2.3 T  he negative health effects of solitary confinement: reported symptoms Physiological effects Although psychological effects are most common and usually dominant, physiological effects are nevertheless commonly reported. Some of these may be physical manifestations of psychological stress, but the lack of access to fresh air and sunlight and long periods of inactivity are likely also to have physical consequences. Grassian and Friedman (1986) list gastro-intestinal, cardiovascular and genito-urinary problems, migraine headaches and profound fatigue. Other signs and symptoms recorded by the some of the studies reviewed above are • • • • • • • • • • Heart palpitations (awareness of strong and/or rapid heartbeat while at rest) Diaphoresis (sudden excessive sweating) Insomnia Back and other joint pains Deterioration of eyesight Poor appetite, weight loss and sometimes diarrhoea Lethargy, weakness Tremulousness (shaking) Feeling cold Aggravation of pre-existing medical problems. Psychological effects The most widely reported effects of solitary confinement are its psychological effects26. These will vary with the pre-morbid adjustment of the individual and the context, length and conditions of confinement. The experience of previous trauma will render the individual more vulnerable, as will the involuntary nature of confinement as punishment, and confinement that persists over a sustained period of time. Initial acute reactions may be followed by more chronic symptoms if the confinement persists. While the majority of those held in solitary confinement will report some form of disturbance, there may be a small number of prisoners who show few signs and symptoms and may be more resilient to the negative effects of solitary confinement. Symptoms occur in the following areas and range from acute to chronic. Anxiety, ranging from feelings of tension to full blown panic attacks • • • • Persistent low level of stress Irritability or anxiousness Fear of impending death Panic attacks Sourcebook on solitary confinement: The health effects of solitary confinement 15