2.2 T  he health effects of solitary confinement: a brief review of the literature and prisoners’ accounts General observations There is unequivocal evidence that solitary confinement has a profound impact on health and wellbeing, particularly for those with pre-existing mental health disorders, and that it may also actively cause mental illness. The extent of psychological damage varies and will depend on individual factors (e.g. personal background and pre-existing health problems), environmental factors (e.g. physical conditions and provisions), regime (e.g. time out of cell, degree of human contact), the context of isolation (e.g. punishment, own protection, voluntary/ non voluntary, political/criminal) and its duration. Notwithstanding variations in individual tolerance and environmental and contextual factors, there is remarkable consistency in research findings on the health effects of solitary confinement throughout the decades. These have mostly demonstrated negative health effects, with studies reporting no negative effects being few and far between, and virtually no study reporting positive effects21. Historic accounts The extensive use of solitary confinement in prisons of the early 19th century was well documented, and its effects on prisoners reported in medical journals of the time. Grassian and Friedman (1986) cite thirty seven reports and articles published in Germany alone between 1854 and 1909, identifying solitary confinement as the single central factor in the development of psychotic illness among prisoners. Examples include an 1854 report by the chief physician of Halle prison, Germany, who observed what he termed Prison Psychosis among isolated prisoners and concluded that “prolonged absolute isolation has a very injurious effect on the body and mind and seems to predispose to hallucinations” and should therefore be immediately terminated (Nitsche & Williams, 1913). A report from 1863 describes vivid hallucinations, delusions, apprehension and psychomotor excitation experienced by 84 prisoners suffering from what its authors termed the Psychosis of Solitary Confinement. In 1881, a summary of diagnostic assessments of 186 prisoners held at the ‘insane department’ at Waldheim prison, also in Germany, concluded that over half of the prisoners suffered reactive manifestations to solitary confinement (Grassian & Friedman, 1986). Similar observations were made in England, where in 1850 for example, 32 out of every 1000 prisoners had to be removed from their solitary cells in Pentonville prison on grounds of insanity, compared to 5.8 prisoners per 1000 in prisons not practising solitary confinement (McConville, 1981:208-9). In the US, the Boston Prison Discipline Society, which helped devise the ‘Separate’ or ‘Pennsylvania’ system of solitary confinement, reported from as early as 1839 serious mental problems amongst isolated prisoners, including hallucinations and dementia (cited in Scharff-Smith, 2004). Referring to similar reports several years later, the US Supreme Court noted that the effects of solitary confinement were such that “a considerable number of prisoners.... fell into a semi- foetus condition... and others became violently insane” (Re Medley, 1890:167-8). Indeed, the understanding that instead of its intended role of helping to ‘cure the disease of crime’, solitary confinement was creating mental illness in prisoners, played a central role in the dismantling of the isolation prisons on both sides of the Atlantic by the late 19th century. 10 Sourcebook on solitary confinement: The health effects of solitary confinement