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Physicians for Human Rights Testimony Before Senate Judiciary on Solitary Confinement 2012

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Using science and medicine to stop human rights violations

Statement for the Record from Physicians for Human Rights
Senate Judiciary Committee, Subcommittee on the Constitution, Civil Rights and
Human Rights
“Reassessing Solitary Confinement: The Human Rights, Fiscal, and Public Safety
June 19, 2012

Dear Chairman Durbin, Ranking Member Graham, and distinguished Members of this
Physicians for Human Rights (PHR) appreciates this opportunity to join in the growing
chorus of calls to end the use of solitary confinement in America’s prisons, jails, and detention
facilities. As an independent organization that uses medicine and science to stop severe human
rights human violations, PHR firmly believes that the well-documented psychological and
physiological effects of even a brief period spent in solitary confinement are so detrimental that
the practice must be prohibited, except when it is absolutely necessary to protect the lives or
safety of others. Mr. Chairman, we applaud your leadership on this important human rights
issue and look forward to your continued efforts to curb the use of solitary confinement.
In 1842, Charles Dickens visited the newly-constructed Philadelphia Prison, which kept
all of its inmates in solitary confinement for the entire period of their incarceration. After
touring this facility, which many held up as a model for prisons across the country, Dickens
wrote that an inmate in solitary confinement “is a man buried alive … dead to everything but
torturing anxieties and horrible despair.”1


Charles Dickens, “Philadelphia, and Its Solitary Prison,” American Notes (1842), available at

Dickens’ observation remains true 170 years later. American prisons, jails, and detention
facilities use solitary confinement now more than ever, despite overwhelming evidence that it
is ineffective, counterproductive, and causes severe mental and physical suffering. While the
separation of dangerous or vulnerable inmates from the rest of the prison population is
sometimes necessary to running a safe facility, our country’s current widespread use of solitary
confinement veers far outside the realm of the necessary into the purely punitive.
As the title of this hearing acknowledges, the use of solitary confinement implicates
human rights, fiscal, and public safety concerns. But the mere fact that solitary confinement
violates fundamental human rights that apply to all individuals – including those in prisons, jails,
and detention facilities – is alone enough to warrant an end to the practice in virtually all cases.
In the way in which it is used in the United States today, solitary confinement constitutes
torture and/or cruel, inhuman, or degrading treatment, in violation of both international law
and America’s founding principles.
While clearly detrimental to the approximately 25,000 inmates held in isolation in
prisons and jails, we note that the use of solitary confinement is particularly inappropriate for
detainees in immigration detention facilities and national security detention facilities. Unlike
prisons and jails, these detention facilities are used to detain people for administrative
purposes – not as punishment for having been convicted of a crime. Many detainees in these
facilities have been tortured in the past or suffer from mental illnesses, making them
particularly susceptible to the harmful psychological effects of solitary confinement. And
oversight and avenues for judicial review in these facilities are sorely lacking, leaving detainees
with few options for challenging their placement in solitary. We urge Congress to hold
additional hearings to examine the use of solitary confinement in these settings.
Given Physicians for Human Rights’ medical and scientific expertise, we will focus our
testimony on the psychological and physiological effects of solitary on inmates and detainees.
These effects are well-documented, pervasive, and uniformly negative across all populations
held in solitary.
Psychological Effects
Almost since solitary confinement was first used in the early 19th century, its harmful
psychological effects have been well-documented. In fact, shortly after solitary confinement
was established in the United States as a means of incarceration, the high rates of severe
mental disturbances resulting from solitary confinement caused it to fall into disuse.2 Early
observers noted that even among prisoners with no prior history of mental illness, those held in
solitary confinement exhibited “severe confusional, paranoid, and hallucinatory features,” as
well as “random, impulsive, often self-directed violence.”3 For those who entered prison with a

Stuart Grassian, “Psychiatric Effects of Solitary Confinement,” Washington University Journal of Law and Poilcy
22:325-383 (2006), at 328.

preexisting mental illness – as a disproportionately large portion of today’s incarcerated
population do – solitary confinement exacerbated those conditions.4
Recent research has confirmed that solitary confinement often results in a syndrome
described as “prison psychosis,” the symptoms of which include anxiety, depression, anger,
cognitive disturbances, perceptual distortions, paranoia, psychosis, and self-harm.5 Dr. Stuart
Grassian, a noted expert on the psychological effects of solitary confinement, has identified a
group of symptoms associated with solitary confinement:

Hyperresponsivity to external stimuli;
Perceptual distortions, illusions, and hallucinations;
Panic attacks;
Difficulties with thinking, concentration, and memory;
Intrusive obsessional thoughts;
Overt paranoia;
Problems with impulse control, including random violence and self-harm.6

This combination of symptoms – some of which Grassian notes are found in virtually no other
psychiatric illnesses – together form a unique psychiatric syndrome resulting exclusively from
solitary confinement.7
While the mental health effects of even a short, defined period of time in solitary
confinement can be disastrous, many individuals are held in solitary for prolonged or indefinite
lengths of time. These individuals “are in a sense in a prison within a prison,”8 and the effects
on mental health are correspondingly severe. The effects of prolonged solitary confinement,
which the UN Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment
or Punishment defines as solitary confinement lasting longer than 15 days, 9 include symptoms
of post-traumatic stress such as flashbacks, chronic hypervigilance, and hopelessness; and
continued intolerance of social interaction after release.10
Furthermore, the deleterious effects of solitary confinement can be even more
pronounced among the high proportion of inmates and detainees in American prisons and
detention facilities who suffer from preexisting personality disorders or other mental health


Id. at 329.
Interim Report of the Special Rapporteur of the Human Rights Council on Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment, ¶62, U.N. Doc. A/66/268 (August 5, 2011) (prepared by Juan Mendez)
(hereinafter “Mendez Report”), available at
Grassian, “Psychiatric Effects of Solitary Confinement,” at 335-36.
Id. at 337.
Mendez Report at ¶ 57.
Mendez at ¶ 79.
Grassian, “Psychiatric Effects of Solitary Confinement,” at 353.

problems.11 Indeed, such inmates are the most likely to develop psychoses after being placed in
solitary confinement.12 But even inmates with histories of relatively strong psychological
functioning suffer severe psychological trauma as a result of solitary confinement. 13
Moreover, the negative mental health effects of solitary confinement often continue
after an inmate is released, as most eventually are. One notable study found that the symptoms
of prison psychosis last long after release from solitary confinement, while lasting personality
changes resulting from solitary can permanently impair social interaction.14 This not only
inhibits an inmate’s ability to adjust to life in the general prison population – where
maladjustment often leads to disciplinary infractions, which in turn lead to more solitary
confinement – but severely impairs a released inmate’s ability to safely and successfully
reintegrate into general society, effectively defeating any purported rehabilitative component
of incarceration.15 Instead of curing antisocial behavior, solitary confinement exacerbates it,
perpetuating a cycle that results in more incarceration and more solitary confinement.
In interviews of inmates who were released from prison after spending time in solitary,
many report having difficulty interacting with their families. One describes how he “curls up in a
corner of his apartment, blinds drawn, alone,” while another gave himself a black eye while on
parole.16 Eighteen months after being released back into society from solitary confinement,
Brian Nelson describes how he feels every day: “People ask me what hurts. I say the box, the
gray box. I can feel those walls and I can taste them every day of my life. I’m still there, really.
And I’m not sure when I’m ever gonna get out.”17
The potential for this cycle is particularly worrisome for immigration and national
security detainees, the vast majority of whom are released back into society. Indeed, such
detainees are held with the intention of temporary detention and the presumption of future
release. Safe reintegration into society is imperiled when these detainees are isolated in solitary
In short, the lack of social interaction that is the defining feature of solitary confinement
causes severe psychological impairment in inmates and detainees that is severely
disproportionate to almost any possible reason for their placement in solitary.


Id. at 348.
Id. at 349.
Id. at 354.
Sharon Shalev, “A Sourcebook on Solitary Confinement” (2008) (hereinafter “Sourcebook”) at 13, 22, available at
Grassian, “Psychiatric Effects of Solitary Confinement,” at 332-33.
Susan Greene, “The Gray Box: An Investigative Look at Solitary Confinement,” January 24, 2012, available at

Physiological Effects
Solitary confinement also results in a number of serious and well-documented
physiological effects as a result of both the physical manifestations of psychological problems,
as well as common features of solitary confinement such as lack of access to fresh air and
sunlight, and long periods of inactivity.18
Inmates and detainees held in solitary for even a short period of time commonly
experience sleep disturbances, headaches, and lethargy. In one study, researchers found that
over 80% of the isolated inmates in the study suffered from all three of these ailments, while
more than half suffered from dizziness and heart palpitations as well.19 Inmates in solitary
confinement often suffer from appetite loss, weight loss, and severe digestive problems,
sometimes resulting from their inability to tolerate the smell or taste of food in an environment
of near-total sensory deprivation. Other common signs and symptoms include heart
palpitations, diaphoresis, back and joint pain, deterioration of eyesight, shaking, feeling cold,
and aggravation of pre-existing medical problems.20 Moreover, as a result of the psychological
trauma common to inmates in solitary confinement, self-harm and suicide are more common in
solitary than among the general prison population.21
Because inmates in solitary confinement are often kept in separate wings of prisons and
detention facilities and are, by definition, separated from other inmates, they are more likely to
be subjected to excessive force and other physical abuse by corrections officers and guards. 22
And because they have more limited access to medical services, both pre-existing illnesses and
illnesses resulting from time spent in solitary confinement often go untreated.
The physiological and, especially, psychological harm caused by even a relatively short
period in solitary confinement is indisputable. A review of the medical literature on solitary
confinement by Dr. Craig Haney concludes that “there is not a single published study of solitary
or supermax-like confinement in which nonvoluntary confinement lasting for longer than 10
days, where participants were unable to terminate their isolation at will, that failed to result in
negative psychological effects.”23 There is no question that the harm caused to an inmate or
detainee kept in solitary confinement outweighs any benefit in all but the most extreme cases.

Shalev, “Sourcebook” at 15.
Id. at 11.
Id. at 15.
Craig Haney and Mona Lynch, “Regulating Prisons of the Future: A Psychological Analysis of Supermax and
Solitary Confinement,” New York University Review of Law and Social Change 23:477-570 (1997), at 525.
Leena Kurki and Norval Morris, “The Purposes, Practices, and Problems of Supermax Prisons,” Crime & Justice
28:385-424 (2001), at 409.
Craig Haney, “Mental Health Issues in Long-Term Solitary and ‘Supermax’ Confinement,” Crime & Delinquency
49:124-156 (2003), at 132.

Social interaction is neither a right nor a privilege – it is a fundamental human need. “Simply to
exist as a normal human being,” writes Atul Gawande, “requires interaction with other
Physicians for Human Rights urges members of Congress to work towards ending the
use of solitary confinement in all facilities under federal jurisdiction, including federal prisons,
immigration detention facilities, and national security detention facilities, in all but the most
extreme cases. PHR believes that solitary confinement should never be used as a means of
controlling mentally ill inmates and detainees, and that any use of solitary confinement should
conform to the recommendation contained in the Istanbul Statement on the Use and Effects of
Solitary Confinement: “As a general principle solitary confinement should only be used in very
exceptional cases, for as short a time as possible and only as a last resort.”25
While PHR firmly believes that solitary confinement should be used only in the rarest
cases and only as a last resort, we recognize that it will continue to be used in prisons, jails, and
detention facilities in the near future. Given the extremely harmful psychological and
physiological effects of even a short period of time in solitary confinement, we emphasize that
inmates and detainees held in solitary confinement must have the same or greater access to
medical and mental health care as the general incarcerated or detained population. Individuals
held in solitary must receive daily assessments from qualified medical and mental health
professionals, whose ethical obligations are to their patients, not to the detaining authority.
We thank you for the opportunity to submit testimony for this important hearing, and
we at PHR stand ready to engage with all congressional leaders to begin a serious dialogue
focused on ending the use of this dangerous and counterproductive practice.


Atul Gawande, “Hellhole,” The New Yorker (March 30, 2009), available at
The Istanbul Statement on the Use and Effects of Solitary Confinement (December 9, 2007), available at