Saturday, February 2, 2008


Stuart Grassian, M.D.
401 Beacon Street
Chestnut Hill, MA 02467-3976


September 1993 in Madrid v. Gomez, 889F.Supp.1146

In my opinion, solitary confinement - that is confinement of a prisoner alone in a cell for all or nearly all of the day, with minimal environmental stimulation and minimal opportunity for social interaction - can cause severe psychiatric harm. This harm includes a specific syndrome which has been reported by many clinicians in a variety of settings, all of which have in common features of inadequate, noxious and/or restricted environmental and social stimulation. In more severe cases, this syndrome is associated with agitation, self-destructive behavior, and overt psychotic disorganization.

In addition, solitary confinement often results in severe exacerbation of a previously existing mental condition, or in the appearance of a mental illness where none had been observed before. Even among inmates who do not develop overt psychiatric illness as a result of confinement in in solitary, such confinement almost inevitably imposes significant psychological pain during the period of isolated confinement and often significantly impairs the inmate's capacity to adapt successfully to the broader prison environment.

Moreover, although many of the acute symptoms suffered by these inmates are likely to subside upon termination of solitary confinement, many -- including some who did not become overtly psychiatrically ill during their confinement in solitary -- will likely suffer permanent harm as a result of such confinement.

This harm is most commonly manifested by a continued intolerance of social interaction, a handicap which often prevents the inmate from successfully readjusting to the broader social environment of general population in prison and, perhaps more significantly, often severely impairs the inmate's capacity to reintegrate into the broader community upon release from imprisonment.

In my experience, many inmates housed in such stringent conditions are extremely fearful of
acknowledging the psychological harm or stress they are experiencing as a result of such confinement.

This reluctance of inmates in solitary confinement is in substantial measure a response to the perception that such confinement is an overt attempt by authorities to "break them down" psychologically, and in my experience, tends to be more severe when the inmate experiences the stringencies of his confinement as being the product of an arbitrary exercise of power, rather than the fair result of an inherently reasonable process. Furthermore, in solitary confinement settings, mental health screening interviews are often conducted at the cell front, rather than in a private setting, and inmates are generally quite reluctant to disclose psychological distress in the context of such an interview, since such conversation would inevitably be heard by other inmates in adjacent cells, exposing them to possible stigma and humiliation in front of their fellow inmates.

Lastly, the adverse impact of punitively imposed solitary confinement will often be more severe than the effect of such confinement when it is imposed for administrative purposes, since by intent, punitive solitary confinement imposes stringencies and deprivations which are in excess of those which are minimally required to maintain an inmate in segregated confinement; such stringencies often include limitations on programming, occupational and education opportunities, visitation, use of telephone, television and radio access, and access to reading materials, among others. Conversely, inmates housed in segregation for administrative reasons - such as for the protection of the inmate himself from possible harm by other inmates - will often retain access to many of the same opportunities and privileges which are provided to inmates in congregate housing.

Indeed,the institutional policies which create different conditions in administrative segregation, as opposed to punitive segregation, reflect an important underlying reality - that "institutional security" actually is employed to mean two very different things. The narrower usage of the terms reflects concerns about the safety of the individual inmate being housed, as well as the safety of those with whom he has contact.

The broader use of the term, however, is fundamentally unbounded - or at least, has boundaries which are not really distinguishable from the broad purposes of any system of criminal justice.

The harsh stringencies which are employed in punitive segregation reflect institutional assumptions that the harshly painful deprivations associated with a sentence to punitive solitary confinement, will serve as a deterrence to other in mates who might be tempted to break institutional rules. This rationale for imposing pain on an offender - the rationale that the punishment of this offender might deter other possible offenders - is simply a rationale for any system of criminal justice and punishment.

A multiyear sentence of punitive solitary confinement is an imposition of pain of staggering proportions, and it is imposed without the due process safeguards which anchor our system of criminal justice...

...I have since published on this topic in peer-reviewed journals.These are: 1. Grassian, S. (1983). "Psychopathological Effects of Solitary Confinement." American Journal of Psychiatry, 140, 1450-1454. 2. Grassian, S., & Friedman, N. (1986). "Effects of Sensory Deprivation in Psychiatric Seclusion and Solitary Confinement." International Journal of Law and Psychiatry, 8, 49-65.