Special Report to the Storting Document 4:3 (2018–2019) 26 Social isolation tends to reinforce itself. Inmates have been found to withdraw from social contact as a ­consequence of solitary confinement, both while they are confined and afterwards.61 Imposed isolation can thus result in self-isolation. This places stringent demands on a prison’s capacity to prevent solitary ­confinement, and to compensate for the harmful effects of solitary confinement when its use is strictly ­necessary. This does not only concern the amount of time that is devoted to the task, but also the ­competence of staff to look after inmates who are excluded from the company of others.62 Solitary confinement offers very limited possibilities of engaging in activities and few sensory inputs from the outside world. Research has demonstrated that prolonged periods of inactivity and without sensory input lead to passivity, fatigue and apathy. The capacity for attention, concentration, planning and motivation is reduced, and people tend to move and talk less. In step with this, their brain activity is significantly reduced.63 An explanation of these effects of lack of stimulation and activity can be found in studies of sensory ­deprivation, where lack of external stimulation causes lethargy and passivity.64, 65 Passivity and withdrawal make it difficult for individuals to attend to their own health and welfare, and can lead to further negative development with withdrawal and depression. Loss of predictability and lack of control cause stress, even in individuals who are not deprived of their liberty or placed in solitary confinement.66 Isolated individuals have much less control of their own situation and daily life. A known consequence of this is that they no longer believe it possible to influence the situation.67 This has been demonstrated to result in withdrawal, a feeling of helplessness and depression. Not knowing for how long one is being held in isolation has also proved to be a risk factor.68 This can be explained, among other things, by the loss of control of the situation. Inmates held in isolation may have a poor under­ standing of their own mental health state and can play down and understate the harmful effects isolation has on them.69 It has also been documented that they can be reluctant to accept psychiatric treatment and avoid seeking such help. This is possibly an attempt to master the situation rather than focusing on the symptoms, or they may not be aware of or understand the development of their own symptoms.70 The harmful effects of isolation can therefore be difficult to detect. Both the prison administration and the health services are therefore responsible for assessing the harmful effects regardless of how these are described by the inmates themselves. 27 4.2 Health effects of solitary confinement It is well-documented in both old and more recent research literature that isolation can be harmful to health.71, 72, 73, 74 The findings indicate that a large ­proportion held in solitary confinement experience some form of physical or mental problems or ­symptoms as a result of being isolated. The harmful effects of solitary confinement can be immediate, but the number of inmates who develop health problems and the severity of such problems increase with the length of confinement. The most common symptoms are mental, but physiological symptoms and complaints have also been ­documented. In her Sourcebook on Solitary Confinement, Sharon Shalev summarises possible harmful effects of isolation as being anxiety, ­depression, cognitive disturbances, perceptive distortions, paranoia and psychosis.75 The symptoms can vary from light tension, lack of concentration, hypersensitivity to noise and confused thought processes, to major ­depression, panic attacks and acute psychosis. Levels of ­aggression, anger, self-harming and suicidal attempts are also reported to increase. Among the physiological symptoms, attention has been drawn in particular to heart palpitations, diaphoresis, insomnia, back and other joint pains, eyesight deterioration, poor appetite and digestive complaints, lethargy/weakness, tremulousness and feeling cold and aggravation of existing medical problems as a result of isolation. ‘The damage I suffered in ­solitary confinement will never be ­mended. I was completely ­isolated for five or six months without a television. I will never be myself again’. Inmate interviewed by the NPM Inmates in solitary confinement will suffer varying degrees of mental and physiological symptoms, depending on several factors relating to the ­individual concerned as well as the conditions of solitary ­confinement.76 These include the degree and quality of human contact, the degree of activity and the physical conditions of confinement. Short duration and clear time limits are factors that protect the inmate. The grounds for solitary confinement and whose decision it was are other factors of importance, even though the risk of harmful effects is also present in inmates who are isolated by choice.77 ,78 Isolation can lead to anxiety, ­depression, confused thought processes, sensory disturbances, insomnia, delusions, psychosis, self-harming and suicide attempts. 61 62 63 64 65 66 67 68 69 70 Shalev, S (2008). A Sourcebook on Solitary Confinement. London: Mannheim Centre for Criminology, London School of Economics. See also: http://solitaryconfinement.org/uploads/sourcebook_web.pdf. University of Essex & Penal Reform International (2016). Essex paper 3. Initial guidance on the interpretation and implementation of the UN Nelson Mandela Rules, pp. 88–89. Scott, G D and Gendreau, P (1968). Psychiatric Implications of Sensory Deprivation in a Maximum-Security Prison. Canadian Psychiatric Association Journal, 14, 337-341. Lethargy is a state of decreased consciousness that resembles sleep, to which the patient returns automatically after being aroused. Smith, P S (2006). The effects of Solitary confinement on prison inmates: A brief history and review of the literature. Crime and Justice, 34, 441-528. Nolen, J L (2009). Learned helplessness. Encyclopaedia Britannica. Benight, C C & Bandura, A (2004). Social cognitive theory of posttraumatic recovery: the role of perceived self-efficacy. Behavior Research and Therapy, 42, 1129-1148. Shalev, S and Edgar, K (2015). Deep custody: segregation units and close supervision centres in England and Wales. London: Prison Reform Trust. Haney, C (2003). Mental Health Issues in Long-Term Solitary and “Supermax” Confinement. Crime & Delinquency 49, 138. Coid, J et al. (2003). Psychiatric morbidity in prisoners and solitary cellular confinement, 1: Disciplinary segregation. Journal of Forensic Psychiatry & Psychology, 14, 310 - 315. 71 72 73 74 75 76 77 78 Shalev, S (2008). A Sourcebook on Solitary Confinement. London: Mannheim Centre for Criminology, London School of Economics. See also http://solitaryconfinement.org/uploads/sourcebook_web.pdf. Smith, P S (2006). The Effects of Solitary Confinement on Prison Inmates: A Brief History and Review of the Literature. Crime and Justice, 34, 476-487. Howard, F F (2018). The effect of segregation. Prison Service Journal, 236, 4-11. Smith, P S (2008). Solitary confinement. And introduction to the Istanbul Statement on the Use and Effects of Solitary Confinement. Torture Journal, 18, 56-62. Shalev, S (2008). A Sourcebook on Solitary Confinement. London: Mannheim Centre for Criminology, London School of Economics. See also http://solitaryconfinement.org/uploads/sourcebook_web.pdf. Shalev, S and Edgar, K (2015). Deep custody: segregation units and close supervision centres in England and Wales. London: Prison Reform Trust. Edgar, K (2018). Segregation by choice. Prison Service Journal, 236, 38-42. Brodsky, S and Scogin, F (1988). Inmates in protective custody: First data on emotional effects. Forensic Reports, 1, 267-280.