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Terry A Kupers M.D.

The Harm of Solitary Confinement

The psychological and social effects of supermax isolation.

I first realized how important jail and prison are to individuals with serious mental illness when I noticed, early in my career, that my patients in community clinics were talking about time they had spent behind bars. My friends and colleagues had not been incarcerated, and I had not heard much about mental illness behind bars while I was in training. Then I was asked to tour the Los Angeles County Men’s Central Jail and testify as a psychiatric expert in a lawsuit the ACLU was bringing on behalf of prisoners claiming that mental health care at the jail was abysmal, while a large proportion of those locked up were suffering from serious mental illness. Crowding was the issue for class action lawsuits in the 70’s and 80’s. With crowding there was more violence, more psychiatric breakdown and more suicide.

Appended to the majority decision in Brown v. Plata (2011).
Source: Appended to the majority decision in Brown v. Plata (2011).

Prisoners living in a gym converted into a dorm at Mule Creek State Prison, August 2008. The words on the left wall read, “No Warning Shot Is Required.” This pho­tograph was appended to the majority decision in Brown v. Plata (2011).

In the late 1980’s, a historic wrong turn occurred. The jails and prisons were plagued by violence and seemed out of control. Instead of down-sizing the population and expanding rehabilitation programs—reasonable and safe measures that would have effectively resolved the crisis—the powers that be decided to lock up “the worst of the worst” in solitary confinement, often in special facilities called supermax prisons.

Photo by ACLU Nat'l Prison Project & Southern Poverty Law Center
Source: Photo by ACLU Nat'l Prison Project & Southern Poverty Law Center


Photo by ACLU Nat'l Prison Project & Southern Poverty Law Center
Source: Photo by ACLU Nat'l Prison Project & Southern Poverty Law Center

Solid metal cell doors on pod of administrative segregation unit with evidence of fires set by prisoners desperate to have officers pay atten­tion to their needs, Eastern Mississippi Correctional Facility, 2014.

Tanya’s story is fairly representative of the dreadful result. Because of rule violations, Tanya (not her real name) had been consigned to SHU (the acronym for supermax isolation) and had spent two years there before being returned to general population a week prior to our meeting. The SHU had an “extreme effect” on her, and she described to me how she “flipped out”—including frequent anxiety attacks and paranoia. She associated being in SHU with being locked in the closet as a girl and had many “reliving” experiences while in SHU. Her mother would beat her before locking her in a closet, and the two occasions when officers did a “takedown” she felt she was reliving that traumatic experience. In SHU she cried a lot and was overwhelmed by very pain­ful memories. She described wanting to tell staff about the closet, but in solitary the staff did not really engage prisoners in conversation. Tanya experienced flashbacks to abuse by her mother, had nightmares, and had phobias about rats and dogs biting her. She told me that officers used searches to harass prisoners and that they did it more to her because they knew she couldn’t control her temper.

The supermax boom did not occur in a vacuum. By the mid-1970s, as the post–World War II economic prosperity declined and as wealth was more concentrated in fewer hands, the public education system and social pro­grams such as the 1960s’ War on Poverty became less of a funding priority and dwindled in scope and reach. Government officials would henceforth focus more on the maintenance of law and order, the dismantling of federal regulations on corporations, and the expansion of corporate markets and profits, even when that meant waging wars. The Reagan years put the retreat from social responsibility into overdrive, as budgets for education and safety net programs were slashed. The slashing continues today and even accelerates as foreign wars and homeland security draw heavily upon the state’s fiscal resources and as the gap between rich and poor widens. Meanwhile, many people face dismal employment prospects, they cannot find afford­able housing, and they receive inadequate medical and mental health treat­ment. Tragically, in all too many cases, they find their way into the criminal justice system. In other words, poor and disenfranchised people are “disap­peared” by an increasingly inequitable society that refuses to adequately fund services they need to stay afloat. Then, in the prisons, many of the most dis­advantaged and disabled are warehoused in solitary confinement. The public hears even less about their plight, and, not accidentally, some of the worst abuses in prison occur in secrecy in solitary confinement units.

The most effective alternative to long-term solitary confine­ment would be massive reduction of the prison population with concurrent upgrading of mental health and rehabilitation programming in the com­munity as well as in correctional settings. We have learned that the more criminals that we lock away, the more those criminals are beaten, raped, and locked up in solitary, where they despair of ever returning to their families or finding meaningful employment. Eventually, 93 percent of prisoners are released, and if they were forced to endure significant time in solitary they are quite damaged.

(This blog post includes excerpts and photos from Solitary: The Inside Story of Supermax Isolation and How We Can Abolish It (2017).


About the Author

Terry Allen Kupers, M.D., is a psychiatrist and Professor Emeritus at The Wright Institute Graduate School of Psychology. He is an expert on the mental health effects of solitary confinement