example, identified that five of the eight had significant mental health problems but that there was very little take up of the mental health service provided (An Inspection of the Category A Detainee Unit at Long Lartin, HMCIP, 2007). Nonetheless, accounts from prisoners themselves illustrate a range of severe adverse health effects. What follows is what has emerged from interviews with prisoners in isolation, or after the event, and from writings by formerly isolated prisoners. One of the problems most commonly reported by prisoners who were isolated is that they found it hard to distinguish between reality and their own thoughts, or found reality so painful that they created their own fantasy world. Researchers link such incidents to the absence of external stimuli which results in the brain starting to create its own stimulation, manifesting in fantasy and hallucinations. One study of prisoners who were isolated for periods ranging from 11 days to 10 months reported both auditory and visual hallucinations. One interviewee described how: “the cell walls start wavering... everything in the cell starts moving; you feel that you are losing your vision”. Others reported auditory hallucinations: “I overhear guards talking. Did they say that? Yes? No? It gets confusing. Am I losing my mind?” Prisoners also reported high sensitivity to noise and smells: “you get sensitive to noise. The plumbing system... the water rushes through the pipes- it’s too loud, gets on your nerves. I can’t stand it. Meals- I can’t stand the smells....the only thing I can stand is the bread” (Grassian, 1983). Other studies have reported similar experiences, ranging from hypersensitivity to sound and smell, to paranoid episodes and self-injury. One former female prisoner described extreme sensitivity to sounds “Your vision was highly restricted, so you live by sound… you could hear every creaking of the place, you know, the building. It was almost amplified… not that our hearing was better, it was just that we paid more attention because sound had to do with… with life” (Cited in Shalev, forthcoming). Another former prisoner who was isolated in a dark punitive isolation cell ‘saw faces’ and ‘held conversations’ with people who were not there: Sometimes I felt like I was losing my mind, or that I have lost it already, you know… Holding conversations with myself… I had conversations with people. I mean dialogues, long dialogues with people. Some of them I knew, and some of them I didn’t know. There were times when the darkness wasn’t dark. I could see faces… I think that I found out that I may be hallucinating when I touched my eyes and my eyes were open so I kind of knew I wasn’t dreaming. After a while I thought that maybe I will die there. I really thought I would [Former prisoner, USA, cited in Shalev, forthcoming]. Similar findings were reported by Siegel’s (1984) study of 31 people who were subjected to isolation, visual deprivation and restraint on physical movement as hostages, prisoners of war or convicted prisoners over varying periods. All interviewees reported visual and auditory hallucinations that appeared within hours of being isolated and became more and more elaborate as time went by. Prisoners participating in Toch’s (1992) large-scale study of the psychological effects of incarceration reported similar experiences in solitary confinement. Interviewee ‘M’, for example, described panic and paranoid thoughts during his first days in isolation: …and then I lay on the mattress, and then after I sit there I feel the walls coming in around me. And then when the guards come in and I am screaming, they say: ‘what the fuck is going on here?’ and I say ‘the walls are closing in on me’ and they say ‘that’s tough, you’re going to die anyway. We’ll strangle you’… I was thinking that if I don’t get the hell out of there, they’re going to kill me. And I don’t feel like fighting them (Toch 1992:150). Sourcebook on solitary confinement: The health effects of solitary confinement 13