The confined mind

After prisoners went on strike across the United States, guards locked some protestors in solitary confinement. How does isolation in prison affect mental health?

Illustration by Kayla Oliver

Illustration by Kayla Oliver

Content warning: this article discusses suicide.

Mergensana Amar spent the final days of his life locked in solitary confinement. The 40-year-old had left his home country, Russia, to seek asylum in the United States, where authorities incarcerated him at the Northwest Detention Center, a privately owned immigration prison in Tacoma, Washington. In October, he was put on a temporary suicide watch after guards discovered a handmade rope under his bed. He was scheduled for deportation the following month. 

On 15 November, Amar took his own life. A person in a nearby cell reported seeing paramedics carry Amar’s body — limp, with blue hands and feet — away after a failed attempt to revive him. Amar was declared officially dead a few days later.

Amar’s death is not an outlier. While scant data exist on self-harm among incarcerated people, and even fewer statistics are available on those in immigration detention, experts estimate that people in isolation account for 5% of the US prison population, but almost half of prison suicides. Many researchers point to the intense isolation of solitary confinement as a mental health minefield, while others say the scientific evidence is more uncertain.

Solitary confinement and the nationwide prison strike

Prior to his death, Amar had gone on a weeks-long hunger strike, protesting his pending deportation and conditions at the Northwest Detention Center. “I would prefer to die on this soil than go back to Russia,” he said, according to online news outlet Crosscut. Amar began refusing food in August as part of a nationwide prison strike, triggered by an April riot in South Carolina, where seven prisoners died while guards waited hours to intervene.

Media representatives for the strikers say incarcerated organisers have faced retaliation. In several instances, that crackdown has taken the form of solitary confinement. Megan Ybarra, an activist with NWDC Resistance — a group focused on the facility where Amar was held — says that the Immigration and Customs Enforcement (ICE) threatened dozens of hunger strikers with time in solitary. ICE denied claims of retaliation, but provided Lateral with a policy document that does permit isolation for hunger strikers. In a state prison in Ohio, officials put one man in solitary confinement this July for actions supporting the strike.

 
The Northwest Detention Center in Tacoma, Washington, where Mergensana Amar spent his final days.   Seattle Globalist/Flickr  (CC BY-SA 2.0)

The Northwest Detention Center in Tacoma, Washington, where Mergensana Amar spent his final days. Seattle Globalist/Flickr (CC BY-SA 2.0)

 

At another Ohio prison, two men were isolated after starting a hunger strike, according to the Incarcerated Workers Organizing Committee (IWOC), a group supporting strikers from the outside. In an email to Lateral last month, IWOC spokesperson Brooke Terpstra said those two prisoners, David Easley and James Ward, remained in solitary confinement and had been maced by prison guards. The Ohio Department of Rehabilitation and Correction did not return Lateral’s request for comment on these allegations. 

Even Amar’s time in solitary is shrouded in uncertainty. In a news release, ICE said that Amar was in ‘voluntary protective custody’ when he died. An ICE spokesperson declined to answer follow-up questions from Lateral about why Amar had requested isolation and whether he had at any point been held in solitary against his will. In an email, Maru Mora Villalpando, a community organiser with NWDC Resistance, expressed skepticism about ICE’s claim and called for an independent investigation into Amar’s death. 

Prisoners are isolated from the outside world. This makes it difficult for people outside prison walls — including journalists, activists, and scientists — to know with any certainty what’s going on inside. This same dynamic creates the potential for psychological damage. Nowhere is this more true than solitary confinement. 

How isolation impacts the mind

A typical solitary confinement cell in the US measures less than eight square metres in area. It has spartan furnishings: a cot, sink, toilet and nothing else. People locked in solitary spend 22 to 23 hours in their cell each day and are usually allowed one hour of recreation. These prisoners “have little exposure to natural sunlight,” a 2015 article in the American Journal of Public Health explained. "[B]right fluorescent lights illuminate each cell, often through the night, disrupting natural sleep cycles and circadian rhythms.” 

A typical solitary confinement cell measures less than eight square metres and contains only a cot, sink and toilet.   Allen Watkin/Wikimedia Commons  (CC-BY-SA-2.0)

A typical solitary confinement cell measures less than eight square metres and contains only a cot, sink and toilet. Allen Watkin/Wikimedia Commons (CC-BY-SA-2.0)

Keith “Malik” Washington is no stranger to the flickering fluorescent lights of solitary confinement. He is imprisoned at the McConnell Unit, a state prison in Beeville, Texas where authorities have placed him in administrative segregation (or ‘ad seg’). Officials say this solitary confinement is necessary to preserve prison security, but IWOC points to political activism as the reason for Washington’s confinement in ad seg. Texas Department of Criminal Justice spokesperson Robert C. Hurst declined to comment on IWOC's allegation, saying they couldn’t share information on specific prisoners.

In letter posted to IWOC’s website, Washington discussed his isolation. “I've recently shaken off a recent bout of depression which I attribute to my on-going and lengthy stay in a solitary confinement setting,” he wrote. “These CONTROL UNITS like McConnell AD-SEG were designed to break the human psyche and spirit.” 

Washington’s story matches other anecdotal evidence about isolation in prisons. Former prisoners have testified to Congress, describing solitary confinement as torture. “I had no physical contact with another human being for at least 10 of the 18 years I was incarcerated,” said Anthony Graves, a former Texas prisoner incarcerated for a crime he didn’t commit, in his 2012 testimony. “Today I have a hard time being around a group of people for long periods of time without feeling too crowded. No one can begin to imagine the psychological effects isolation has on another human being.” 

Aaron Fox works as co-director of the Montefiore Transitions Clinic in the Bronx, New York City. The clinic is part of the Transitions Clinic Network, a national web of health centres serving formerly incarcerated people with chronic diseases. “When we meet as a Network… there is always discussion about patients or acquaintances who had worsening of mental health conditions or development of new mental health conditions due to incarceration, especially people with exposure to solitary confinement,” writes Fox, who is also a clinician-investigator and an associate professor of medicine at Montefiore Medical Center-Albert Einstein College of Medicine, in an email. “Not everyone has these symptoms, but it happens frequently enough that as a physician, I'm concerned.” 

Prompted by these concerns, Fox worked with a team of other researchers to examine how solitary confinement relates to symptoms of post-traumatic stress disorder (PTSD). The team surveyed patients at two sites in the Transitions Clinic Network, asking whether they had been put in isolation during their last stint in prison. The survey also included four questions regarding PTSD (the authors are careful to note that the study didn’t actually diagnose PTSD, but rather screened for symptoms of the disorder). 

The results? Forty-three per cent of people who had spent time in solitary reported symptoms of PTSD, compared to just 16% of those who hadn’t.

The study shows a correlation, though it doesn’t necessarily prove that solitary confinement is the cause of the self-reported symptoms. “Our findings were preliminary, so I wouldn't suggest drawing definitive conclusions from our study,” Fox writes in the email, “but it suggests that we need to be looking more carefully at the long term consequences of solitary confinement.” 

Looking more carefully is easier said than done. While it’s not impossible for researchers to get data on those who are incarcerated, it is deeply difficult, says Brian Hagan, who worked on the study and is now a resident physician at UCLA Health. “You just don’t get access to these people because they’re in jail, they’re in prison, they’re in solitary confinement,” he says. “When they do leave jail or prison, they’re usually lost to the system.” 

 
Prisoners experiencing prolonged solitary confinement have a higher risk of developing psychiatric consequences, including depression, anxiety and self-harm.   Donald Tong/Pexels  (no copyright restrictions)

Prisoners experiencing prolonged solitary confinement have a higher risk of developing psychiatric consequences, including depression, anxiety and self-harm. Donald Tong/Pexels (no copyright restrictions)

 

The prison walls and cell bars that keep researchers out also keep prisoners in. This isolation can make the incarcerated invisible to others, so one goal of this year’s national prison strike was simply awareness.

Within the penitentiary, solitary confinement compounds isolation. And by locking people away even from the rest of the facility, like a prison within a prison, solitary might exact a unique psychological toll. “People have said again and again that already being detained is torture,” said Mora Villalpando, the NWDC Resistance organiser, speaking on immigration prisons. “If the detention conditions are already torture, the usage of solitary confinement makes it even more so.” 

Some academic findings echo that analysis, showing an association between solitary confinement and psychological harm. Earlier this year, new research revealed that US prison officials currently hold over 4,000 prisoners with serious mental illness in solitary. A 2012 study in the Journal of Correctional Health Care looked at suicides in federal prisons over a five-year period, finding that 53% of people who had killed themselves were in isolation.

Similar results appeared in a 2014 paper published in the American Journal of Public Health. Looking at jails — facilities intended for shorter term, pre-trial incarceration — in New York City, the researchers found that while just 7% of those jailed spent time in solitary confinement, those same people accounted for 53% of recorded acts of self-harm. And two psychiatrists reviewed the 26 suicides that occurred in New Jersey’s state prisons between 2005 and 2011, finding that the suicide rate for prisoners isolated alone in a cell was 23 times that of the state’s prisoners overall. 

But not all research concurs. A 2001 study of a few dozen men imprisoned in Canada found no evidence of harm to the mental health of those who spent 60 days in administrative segregation. A controversial 2010 paper, the so-called Colorado study, concluded that time in isolation actually improved prisoners’ psychological wellbeing. (The study got big pushback, sparking debate.) 

Earlier this year, a review of 37 quantitative studies said “no firm conclusions can be drawn” in studies about solitary confinement and psychological functioning. One critical issue that emerges in the research is the direction of causation: Does solitary cause psychological harm, or is it that prisoners with more mental health issues to begin with have a higher likelihood of being put in isolation?

A survey by NPR and The Marshall Project found that more than half of US states couldn’t provide stats for how many prisoners go straight from solitary to the outside world. But the available data sketch a worrying picture: in Texas in 2006, 49% of people released from prison were arrested again within three years, while that number was 61% for those released directly from solitary. In Connecticut, 66% of regular prisoners freed were swept back into the system within three years, compared to 92% of those who had been held in isolation.

Stuart Grassian, a psychiatrist and former Harvard Medical School faculty member, wrote that solitary confinement “may result in prolonged or permanent psychiatric disability, including impairments which may seriously reduce the inmate’s capacity to reintegrate into the broader community upon release from prison.” 

In 2013, the American Public Health Association released a policy statement saying that solitary confinement “can cause significant mental suffering,” urging prison officials to dramatically limit the practice for all prisoners. Other organisations have specifically addressed eliminating solitary confinement for vulnerable groups, including young people (under 18), prisoners with disabilities, and people with serious mental illnesses.

Despite such admonitions, solitary confinement continues — and not only in the US. A February report from Human Rights Watch found that in Australia, prison officials can lock people alone in cells with minimal human contact for years on end — in one case, a man with a psychosocial disability was held in isolation for over 19 years. Anecdotal evidence in the country also points to isolation’s impact on the mind: Jesuit Social Services reports on one man they worked with who had spent time in solitary and, after being released from prison, habitually confined himself to his bathroom, sleeping in the bathtub because the size of the room resembled his cell. They also say that man readily experienced panic attacks when in public situations.

In September last year, Jesuit Social Services published a report based on data collected from their program participants suggesting that, in Victoria, prison authorities disproportionately place people younger than 25 in solitary. Just a few months earlier, an Aboriginal man sued the Victorian government for locking him in isolation at an adult prison for over three months when he was just 16 years old.

In 2015, the United Nations updated its Nelson Mandela Rules, a set of guidelines for how countries should treat prisoners. The UN’s new rules condemned placing imprisoned people in cells for 22 or more hours per day without meaningful human contact for longer than 15 days.

Efforts at change

Most high profile efforts to change public policy aim to reform, rather than abolish, solitary confinement. Last year, Texas said it was eliminating the use of solitary as a punishment for prisoners who break rules. But critics pointed out that the state still allows administrative segregation that prison officials justify by appealing to general security threats. Texas’s policy change affected about 75 prisoners, with almost 4,000 others remaining in administrative segregation (including Keith “Malik” Washington, the IWOC member who alleges that officials locked him in solitary as retaliation for his political activism). 

Other pushes for reform include Colorado banning isolation for periods longer than 15 days and the American Civil Liberties Union’s Stop Solitary campaign.

 
Prisoner strikes for fair treatment of prisoners and ending solitary confinement have growing support from public organisations and committees.   Justin Goh/Flickr  (CC-BY-2.0)

Prisoner strikes for fair treatment of prisoners and ending solitary confinement have growing support from public organisations and committees. Justin Goh/Flickr (CC-BY-2.0)

 

While such endeavours have gained traction in recent years, reform efforts are as old as solitary confinement itself. “Historically, we go through phases where we pay attention to solitary confinement. There’s a moment now where it’s getting a lot of attention nationally and internationally,” says Keramet Reiter, a criminologist at the University of California Irvine. Her research outlines an ongoing cycle: solitary confinement has existed since the US built its first prisons, but reformers have repeatedly discredited solitary and forced cutbacks in its usage. In 1890, even the Supreme Court offered criticism. The Court wrote about earlier experiments with solitary confinement, stating that some prisoners “became violently insane; others, still, committed suicide; while those who stood the ordeal better … in most cases did not recover sufficient mental activity to be of any subsequent service to the community.” 

At other times in history, the popularity of solitary confinement among prison administrators has risen. “In the 1970s and 1980s prison systems across the United States began testing out new technologies of longer-term, more systematic isolation,” writes Reiter and a colleague, University of Toronto criminologist Ashley Rubin. This included supermax prisons.

While academic researchers and prison officials alike continue to debate the psychological impact of solitary, imprisoned people themselves continue to organise against it. In 2011, hundreds of prisoners locked in solitary confinement at California’s Pelican Bay State Prison launched a weeks-long hunger strike. They urged changes to make confinement more bearable and demanded periodic status reviews for people held in isolation indefinitely. At the protest’s peak, over 6,000 prisoners across the state participated. 

Two years later, prisoners in California again protested solitary confinement by refusing meals. “In the end, as many as 30,000 prisoners across the state participated, refusing food for weeks at a time,” Reiter says. The strikes sparked a lawsuit challenging the state’s policies, and the resulting legal settlement brought many prisoners out of solitary and back into the general prison population. 

“These kinds of actions are always iterative,” says Dan Berger, an historian at the University of Washington. The 2018 national prison strike builds on previous efforts, like those in California in the early 2010s.

Still, prison administrators continue to impose solitary confinement on incarcerated people. “The idea that we have a prison and we need a place within it where people are under more restrictive conditions than general has existed since the first prisons were built in the US and Europe,” says Reiter. Concerns over solitary confinement’s impact on mental health, she explains, are likewise “disturbingly timeless”. 

And so, the cycle continues: prisoners organise to improve conditions, researchers debate the details of isolation’s relationship to mental health, and prison administrators confine people in solitary. Meanwhile, those released from isolation into the general prison population, or even directly to the outside, may struggle to adjust to a world full of people and sounds, a world bigger — and more unpredictable — than a box just a few metres wide. And other people held in solitary confinement, people like Mergensana Amar, don’t make it out alive.

Edited by Sumudu Narayana and Ellen Rykers.