April 13, 2010
In the prevailing number of cases, the imposition of the punishment of solitary confinement in U.S. federal and state prisons is detrimental to prisoners’ psychological and physical health, ineffectual in containing violence, and at times the equivalent of torture.
That was the assessment of Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and associate professor at Harvard Medical School and the Harvard School of Public Health, in an April 7 talk at Harvard Law School. Gawande, who has gained acclaim as a New Yorker staff writer on medical issues, recently wrote an article on solitary confinement for the magazine. He is also the author of several books, most recently his 2009 “The Checklist Manifesto: How to Get Things Right.”
The April 7 event was co-sponsored by the Office of Clinical and Pro Bono Programs, the Harvard Prison Legal Assistance Project, the Criminal Justice Institute, Harvard Defenders, and the Human Rights Program.
Gawande explained how solitary confinement deleteriously impacts the physical and psychological health of the subject, sometimes to the point of permanently damaging the capacity for social interaction. He drew upon the experiences of Terry Anderson, a journalist held for seven years in solitary confinement in Lebanon, John McCain (who was held in a North Vietnamese POW camp), and prisoners in the U.S. penal system—especially those held in the U.S.’ SuperMax prisons.
Gawande described how severance from all human contact for extended periods induces a devolution ranging from depression to a catatonic state, suicidal attempts, and even a frequent inability to manage normal interaction after release. He noted that McCain judged solitary confinement as “an awful thing that weakens your resistance more effectively than any other form of mistreatment,” a powerful statement taken in the context of McCain’s physical torture.
The “physical effects on the brain of solitary confinement”, Gawande noted, “are EEG abnormalities.” He cited a 1992 study using EEGs of POWs who had spent 6 months in detention camps in Yugoslavia in the 1950s. The most severe abnormalities, Gawande noted, were found in those who had “endured head trauma to the point of losing consciousness, or, simply solitary confinement.”
Gawande related that none of the subjects he profiled saw their experiences “as anything less than torture”, which, he argued, raises a difficult question for the United States: “If prolonged isolation is, as research and experience have confirmed for decades, so intrinsically cruel, how do we end up with a prison system that subjects more of our own citizens to it than any other country in recent history has?”
The criteria for social isolation vary from state to state such that both “violent and non-violent infractions” can lead to solitary confinement, Gawande said.
He detailed one prisoner’s case of solitary confinement as typical, reporting that the penal system enforces isolation for 23 hours per day in the 13’ x 8’ SuperMax facilities. After a few months, Gawande said, the prisoner’s experience was “no different than that of Anderson or McCain—he started losing his mind, would pace compulsively, having panic attacks and hallucinations, and became enraged by the most routine events.” The paradox of solitary confinement, Gawande remarked, is that the confined “crave social interaction but become often unfit for social interaction,” often overwhelmed by normal human contact.
Citing a study of California SuperMax prisoners in solitary confinement, Gawande noted that inmates lost ability to initiate behavior, developed irrational anger, and changed their identity to that of combatants. The last effect creates what Gawande termed a “perversity” in which the instinct to fight back maintains the sanity of those in isolation, “providing their sole means of maintaining a sense of human purpose.” Prisoners have to be able to withstand the experience in order to return to a mainstream prison or society, Gawande observed. Those who can’t handle prolonged isolation are forced to remain “because of their acting out,” while those able to adapt are “prime candidates for release to a social world in which they become incapable of fully adjusting.”
Gawande ultimately dismissed the main argument for solitary confinement, namely, that it provides discipline and prevents violence when less stringent measures fail. The evidence “doesn’t bear this out”, he claimed. A 2003 study of 3 states that adopted SuperMax prisons found that levels of inmate on inmate violence went unchanged. Prison violence is not “just an issue of a few outlier belligerents,” Gawande argued. The reason for increased violence in prisons is that, over the last 30 years, a quadruple in the incarceration rate occurred without a corresponding increase in prison space. This increase, coupled with the cancellation of most work and education programs, Gawande stated, has resulted in “unprecedented overcrowding and idleness, which makes a nice formula for violence.”
Gawande estimated that there are 25,000 prisoners in SuperMax isolation today. He questioned the practice’s efficacy, cautioning that the truly violent are only a “subset of those in long-term isolation.” The U.S. should look at “the experience of other places” for a model in which security is maintained without long-term isolation, he argued.
Drawing from Britain’s treatment of IRA prisoners during the Northern Ireland conflict, Gawande noted that violence did not decrease when Britain adopted units for long-term isolation. Moreover, when Britain later reduced the use of isolation, some previously unmanageable prisoners corrected their behavior. Thus, he concluded, the behavior that solitary confinement seeks to prevent is a “function to some degree of the conditions they were under,” especially for those prisoners for whom “avoiding humiliation is instinctive.” Gawande noted that placing these prisoners in smaller units with non-confrontational prisoners reduced the number of prisoners in long-term isolation to a negligible number, and did not sacrifice security.
In June 2006, a bipartisan task force on long-term isolation in the United States recommended the practice’s termination, finding no benefit, and harm to both prisoners and society upon their release. Gawande said that some prison administrators would like to end the practice, but refuse to do so out of fear of public reprisal.
“Previous Americans have not found [long-term isolation] acceptable,” Gawande said. Our generation “countenances legalized torture” through the use of long-term solitary confinement, he claimed, much in the same way previous generations had “countenanced legalized segregation.”
Strikingly, Gawande identified public sentiment as the origin of the proliferation of long-term isolation. He noted that some prison administrators would like to end the practice, but refuse to do so out of fear of public reprisal.
“The reason is us,” he declared.
— Gregory Dibella