2.6 S  equelae of isolation: the lasting effects of solitary confinement There are few longitudinal studies of the effects of solitary confinement and no follow-up studies of formerly isolated prisoners following their release from prison. Again, any long term effects are likely to be dependent on the individual, the type of confinement and its duration. One study of detainees held on remand in solitary confinement at the Western prison in Copenhagen, which examined them on the second to fourth day of their isolation and thereafter at monthly intervals, found a decrease in symptoms soon after transfer to the general population, indicating that “solitary confinement conditions are distressing and probably temporary, at least partially” (Andersen et al. 2003:174). The authors note, however, that “the finding that mental health condition improved when prisoners were moved from solitary confinement to non-solitary confinement indicates that solitary confinement imposes a condition that arguably could be avoided by abolishing it” (Ibid. at page 175). Similarly, Grassian’s (1983) study of prisoners held in solitary confinement at Walpole prison in Massachusetts, where the legal statute required that isolated prisoners be relieved from their status for at least 24 hours every 15 days, reported rapid diminution of symptoms during breaks in confinement. However, other studies report sleep disturbances, nightmares, depression, anxiety, phobias, emotional dependence, confusion, impaired memory and concentration (Hocking, 1970) long after release from isolated environments. These symptoms are similar to those experienced by prisoners in isolation and may imply a degree of irreversibility. But the lasting effects of solitary confinement are perhaps most evident in social settings and with interpersonal relationships: Although many of the acute symptoms suffered by inmates are likely to subside upon termination of solitary confinement many [prisoners], including some who did not become overtly psychiatrically ill during their confinement in solitary, will likely suffer permanent harm… this harm is most commonly manifested by a continued intolerance to social interaction, a handicap which often prevents the inmate from successfully readjusting to … general population prison and often severely impairs the inmate’s capacity to reintegrate into the broader society upon release from imprisonment (Grassian, 2006:332). Former prisoners who have spent prolonged periods in solitary confinement have testified to experiencing difficulties in social situations long after their release: I mean there are still times where I may go to the walk-in and after the movie’s over and, you know, it’s like I’ve been in the dark and all of the sudden the light comes on and boom all these millions of people around me, I’m like, you know, looking around like, okay, okay, who’s gonna hit me, what’s gonna happen ... I mean, you feel real uncomfortable and then all of the sudden you start shaking, you know, you feel your heart beat and then you realise, wait a minute, I’m at a theatre, what am I tripping on? There ain’t nobody out here all crazy. I’m not in prison. It gets real uncomfortable when I’m around a big crowd. Like sometimes even going to the grocery store I feel uncomfortable, you know, when people look at me, and I’m wondering, you know, wow, what are they looking at? [Former prisoner, US. Cited in Shalev, forthcoming]. My character and personality have undergone many negative changes and I am now a very paranoid and suspicious person. The paranoia has become so extensive that I find it impossible to trust anyone anymore and I have developed a tendency to hate people for no apparent reason (Wakefield, 1980:30). 22 Sourcebook on solitary confinement: The health effects of solitary confinement