2|T  he health effects of solitary confinement 17 2.1 Introduction Being held in solitary confinement is, for most prisoners, a stressful experience with potentially harmful health effects. The prisoner is socially isolated from others, his human contacts reduced to superficial transactions with staff and infrequent contact with family and friends. He is almost completely dependent on prison staff – even more than is usual in the prison setting – for the provision of all his basic needs, and his few movements are tightly controlled and closely observed. Confined to a small sparsely furnished cell with little or no view of the outside world and with limited access to fresh air and natural light, he lives in an environment with little stimulation and few opportunities to occupy himself. Throughout the long history of its use in prisons – from the ‘silent’ and ‘separate’ penitentiaries of the 19th century through to modern-day segregation units and ‘supermax’ prisons – practitioners and researchers have observed the adverse effects of solitary confinement on prisoners’ health. In the context of coercive interrogation, international experts have identified solitary confinement as psychological torture18. The potentially damaging effects of solitary confinement are also recognised by national and international instruments and by monitoring bodies, which view it as an extreme prison practice which should only be used as a last resort and then only for short periods of time. Indeed, expressing strong concern about the use of solitary confinement as punishment, in 1990 the United Nations went as far as to call for its abolition19. This chapter examines some of the research findings on the health effects of solitary confinement dating back to the 19th century, and attempts to explain how and why solitary confinement adversely affects physical, mental and social wellbeing20. Although negative health effects may emerge after a very short period of time in solitary confinement, this chapter is mostly concerned with the more serious health effects that are associated with longer periods of solitary confinement. Sourcebook on solitary confinement: The health effects of solitary confinement 9