Self-harm and suicide Historical reports of 19th Century isolation prisons repeatedly describe acts of auto-aggression, selfmutilation, and suicide. Contemporary studies have also shown that self-harm (including banging one’s head against the cell wall) and suicides are more common in isolation units than in the general prison population (Haney & Lynch 1997:525). In California, for example, a reported 69% of prison suicides in 2005 occurred in segregated housing units (USA Today, 27/12/2006), and in England and Wales in 2004/5 a fifth of prison suicides took place in segregation units (National Offender Management Service, Safer Custody Group. Self inflicted deaths Annual Report, 2004/5). Other forms of self-harm are also prevalent in solitary confinement. Researchers have noted that self-mutilation or cutting is often “a result of sudden frustration from situational stress with no permissible physical outlet... Self-addressed aggression forms the only activity outlet” (Scott & Gendreau, 1969:341). Another study found that self-mutilation was a means to “liberate the self from unbearable tension- the physical pain becomes a compensatory substitute for psychic pain or shame” (Dabrowski (1937), cited in McCleery, 1961:303). Former prisoners have testified that self harm played another role for them when they were held in segregation – it asserted that they were still alive. I was totally frustrated… I started smashing up the cell. I refused to eat. I started refusing water. I was totally paranoid. I started sipping my own urine because I thought they were trying to poison me. I resorted to self-injury, was put in a body belt. You become so angry. It’s an outlet, but you have to vent it out. Even your own blood is something real [Former prisoner, UK, cited in Shalev, forthcoming]. I found myself curled up in a foetal position rocking myself back and forth and banging my head against the wall. In the absence of sensation, it’s hard sometimes to convince yourself that you’re really there [Former prisoner, US, cited ibid.]. It is difficult to obtain figures for forms of self-harm that do not result in death. Nonetheless, there is compelling anecdotal evidence that the prevalence of such incidents in segregation and isolation units is particularly high. 2.4 What makes solitary confinement harmful? Each of the three main factors inherent in solitary confinement- social isolation, reduced environmental stimulation and loss of control over almost all aspects of daily life- is potentially distressing. Together they create a potent mix. Moreover, psychiatric morbidity studies of prisoners indicate that they are a particularly vulnerable population, even when not in solitary confinement. In England and Wales, a morbidity survey of prisoners carried out by the Office for National Statistics in 1998 found that only 10% were without any history of neurotic disorder, psychotic disorder, personality disorder or substance misuse, and many experienced some or all of these in combination (ONS psychiatric morbidity survey, 1998). It is also known that about 7% of prisoners have a severe learning disability, with an IQ of 70 or below27, and that those with learning disabilities find it particularly difficult to cope with isolation. About 12% will also be receiving psychiatric treatment while in prison for severe and enduring mental illness (HMCIP, The mental health of Prisoners, 2007). One cause of these high levels of disturbance is the experience of early life trauma Sourcebook on solitary confinement: The health effects of solitary confinement 17