Ball, supra
supra note
Deprivation: A
A Personal
Personal Experience,
Experience, 73
Ill.
111.
114. See, e.g., Kenneth Z. Altshuler,
the Deaf:
Altshuler, Studies of
o/the
Deaf Relevance to Psychiatric
Psychiatric Theory,
127 AM.
(1971); F. Houston
127
AM. J.
J. PSYCHIATRY
PSYCHIATRY 1521
1521 (1971);
Houston &
& A.B. Royse,
Royse, Relationship
Relationship Between
Deafness
JIlness, 100
\00 J. MENTAL
MENTAL SCI.
SCI. 990
990 (1954).
(1954).
Deafness and Psychotic
Psychotic Illness,

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became deaf in later life. Experimentally
Experimentally induced deafness in
psychiatrically unimpaired
psychiatrically
unimpaired adults also produced paranoia.1I 15
15

E. Other
Other Medical
Medical Patients
Patients
E.
Disorientation and delusional psychoses have also been reported
reported
postsurgically
among immobilized
immobilized orthopedic patients and in patients postsurgically
bed-confined. Nursing researchers have studied this phenomenon
phenomenon and
have concluded
concluded that frightening hallucinatory
hallucinatory experiences
"are
suspected."'1I 1616
been suspected."
has been
than has
probably far more widespread than
VI. OCCUPATIONAL
OCCUPATIONAL SITUATIONS
SITUATIONS

Medicine on
Researchers reported
reported in the New England Journal of Medicine
a study of fifty long-distance truck drivers; of these, thirty
experienced
experienced vivid
visual hallucinations
hallucinations and some became
became disoriented
disoriented
117
dream.
in a dream.117
ifin
as if
VII. ANIMAL
ANIMAL STUDIES
As noted in the body of this article, many prisoners
prisoners confined
confined in
in
solitary become intolerant
environmental
intolerant of normal
normal levels of environmental
(especially
experimental
(especially social) stimulation. These reports receive
receive experimental
confirmation
confirmation in laboratory research on animals. Such research
research
demonstrates
demonstrates that sensory deprivation
deprivation produces
produces an intolerance to
normal levels
levels of environmental
environmental stimulation; animals exposed to
sensory deprivation
deprivation conditions
conditions became
became overly
overly arousedaroused"hyperexcitable"-when
exposed
to
normal
levels
of
environmental
"hyperexcitable"-when exposed
environmental
8
behavioral disturbances."
resulting in
stimulation, often resulting
in severe
severe behavioral
disturbances. 118
115.
115. See Phil
Phil G.
G. Zimbardo
Zimbardo et
et al.,
aI., Induced Hearing
Hearing Deficit
Deficit Generates
Generates Experimental
Experimental
Paranoia,
1529-31 (1981).
(1981).
Paranoia, 212
212 SC.
SCI. 1529,
1529, 1529-31
116.
S.Downs,
Florence S.
Downs, Bed Rest
Rest and Sensory Disturbances,
Disturbances, 74
74 AM.
AM. J.
J. NURSING
NURSING 434,
434, 438
438
116. Florence
(1974).
(1974).
117. Ross A.
A. McFarland &
& Ronald C.
C. Moore,
Moore, Human Factors
Factors in Highway
Highway Safety, 256
256 NEW
NEW
ENG.
792, 797
ENG. J.
J. MED.
MED. 792,
797 (1957).
(1957).
118.
118. See
See Austin
Austin H.
H. Riesen,
Riesen, Excessive
Excessive Arousal
Arousal Effects
Effects of
of Stimulation
Stimulation After
After Early
Early Sensory
Deprivation,
at35-36.
Deprivation, in SENSORY
SENSORY DEPRIVATION-HARVARD,
DEPRIVATION-HARVARD, supra
supra note 47,
47, at
35-36.

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of
produced agitation in mice and rats after a few days of
One study produced
isolation, a report which corroborated
corroborated previous
19
previous studies with rats. 119
Others have also found isolation-induced
aggressive behavior in mice
isolation-induced aggressive
120
Further, social isolation
isolation has been
(such as biting attacks). 120
demonstrated to produce profound and lasting psychological
demonstrated
psychological effects
in primates. Researchers
Researchers have noted that over four hundred published
published
investigations of the effects
effects of social isolation
isolation on primates show such
investigations
deleterious effects
disturbances in perception
deleterious
effects as self-mutilation
self-mutilation and disturbances
perception
21
They found that in adult rhesus monkeys even brief
brief
and learning. 121
compromised cognitive
cogmtIve
periods of social isolation produce compromised
122
processing. 122
Others
Others have produced symptoms of depression
depression in
confining them for thirty days. 123
123 They concluded
rhesus monkeys by confining
concluded
"confinement produced greater
that solitary "confinement
greater destructive behavioral
effects in less time and with fewer individual differences among
[demonstrated to
subjects than did total social isolation, previously
previously [demonstrated
be] the most powerful technique for producing psychopathological
psychopathological
behavior
subjects."' 124 Induced depression
behavior among monkey subjects.,,124
depression through25
both young
confinement has been reported in
in both
young and
and mature
mature monkeys.'
monkeys. 125
isolation-produced
fear III
in dogs has been clearly
Finally, isolation-produced
26
demonstrated. 126
119.
T.C. Barnes,
Isolation Stress in Rats and
and Mice as a Neuropharmacological
Test,
119. See T.e.
Barnes, Isolation
Neuropharmacological Test,
18
18 FED'N PROC. 365 (1959).
(1959).
120.
al., Desipramine
Enhances Isolation-Induced
Aggressive
Matsumoto et aI.,
Desipramine Enhances
Isolation-Induced Aggressive
120. Kinzo Matsumoto
Behavior
BIOCHEMISTRY & BEHAV.
(1991).
Behavior in Mice, 39 PHARMACOLOGY
PHARMACOLOGY BIOCHEMISTRY
BEHAV. 167, 168
168 (1991).
121.
& Duane M. Rumbaugh,
ImpairedPerformance
from Brief
121. See David A. Washburn &
Rumbaugh, Impaired
Performance from
Brief
Social
Isolation ofRhesus
Rhesus Monkeys, 105
Social Isolation
105 J.
J. COMP.
COMPo PSYCHOL.
PSYCHOL. 145 (1991).
(1991).

122. Id.
145.
Id. at 145.
123.
McKinney et aI.,
al., Depression
Primates, 127 AM. J. PSYCHIATRY
PSYCHIATRY 1313,
123. William T. McKinney
Depression in Primates,
1313,
(1971).
1316 (1971).
124.
124. Id.
Id. at 1317.
1317.
125.
J. Suomi, Induced
125. See Harry
Harry F. Harlow &
& Steven 1.
Induced Depression
Depression in Monkeys, 12 BEHAV.
BIOLOGY
BIOLOGY 273
273 (1974).
(1974).
126. See W.R. Thompson
Early Environment,
Environment, 194 SCI. AM.
(1956).
Thompson &
& R. Melzack, Early
AM. 38 (1956).

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ApPENDlXB:
APPENDIX B:

CENTURY GERMAN EXPERIENCE
THE NINETEENTH
NINETEENTH CENTURY
EXPERIENCE WITH SOLITARY
SOLITARY
CONFINEMENT
CONFINEMENT

Between
1854 and 1909 thirty-seven
appeared in the
Between 1854
thirty-seven articles appeared
psychotic disturbances
disturbances
German medical
medical literature on the subject
subject of psychotic
summarizing years of work and many hundreds
of
hundreds of
among prisoners, summarizing
was published
literature was
cases. A major review of this
this literature
published in
in 1912.127
1912.127
Solitary confinement
confinement was the single most important
identified
important factor identified
in the etiology of these psychotic
illnesses.
psychotic
Indeed, the first report on the subject of prison psychoses was that
of Delbruck, chief physician of the prison
prison at Halle, in which the
disturbances was at last so great that it attracted
frequency of mental disturbances
the attention of the authorities. 128
128 Delbruck's report concluded
concluded that
prolonged
prolonged absolute isolation has a very injurious effect
effect on the body
and mind and that it seems to predispose inmates to hallucinations
29
confinement. 1129
solitary confinement.
of solitary
and advised
advised the immediate
immediate termination
termination of
In 1863 Gutsch reported
reported on eighty-four
eighty-four cases
cases of psychosis
psychosis
stemming
confinement and described
stemming from solitary confinement
described vivid
vivid
hallucinations
apprehensiveness,
hallucinations and persecutory delusions, apprehensiveness,
psychomotor excitation, sudden onset of the syndrome,
syndrome, and rapid
rapid
psychomotor
recovery
130 Many of these
recovery upon termination of solitary
solitary confinement. 130
maniacal outbreaks."131
"suicidal and
developed "suicidal
individuals
individuals developed
and maniacal
outbreaks." 131
In 1871,
1871, in a report on fifteen cases of acute reactive psychoses,
some of which apparently
apparently occurred within hours of incarceration
incarceration in
solitary, Reich described
described hallucinosis and persecutory
persecutory delusions in
addition to severe anxiety
excitement-"[t]he
anxiety leading to motor excitement-"[t]he
patient becomes noisy, screams,
screams, runs aimlessly
aimlessly about, destroys and
and
132
He also described
ruins everything that comes in his way."'
way.,,132
described an
accompanying these symptoms,
acute confusional state accompanying
symptoms, sudden
127.
128.
129.
130.
130.
131.
131.
132.

See NITSCHE
& WILMANNS,
WILMANNS, supra
NITSCHE &
supra note 36.
Id.
1.
!d. at I.
Id.
!d. at 2.
Id.
!d. at 8.
Id.
!d.
Id.
!d. at 31.

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22:325
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cessation
recovery, and subsequent
subsequent amnesia
amnesia for the
the
cessation of symptoms, 33recovery,
psychosis. 1133
events of the psychosis.
summary, Knecht reported
reported in 1891
1891 on
on the
the
In aa statistical summary,
diagnostic assessment
assessment of 186
186 inmates
inmates at the "insane
"insane department"
department" of
of
diagnostic
total
half
of
the
that
over
concluded
and
the prison
at
Waldheim
prison
Waldheim
concluded
over
inmates in this department
department were there
there due
due to reactive
reactive manifestations
manifestations
34 The majority
majority of these35inmates
inmates became
became
confinement. 134
to solitary confinement.'
in solitary.
confinement in
solitary. 135
insane within two years of confinement
In 1884
1884 Sommer reported on 111 cases
cases describing an acute,
acute,
reactive, hallucinatory,
confusional state associated
associated with
hallucinatory, anxious, confusional
reactive,
outbursts" and
solitary confinement, emphasizing
emphasizing the "excited
"excited outbursts"
and
36
"vicious
assaults"
of
these
patients.
1
His
patients'
illness
began with
patients'
"vicious assaults" of these patients. 136
difficulty in concentration
concentration and hyperresponsivity
hyperresponsivity to minor
disturbances of
"inexplicable" external
of
"inexplicable"
external stimuli. These "elementary
"elementary disturbances
(i.e., the five senses)"
the sensorium
sensorium (i.e.,
senses)" were
were seen as leading to
"elementary hallucinations"
"elementary
hallucinations" which
which became
became more numerous,
numerous,
olfactory hallucinations
hallucinations
eventually including
including auditory, visual, and olfactory
eventually
becoming
and eventually
becoming incorporated
incorporated with fearful persecutory
persecutory
137
delusions. 137
Kirn described 129 cases of psychosis
In 1889
1889 Kim
psychosis among the inmates
at the county
county jail at Freiburg, concluding that in fifty of those cases,
"solitary confinement
confinement can
can be
"solitary
be definitely
definitely considered as the etiological
including
stamp" including
characteristic stamp"
factor, (and these) show a certain characteristic
in
multiple
and
hallucinations
delusions
persecutory
persecutory
hallucinations
multiple spheres
138
He also noted that these
these
(auditory, visual olfactory, tactile).138
tactile).
symptoms often precipitated at night:

[T]he
[T]he patient
patient is suddenly surprised
surprised at night by hallucinatory
These
experiences which bring on an anxious excitement. These
experiences
manifestations become constant from now on, in many cases
manifestations
occurring only at night, in others also in the daytime. Attentive
infrequently hear at first a humming and buzzing
patients not infrequently
133.
134.
135.
136.
137.
138.

Id.at 32-33.
Id.
Id.
Id.
Id. at 17.
Id.atI7.
12, 16.
Id. at 12,
Id.
Id. at 12-16.
!d.
Id. at 21.
Id.

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in their ears,
ears, unpleasant noises and inarticulate
inarticulate sounds which
which
they cannot understand until finally they hear well
differentiated sounds and distinct words and sentences....
differentiated
sentences ....
39
. . . The visual hallucinations
hallucinations are very vivid. 139
...

contributed a description of "vorbereiden"-also
In 1888 Moeli contributed
"vorbereiden"-also
140
symptom of approximate
answers.,,140
Ten years later
later
"the symptom
approximate answers."'
known as "the
literature the elucidation
Ganser contributed
contributed to the literature
elucidation of a syndrome
141 As Arieti points out, Ganser's
Ganser's
which included
included Moeli's
Moeli's symptom. 14
Syndrome became
Syndrome
became well known-indeed,
known-indeed, almost a codification
codification of the
the
42
1 Ganser provided
provided
whole body of literature
literature on the prison
prison psychoses. 142
well-elucidated synthesis of symptoms, most of
of
comprehensive and well-elucidated
a comprehensive
which had been previously described
described elsewhere.
elsewhere. The syndrome
syndrome he
he
described
described included (in addition
addition to vorbereiden)
vorbereiden) vivid visual and
and
sudden
auditory
auditory hallucinations,
hallucinations, a distinct clouding of consciousness,
consciousness, sudden
dream," and "a
"a more or less
cessation
"as from a dream,"
cessation of symptoms "as
complete
complete amnesia
amnesia for the events during the period of clouded
clouded
43 Ganser's most original
original description
description was of
consciousness."' 143
of
consciousness."'
conversion
"hysterical
"hysterical stigmata" within the syndrome, including conversion
144
symptoms, especially total analgesia. 144
Some of the German authors failed to note whether the inmates
they were describing were housed in solitary confinement
confinement and,
unfortunately,
unfortunately, Ganser was one of these, stating only that his were
1901, also reporting
prisoners awaiting trial. However, Langard, in 1901,
reporting
on observations
accused prisoners awaiting
awaiting trial, described
described an
observations of accused
acute violent hallucinatory
hallucinatory confusion with persecutory delusions and
and
Id. at 23-24.
139. [d.
Vorbereiden is a rather remarkable
140. Vorbereiden
remarkable symptom
symptom of deranged
deranged and confused thought
thought
of
processes
processes in which the individual's
individual's response
response to a question suggests that he grasped the gist of
the question, and his answer is clearly relevant
relevant to the question, and related to the obvious
obvious
"How many
correct
many
correct answer, yet it still oddly manages to be incorrect. An example would
would be: Q: "How
"Yellow".
States" A: "Four". Q: "What
colors are there in the flag of the United States"
"What are they?"
they?" A: "Yellow".
FOR
ARCHIV
141. Ganser, Ueber
141.
Ueber Einen Eigenartigen Hysterischen
Hysterischen Dammerzustand,
Diimmerzustand, 30
30 ARCH
IV FOR
NERVENK] 633 (1898)
PSYCHIATRIE
NERVENKRAN-KHEITEN [ARCH PSYCH. & NERVENKj633
PSYCH1ATRIE UND
UND NERVENKRAN-KHEITEN
(1898) (F.R.G.).
AMERICAN HANDBOOK
142. AMERICAN
HANDBOOK OF PSYCHIATRY
PSYCHIATRY 710-12
710--12 (Gerald Caplan ed., 2d ed. 1974).
143. Id.
[d.
144. Id.
[d.

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[Vol.

specifically stated
stated that this syndrome occurred
occurred exclusively
exclusively among
specifically
solitary confinement.
those who
who awaited
awaited trial
trial in solitary
confinement. 145
145
1901 Raecke
Also in 1901
Raecke similarly
similarly reported
reported on prisoners
prisoners awaiting
awaiting trial
including
described the full syndrome
syndrome described
described by Ganser, including
and described
vorbereiden;
vorbereiden; he
he specifically
specifically condemned
condemned solitary
solitary confinement
confinement as
46 He described
described his cases
cases as beginning
beginning
responsible for the syndrome.
syndrome. 1146
responsible
of
apathy, progressing
progressing to "inability
"inability to concentrate, a feeling of
with apathy,
including
features,
catatonic
incapacity
think,"
even
catatonic
including
and
even
to
think,"
incapacity
47
negativism, stupor, and
and mutism.
mutism. 1147
negativism,
In another report, written the same year, Skliar reported on sixty
case histories
histories of which he identified
identified twenty-one
twenty-one as acute prison
prison
While vorbereiden
vorbereiden was
solitary confinement. 148 While
psychoses caused by solitary
symptoms described
described by Ganser
Ganser and
not noted, most of the other symptoms
Raecke were,
were, including massive anxiety
anxiety and fearful auditory and
hallucinations of smell, taste,
visual hallucinations;
hallucinations; in severe cases,
cases, hallucinations
and "general
sensation" as well as persecutory delusions, senseless
senseless
"general sensation"
4
'
agitation and violence,
vioience, confusion, and disorientation.
disorientation.1149
The
incarceration in
psychosis developed rapidly, at times within
within hours of incarceration
noted. 151
150 Catatonic
solitary confinement.
confinement. 150
Catatonic symptomatology
symptomatology was
was also
also noted.
151
solitary
suffered
The German literature reported
reported only on prisoners who suffered
gross psychotic
psychotic symptomatology, some of whom were observed in
departments" of prisons; thus, these reports
hospitals or "insane
"insane departments"
expressions that rose to the level
generally described only syndromal expressions
of overt psychosis.
psychosis. The German reports do, however, powerfully
powerfully
distinguishable
demonstrate the existence of a particular, clinically distinguishable
psychiatric syndrome associated
associated with solitary confinement. These
multiple reports described
described a syndrome
syndrome which included:

1. Massive
1.
Massive free-floating
free-floating anxiety.
includingSensorium," including"Disturbances of the Sensorium,"
2. "Disturbances
145.
145.
146.
146.
147.
147.
148.
148.
149.
149.
150.
150.
151.
151.

supra note 36, at 32.
NITSCHE
& WILMANNS,
WILMANNS, supra
NITSCHE &
Id. at 34.
!d.
Id.
Id. at 33-35.
33-35.
Id.
Id. at 40.
41.
Id.
Id. at 41.
Id.
Id.
Id.

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a. hyperresponsivity
hyperresponsivity to external stimuli; and

hallucinations in multiple spheres (including
b. vivid hallucinations
(including
auditory, visual, olfactory,
olfactory, gustatory, and tactile
began as simple
modalities); in some reports, these began
"elementary" hallucinations
and progressed to complex,
"elementary"
hallucinations and
formed hallucinations.
3. Persecutory
Persecutory delusions,
complex
complex hallucinations.

often
often

incorporating coexistent
coexistent
incorporating

confusional states. In some reports these were seen
4. Acute
Acute confusional
seen
as beginning
beginning with simple inattention
inattention and difficulty in
concentration. In others, the onset was described as sudden.
concentration.
several reports
The confusional
confusional state and disorientation
disorientation was in several
described
as
resembling
a
dissociative,
dreamlike
state, at
described
dissociative,
times involving
features
of
a
catatonic
stupor,
including
involving
negativism and mutism; and, upon recovery, leaving
leaving a residual
amnesia for the events of the confusional state. Ganser and
others observed
observed hysterical conversion symptoms during this
confusional state.
5. Vorbereiden:
5.
Vorbereiden: This was an infrequent finding, mostly
hallucinatory
described in conjunction
conjunction with a confusional, hallucinatory
state.
state.
6. Motor excitement, often
often associated
associated with sudden, violent
destructive outbursts.

7. Characteristic
Characteristic course of the illness:
a. onset was described
described by some authors as sudden, by
others as heralded by a progression beginning with sensory
disturbances
disturbances and/or inattention and difficulty
difficulty in
concentration;
and
concentration;
subsidence of acute symptoms
b. in many cases, rapid subsidence
solitary confinement.
upon termination of solitary
The German
German reports were generally based upon prisoners who had
psychotic illness. In contrast, the
been hospitalized because
because of their psychotic
population
preselected by
population reported upon in the Walpole study was not preselected
overt psychiatric
psychiatric status. Despite this, all of the major symptoms
symptoms

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reported
German clinicians were observed in the Walpole
reported by the Gennan
vorbereiden and hysterical conversion
population, except for vorbereiden
symptoms. In addition, less severe forms of the isolation
isolation syndrome
were observed
observed in the Walpole population, including:
"
Perceptual distortions and loss of perceptual constancy, in
• Perceptual
some cases without hallucinations.
*• Ideas of reference and paranoid ideation short of overt
delusions.
"
Emergence of pnmlttve
primitive aggressive
aggressive fantasies which
• Emergence
remained ego-dystonic
ego-dystonic and with reality-testing
reality-testing preserved.
"
Disturbances of memory and attention short of overt
• Disturbances
disorientation and confusional state.
disorientation
"
Derealization experiences
• Derealization
experiences without massive dissociative
regression.
regresslOn.
clearest
Since Ganser's report has become the twentieth century's clearest
memory of a much vaster body of literature, it is also of interest
interest to
review the literature describing observations
Syndrome
observations of Ganser's Syndrome
in non-prison
non-prison populations. Several of these reports have been studies
suffering from this syndrome.
of patients
patients in psychiatric
psychiatric hospitals suffering
Since these patients were hospitalized, it was possible to obtain more
extensive evaluation
extensive
evaluation and testing of their status. Several reports
suffering long standing
patients studied as suffering
standing
described a majority of the patients
hysterical conversion
conversion symptoms; impulsivity,
childhood
truancy,
and
impulsivity, childhood
antisocial behavior were also commonly described. 152 These findings
antisocial
suggest also that antisocial behavior
behavior patterns and psychopathic
psychopathic
personality disorder may bear a close relationship to primitive
hysterical personality disorder, a53 relationship which has been
1
well. 153
as well.
other authors
described by other
authors as
152.
See, e.g.,
& Moriarty, supra
supra note 59; May et al.,
152. See,
e.g., Ingraham &
aI., supra
supra note 59; Milo
Milo
Tyndel, Some Aspects of the Ganser
State, 102
&
Tynde1,
Ganser State,
102 J. MENTAL
MENTAL Sci.
SCI. 324 (1956);
(1956); Herbert Weiner
Weiner &
Alex Braiman, The Ganser
GanserSyndrome,
Syndrome, 111
111 AM. J. PSYCHIATRY
PSYCHIATRY 767 (1955).
(1955).
153.
AL., PSYCHIATRIC
PSYCHIATRIC DIAGNOSIS
(1974).
153. See ROBERT
ROBERT A. WOODRUFF,
WOODRUFF, JR. ET AL.,
DIAGNOSIS (1974).

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ApPENDIXC:
C:
APPENDIX

EXPERIMENTAL RESEARCH
EXPERIMENTAL
RESEARCH ON THE PSYCHIATRIC
PSYCHIATRIC EFFECT OF
PROFOUND
DEPRIVATION: FACTORS INFLUENCING
PROFOUND SENSORY DEPRIVATION:
INFLUENCING
VULNERABILITY TO PSYCHIATRIC
PSYCHIATRIC HARM
VULNERABILITY

laboratory research
As noted in the body of this article, laboratory
research has
demonstrated
demonstrated that experimentally
experimentally induced
induced sensory deprivation
deprivation has
major psychological effects
effects and can precipitate
precipitate severe
severe psychiatric
psychiatric
illness. Much of the research in this area attempted
attempted to delineate
factors in addition to the duration and intensity of sensory restriction
restriction
which might account for these differing
differing outcomes. The factors which
which
have been elucidated
elucidated include two which are especially
especially relevant to this
discussion and may help to explain
explain the particular
particular malignancy
malignancy of
of
sensory
expectation and
sensory deprivation
deprivation in solitary confinement:
confinement: expectation
and
individual
individual response.
I. THE INFLUENCE
INFLUENCE OF EXPECTATION
EXPECTATION

Research has suggested that a subject's reaction to participation
participation in
experiment could be profoundly
a sensory deprivation experiment
profoundly manipulated
manipulated
by external cues imposed
by
the
experimenter:
imposed

[These] dramatic effects could be a function of the demand
[These]
demand
characteristics
situation....
characteristics of the experimental situation
....
There is evidence
evidence ...
... that preparing
preparing a subject for probable
probable
hallucinations
significantly affects the frequency of
of
hallucinations significantly
hallucinations....
hallucinations. . .. [S]uch devices as "panic buttons" in
experiments
"instructions." The use of
experiments are in a sense
sense eloquent "instructions."
of
such a device increases
the
subject's
expectation
that
increases
subject's expectation
something
intolerable
and,
likelihood of
of
something intolerable
may
occur,
with it, the likelihood
154
a bad experience. 154

154. Martin T. Orne & Karl E. Scheibe, The Contribution of Nondeprivation
Non deprivation Factors in the
Production of
of Sensory
The Psychology of the "Panic Button,
J.
Sensory Deprivation Effects: The
Button,"" 68 1.
Production
ABNORMAL
& SOC.
SOC. PSYCHOL. 3,
3, 4 (1964)
ABNORMAL &
(1964) (citations omitted).

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22:325

In the experiment,
experiment, the researchers
researchers exposed
exposed two groups of subjects
subjects
In
sensory deprivation. The experimental
experimental
identical conditions
conditions of sensory
to identical
experiment included the presence
group's introduction
introduction to the experiment
presence of a
group's
Button."
a
"Panic
medical
"Emergency
Tray,"
instructions
about
a
"Panic
Button."
instructions
and
medical "Emergency Tray,"
the experimental
group became
became significantly
significantly more
experimental group
As predicted, the
cognitive impairment
impairment and
and restlessness,
restlessness,
symptomatic in measures
measures of cognitive
symptomatic
measure-including
more symptomatic
symptomatic in every
every other measure-including
and also more
55
spatial disorientation.'
perceptual aberrations,
aberrations, anxiety,
anxiety, and
and spatial
disorientation. 155
perceptual
confinement generally
In aa related
related manner, prisoners
prisoners in solitary
solitary confinement
generally
In
confinement as threatening
threatening and punitive, and often as a
view such confinement
spirit." In
deliberate attempt to make
make them "crack
"crack up"
up" or "break
"break my spirit."
In
deliberate
suggesting
light of this, it is not surprising that the only recent report suggesting
confinement utilized prisoners
solitary confinement
prisoners who
who
major ill effect of solitary
no major
confinement. 156
solitary confinement.
volunteered to spend four days in
in solitary
156
volunteered

II. INDIVIDUAL
INDIVIDUAL DIFFERENCES
DIFFERENCES IN
IN RESPONSE
RESPONSE
Several authors have directed
directed attention
attention to the fact that within a
given experimental
response can be
experimental format, massive
massive differences
differences in response
observed among individual subjects. Often subjects who tolerated the
observed
experimental situation
situation well reported pleasant, or at least nonexperimental
threatening, visual imagery,
imagery, fantasy, and hallucinatory
hallucinatory experiences.
experiences.
threatening,
The individual's mind may begin to wander, engage
engage in daydreams,
daydreams,
slip off into hypnogogic reveries with their attendant vivid pictorial
images. The individual
may be quietly having sexual and other
157
pleasurable thoughts. 157
pleasurable
On the other hand,

in
Another subject
subject in the same situation may deal with it in
of
quite another manner. He may soon complain of all manner of
things: the bed is causing him a backache, his mind is a blank
of] intense boredom, tenseness,
complains of]
.....
. .. [He also complains
Id. at 3-12.
155. ld.at3-12.
119 AM.
AM.
Confinement on Prisoners,
Solitary Confinement
al., Effects of Solitary
156. See Richard
Richard H. Walters et aI.,
Prisoners, 119
(1963).
J. PSYCHIATRY
PSYCHIATRY 771 (1963).
1.
81, at 36.
al., supra
supra note 81,
157. Wright et aI.,

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of having 158unpleasant
unpleasant thoughts or
depressive feelings or of
depressive
him.
disturb
that
images
picture-like
images
disturb
him.
158
picture-like
of
In response
response to these
these concerns
concerns about the incidence
incidence of
psychopathological reactions to sensory
sensory deprivation,
deprivation, an
an important
important
psychopathological
experimentation in this area has
has been,
been, by prescreening,
pre screening,
thrust of the experimentation
subjects only those persons demonstrating,
demonstrating, by some
some
to select as subjects
psychological strength
strength and capacity
capacity to tolerate regression.
regression.
measure, psychological
such work
work has been:
theoretical premise
premise of such
The theoretical
sensory deprivation
deprivation experiments,
ego's
experiments, it is the ego's
[I]n the sensory
predominately involved ....
....
autonomy from the drives that is predominately
Differences in drive-discharge
drive-discharge thresholds, phantasy
phantasy [sic]
[sic] and
... termed
daydream capacity, capacity
capacity for what [is] ...
"regression in
in the
the service
ego" are other theoretically
of the
the ego"
theoretically
"regression
service of
relevant structural
structural dimensions
dimensions accounting
accounting for differences
differences in
isolation behavior. 159
159

experimental verification,
These ideas
ideas have been subjected
sUbjected to experimental
verification,
corroborated that some individuals
which has corroborated
individuals tolerate
tolerate such isolation
isolation
Rohrshach
better than others. For example,
example, two researchers, using the Rohrshach
concluded that the Rohrshach manifestations
prescreening, concluded
Test for prescreening,
manifestations
of an individual's defense and control mechanisms appear to be a
reliable measure
measure for predicting whether
whether an individual will be
drive-dominated responses
effective in controlling the drive-dominated
responses that might
effective
reduced sensory
emerge during the individual's period of reduced
160
stimulation. 160
Anecdotal reports in a similar vein appear
appear from time to time in the
literature. A subject of one study became panicky during
during sensory
"borderline
deprivation and stated he had been diagnosed "borderline
deprivation
psychotic.,,161
psychotic." 161 Curtis and Zuckerman report on a psychotic paranoid
reaction in one subject who suffered delusions for several days
afterward, and severe anxiety and depression lasting several
several weeks;
122 AM. 1.
J. PSYCHIATRY
PSYCHIATRY 774,
Overview, 122
Isolation: An Overview,
Experimental Isolation:
158. Leo Goldberger, Experimental
158.
(1966).
777 (1966).
159. Id.
Id. at 778 (footnotes omitted).
81, at
at 37.
supranote 81,
al., supra
160. Wright et aI.,
160.
II"
Greenblatt, Studies in Human
Human Isolation
Isolation II:
161.
J. Freedman & Milton Greenblatt,
161. Sanford 1.
J. 1479,
1479, 1486
1486
11 U.S. ARMED FORCES MED. 1.
Findings, II
Other Cognitive
Cognitive Findings,
and Other
Hallucinationsand
Hallucinations
(1960).
(1960).

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prescreening had suggested poor adjustment,
personality test prescreening
insecurity 10
in interpersonal
hostility, lack of insight, and insecurity
162
relationships. 162
Others prescreened
prescreened forty-three subjects and identified
identified seven as
suffering "personality
"personality deviations."
deviations." Two of these subjects, who were
diagnosed as borderline, developed frightening, aggressive fantasies,
prematurely
paranoia, and difficulty
difficulty in reality
reality testing; one of them prematurely
paranoia,
terminated the experiment. Two others were diagnosed
diagnosed as
psychopathic;
psychopathic; both forced the premature
premature termination
termination of the
163
behavior.
disruptive
by
experiment
experiment
behavior. 163
psychological test
Others, using interview
interview techniques
techniques and formal psychological
deprivation on
on
data, studied the effects
effects of two to six days of sensory deprivation
hospitalized
previously nonhospitalized psychiatric patients. Among the previously
psychotic patients
patients they studied, two developed
developed overt paranoid
paranoid
psychotic
ultimately
necessitating
the
experiment,
psychoses during
psychoses
electroshock
particular individuals
individuals appeared
appeared to have
electroshock treatment. These particular
aggressive
fantasies and
been unable to tolerate
tolerate the emergence
emergence of aggressive
been
64
experience.' 164
deprivation experience.
images during the sensory deprivation
AntisocialPersonality
Sensory Deprivation
A.
A. Effects of
o/Sensory
Deprivation on Antisocial
Personality Disorder
Disorder
1. Aversive Conditioning
1.
Individuals
Individuals with psychopathic
psychopathic personality
personality disorder are probably
among the least tolerant of sensory deprivation. One researcher has
psychopathic pathology as a
described the essential core of psychopathic
pathological inability
tolerate restricted environmental stimulation:
inability to tolerate
pathological
characterized as
The psychopath
psychopath is almost universally characterized
....
[pathologically stimulus seeking and] highly impulsive ....
[pathologically
... [H]is
He is unable to tolerate routine and boredom.
boredom....
outbursts
outbursts frequently appear to be motivated by little more than
excitement....
a need for thrills and excitement.
...
Reaction Precipitated
Precipitated
PsychopathologicalReaction
& Marvin
162. George C. Curtis
162.
Curtis &
Marvin Zuckerman, A
A Psychopathological
255, 256 (1968).
(1968).
by Sensory Deprivation,
Deprivation, 125 AM. J. PSYCHIATRY
PSYCHIATRY 255,256
Personality, 116
al., Sensory Deprivation
163.
163. See Henry U. Grunebaum
Grunebaum et aI.,
Deprivation and Personality,
116 AM. J.
PSYCHIATRY
(1960).
PSYCHIATRY 878 (1960).
PerceptualIsolation
164. See H. Azima &
& Fern J. Cramer, Effects of
oj Partial
Partial Perceptual
Isolation in Mentally
Mentally
SYS. 117 (1956).
(1956).
Disturbed
Individuals, 17 DISEASES
Disturbed Individuals,
DISEASES NERVOUS
NERVOUS SYS.

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It
It is the impulsivity
impulsivity and
and lack of even
even minimal
minimal tolerance
tolerance for
for
and
sameness which
which appear
appear
primary
distinctive
the
primary
to
be
sameness
165
features of the disorder. 165
goes on to argue
argue that psychopathic
psychopathic individuals
individuals may
may chronically
chronically
He goes
stimulus deprivation:
deprivation: "[H]ighly
"[H]ighly impulsive,
impulsive,
state of relative stimulus
exist in a state
of stimulation-seeking
stimulation-seeking
psychopathic behavior
behavior [may
[may be
be seen]
seen] in terms
terms of
psychopathic
pathology. If
If decreased
decreased reactivity
reactivity and/or
and/or rapid adaptation
adaptation [to
[to
pathology.
environmental
environmental stimuli]
stimuli] do produce
produce in these persons
persons an affective
affective state
produced by severe
of unpleasantness
severe sensory
unpleasantness close to that produced
deprivation or monotony in the normal
normal individual
individual ....
166
.... ,,166
He argues that behavioral
behavioral impulsivity
impulsivity in such individuals may be
effort at coping with this condition
condition of relative
relative sensory
sensory deprivation
deprivation
an effort
... to view much of the
"It may be possible
possible ...
which they experience:
experience: "It
excitement and
impulsivity of the psychopath, his need to create excitement
and
tolerate
adventure, his thrill-seeking
inability to tolerate
thrill-seeking behavior, and his inability
adventure,
need
routine and boredom
boredom as a manifestation
manifestation of an inordinate
need for
' 167
stimulation."
of
pattern
the
in
changes
or
increases changes
pattern of stimulation." 167
increases
A later study, directly
directly comparing
comparing psychopathic
psychopathic inmates with nonpsychopathic
corroborated these findings. The psychopathic
psychopathic controls, corroborated
psychopathic
inmates scored significantly higher
boredom
higher on measures
measures of boredom
concluded that
susceptibility and of impulsivity. The authors concluded
susceptibility
of
psychopaths are pathologically
pathologically 8stimulation seeking and incapable
incapable of
conditions. 16
168
tolerating isolation conditions.
Others, in a large scale study of criminal offenders
offenders suffering from
from
severe mental illness is
mental illness, noted that the prevalence
prevalence of severe
incarcerated offenders than among the general
higher among incarcerated
population; and that, compared
compared with non-mentally
non-mentally ill inmates, the
mentally ill inmates were more likely to be housed
housed in solitary.
Moreover many of these mentally ill inmates suffered from a
Moreover
combination of psychiatric disorders predisposing them to both
psychotic breakdown
including
breakdown and to extreme impulsivity (often including
supranote 58, at 80.
165. Quay, supra
Id. at 182.
166. !d.
181.
167. Id.
Id. at 181.
Correlates to Emotional
& Warren W. Webb, Subjective Correlates
168. See Timothy D. Emmons &
Emotional
Neurotics, 42
and Acting-Out Neurotics,
Normals, and
Seeking in Psychopaths,
and Stimulation
Responsivity and
Stimulation Seeking
Psychopaths, Normals,
(1974).
& CLINICAL PSYCHOL. 620 (1974).
J. CONSULTING
CONSULTING &

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substance abuse). Such individuals tended to be highly impulsive,
substance
lacking in internal controls, and tended to engage in self-abusive and
self-destructive behavior
self-destructive
in the prison setting, and especially so when
169
housed in solitary. 169
Many of the inmates placed in solitary confinement
confinement are thus likely
experience, and among
to be among the least capable of tolerating the experience,
the most likely to suffer behavioral deterioration
deterioration as a consequence
of
consequence of
Solitary confinement
confinement has at times been
such confinement. Solitary
conditioning," intended to
rationalized as being a form of "aversive conditioning,"
extinguish negative inmate
inmate behaviors. Yet this assertion
assertion ignores
many of the most basic tenets of any behavior modification
treatment, and would in any case clearly violate the ethical guidelines
guidelines
governing the use of aversive conditioning:
a. Ethical Considerations
Considerations
conditioning-the use of punishment as
First of all, since aversive conditioning-the
a means of inducing
behavior
inducing behavior change-is
change-is inherently
inherently suspect ethically
ethically
clear outcome variables
and creates an inherent
inherent risk of harm, very clear
have to be articulated
systematically measured
articulated and systematically
measured over time. As a
result of these serial measurements,
evidence that
measurements, there must be clear evidence
the undesirable
undesirable behavior
behavior is in fact lessening
lessening in frequency
frequency and
and
intensity. Such
Such measurement
measurement will also identify those patients
patients for
whom such aversive
conditioning is actually
aversive conditioning
actually harmful, allowing these
these
individuals
individuals to be removed from the aversive
aversive treatment
treatment protocol. Were
such measurements
measurements done in the prison setting,
setting, staff
staff would inevitably
inevitably
be required to acknowledge
acknowledge the behavioral
behavioral deterioration
deterioration which many
many
inmates were suffering
suffering as a result of placement in solitary, and in
considerations would have
such cases, ethical
ethical considerations
have required
required transferring
transferring
the
the inmate
inmate out of such confinement.

b. SHU
SHU Incarceration
Incarceration is not Aversive
Aversive Conditioning
Conditioning
SHU
SHU incarceration
incarceration does not meet
meet criteria
criteria for aversive
aversive
conditioning.
conditioning. Indeed,
Indeed, any behavior
behavior modification
modification scheme
scheme must define
and describe
describe very explicitly
explicitly two
two variables:
169. Curtis
169.
Curtis & Zuckerman,
Zuckerman, supra
supra note
note 162,
162, at 271-72.
271-72.

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379

(i) The
The behavior
behavior being
being changed:
changed:
Behavior
Behavior researchers
researchers have
have learned
learned that
that in
in order
order for a subject
subject to
benefit from aversive
aversive (or any other
other form
form of) conditioning,
conditioning, the
the
benefit
behavior at issue
issue must
must be a single,
single, very
very clearly
clearly defined
defined behavior.
behavior.
behavior
by the same
same reinforcer
reinforcer or
or
multiple behaviors
behaviors are responded
responded to by
When multiple
punishment, learning
learning and
and behavior
behavior change
change does not occur. Thus,
Thus,
punishment,
different
placement in SHU, which
which is "punishment"
"punishment" for a host of different
placement
with an
consistent
behaviors,
is
simply
not
being
used
in
a
manner
consistent
an
manner
being
simply
behaviors,
any
of
inadequate linkage
modification; there
there is inadequate
linkage
intent of behavior modification;
specific behavior
behavior to this "punishment."
"punishment."
specific
(ii) The "punishment":
"punishment":
(ii)

Moreover,
Moreover, SHU
SHU confinement
confinement is quite clearly
clearly not "punishment."
"punishment."
"punishment" must be very closely linked
To be effective,
effective, a "punishment"
linked in time
to the targeted
targeted behavior, and for learning
learning to occur, there must be
be
experience this close
close link between the target
target
opportunities to experience
repeated opportunities
"punishment" must be brief
brief
behavior and the punishment. Thus, the "punishment"
behavior
and immediate. For example,
example, a mild but painful electric
electric shock or a
sudden
sudden very loud noise would be ideal punishments in aversive
conditioning.
seclusion room to
Occasionally
outs," the brief use of a seclusion
Occasionally "time outs,"
aversive
quickly control disruptive behavior, are used as part of an aversive
conditioning
conditioning program. But when this technique is employed, it is
used very quickly and for a very brief period of time-in order for
the "time
"time out" to work as a behavior modifier, there must be very
clear alternative behaviors which, when manifested, will immediately
end the "time out."
For any behavior modification scheme to work then, there must
always be an exquisitely close relationship between behavior and
response. Indeterminate or prolonged sentencing to solitary simply
has nothing to do with aversive conditioning.

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& Policy
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[Vol. 22:325
[Vol.

APPENDIX D:
APPENDIXD:

REPORTS OF THE LONG-TERM
LONG-TERM EFFECTS OF SOLITARY CONFINEMENT
CONFINEMENT
REpORTS
IN FORMER
FORMER POLITICAL PRISONERS AND IN PRISONERS
PRISONERS OF WAR:
SOLITARY CONFINEMENT
"BRAIN WASHING"
WASHING" AND
SOLITARY
CONFINEMENT AS A MEANS OF "BRAIN
"INDOCTRINATING"
"INDOCTRINATING"

Although concerns
concerns about the psychiatric
psychiatric effects of solitary
confinement
confinement among prisoners
prisoners of war were raised in the medical
literature at least as early as post-World
post-World War II, this issue reached
reached
"brain
massive public
public exposure only after the fearful news of "brain
washing" among American prisoners of war in Korea. As is well
washing"
known, the 1950's were an era of tremendous fear of Communism
and of the attempts by communist states to "indoctrinate"
"indoctrinate" people into
their ideology. As noted in the body of this article, in the 1950s the
Central Intelligence
Intelligence
United States Department of Defense and the Central
Agency
Agency sponsored
sponsored a great deal of research
research on these issues. The
results of extensive research done for the Department
Department of Defense
Defense
70
were
The paper documented
documented interrogation
interrogation
were subsequently
subsequently published. 170
techniques
of
regard to the incarceration
incarceration of
techniques of the Soviet KGB in regard
political
prisoners,
and
the
Chinese
communists'
of
political
communists' imprisonment
imprisonment of
American
American prisoners of war
war in Korea.
The report
indicated that the KGB operated
operated detention prisons,
report indicated
many
.. well built and spotlessly clean ...
which were "modern
"modem ....
...
many of which
[with] attached medical facilities and rooms for the care
care of sick
sick
detainees.
facility."''171 Incarceration
Incarceration in
exercise yard is a standard
standard facility."
detainees. An exercise
these prisons is almost universally
in
solitary
confinement,
universally
solitary confinement, in a cell
approximately
ten
172 "An almost invariable
approximately
feet by six feet in size.
size.172
invariable
feature
under
detention
of the
the management
management of any important suspect
suspect
detention
feature of
173
is a period
of total
total isolation
isolation in
in aa detention
detention cell."'
cell." 173
period of
This isolation
isolation was seen
seen as a central
central feature of
of the imprisonment:
imprisonment:
"The
in the
the isolation cell are
"The effects
effects upon prisoners of the regimen in
170.
171.
171.
172.
173.
173.

HINKLE
HINKLE & WOLFF,
WOLFF, supra
supra note 65.
65.
Id.
125.
Jd. at 125.
Id.
Id.
Id.
Id. at 126.

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experience is isolation....
striking
.... A
A major aspect
aspect of
of this prison experience
isolation ....
striking....
cells] [h]is
[h]is internal
internal as well as external
external life
life is disrupted"
disrupted" and
[In the cells]
which might almost
almost
"he
develops a predictable
predictable group
group
symptoms, which
"he develops
174 of symptoms,
syndrome.'
'disease
be
calIed
'disease
syndrome.
'"
174
called
be
syndrome develops
develops over time:
This syndrome
He becomes
becomes increasingly
increasingly anxious
anxious and restless, and his sleep is
He
disturbed ....
disturbed....

The period of anxiety,
anxiety, hyperactivity,
hyperactivity, and apparent
apparent
adjustment to the isolation routine
routine usually continues from one
adjustment
to three weeks. As it continues,
continues, the prisoner becomes
becomes
increasingly
increasingly dejected and dependent. He gradually
gradually gives up all
spontaneous activity
spontaneous
activity within his cell and ceases to care
care about
personal
personal appearance
appearance and actions. Finally, he sits and stares
stares
with a vacant expression, perhaps
perhaps endlessly twisting a button
button
on his coat. He allows
allows himself to become
become dirty and
through the motions of his prison
prison
disheveled. . .. He goes through
disheveled....
...Ultimately
if he were in a daze.
routine
daze ....
Ultimately he
routine automatically,
automatically, as ifhe
ordinary behavior. He
seems to lose many
many of the restraints
restraints of ordinary
....It usually takes
may soil himself.
himself. He weeps; he mutters
mutters ....
to produce this phenomenon
from four to six weeks
phenomenon in a newly
newly
75
man. 1
175
imprisoned man.
Addressing
Addressing the emotional impact
impact on prisoners of such confinement,
the report noted that:
His sleep is disturbed by nightmares. Ultimately
Ultimately he may reach
depression in which he ceases to care about his
a state
state of depression
personal appearance
appearance and behavior
behavior and pays little attention to
may have illusory
state
the prisoner
In
this
his surroundings.
surroundings.
prisoner ·may
experiences. A distant sound in the corridor sounds like
someone calling his name. The rattle of a footstep may be
interpreted as a key in the lock opening the cell.
interpreted
Id.at 127.
127.
174. Jd.
128.
Id.at 128.
175. Jd.

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Some prisoners
prisoners
may become delirious and have visual
176
176
hallucinations.
hallucinations.
However, the report also notes that each individual may respond
respond
differently:
Not
all
men
who
first
experience
total
isolation
react in
differently:
precisely this manner. In some, these symptoms are less conspicuous.
In others, dejection and utter despondence
despondence set in earlier, or later. Still
others, and especially those with pre-existing
personality
77
psychotic. 1177
frankly psychotic.
disturbances,
disturbances, may become frankly
The authors of this report note that the procedures in the Chinese
detention camps
camps are somewhat
somewhat more complex.
complex. Prisoners there
underwent an initial period of isolation similar to that found in the
178 In the second phase, however
however they were housed in
Soviet prisons. 178
comprising
extremely tight quarters within "group
"group cells"
cells" compnsmg
approximately eight prisoners. 179
179 Under the tensions and hostilities
approximately
created in this environment,
environment, brutality of prisoners by other prisoners
was almost inevitable and was, according
apparently
according to the authors, apparently
180
confinement. 180
cell"
"group
this
of
result
intended
an
"group cell" confinement.
There are many long-term
long-term studies of American
American prisoners of war;
unfortunately,
unfortunately, the factor of solitary confinement has not generally
generally
been separated
separated out in these studies. However, one relatively recent
described long-term effects
prisoners of war described
study of Korean prisoners
including
interpersonal withdrawal and suspiciousness, confusion,
including interpersonal
chronic
chronic depression, and apathy toward environmental
environmental stimuli.
Irritability,
psychosomatic
Irritability, restlessness, cognitive impairment, and psychosomatic
ailments were extremely common
common in the group, most of whom had
suffered
incarceration in solitary confinement
confinement at the hands
suffered periods of incarceration
of the Chinese. This report also included a case
case report of one
individual
conditions of solitary confinement
confinement for
individual exposed
exposed to harsh conditions
more than sixteen months; thirty years after release, he continued
suffering
suffering sleep disturbances,
disturbances, nightmares, fearfulness,
fearfulness, interpersonal
suspicion
suspicion and withdrawal, severe
severe anxiety, and severe depression.
These former prisoners also had psychosomatic
psychosomatic ailments including
including

176.
176.
177.
177.
178.
179.
180.

Id.
[d.
Id. at
at 129.
[d.
Id.at 153.
153.
[d.
Id. at 156.
[d.
Id. at 159.
[d.

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gastrointestinal
disturbances, chronic
chronic headaches, and obsessive
obsessive
gastrointestinal disturbances,
cognitively
ruminations. They tended to become
become confused and thus
cognitively
81
explosive.' 181
and explosive.
volatile and
emotionally volatile
impaired and were emotionally
In former prisoners of war in the Korean conflict, approximately
approximately
forty years after their release from confinement,
confinement, solitary confinement
confinement
was cited as one of the severe
severe stressors
stressors in this group. These former
former
prisoners
demonstrated persistent anxiety, psychosomatic
prisoners demonstrated
psychosomatic ailments,
ailments,
suspiciousness, confusion, and depression. They tended to be
estranged and detached from social interaction,
interaction, suffered
suffered from
from
obsessional ruminations, and tended to become
become confused and
cognitively
concentration difficulties
cognitively impaired, suffering memory
memory and concentration
82
on
performance
cognitive
their
affected
which
performance on formal
formal testing.'
testing. 182
181. See Patricia B. Sutker et aI.,
al., Cognitive
181.
Cognitive Deficits and Psychopathology
Psychopathology Among
Among Former
Former
Prisoners
War and
and Combat
Veterans of the Korean
Korean Conflict,
Conflict, 148 AM. J. PSYCHIATRY
PSYCHIATRY 67
Combat Veterans
67
Prisoners of War

(1991).
(1991).
Id. at 68.
182. Id.

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