Notes 17 This chapter was co-authored with Monica Lloyd, Forensic Psychologist, formerly of the Chief Inspector of Prisons (HMCIP) office, and Jonathan Beynon, MD, Medical Co-ordinator for Health in Detention, International Committee of the Red Cross. The points of view expressed here represent the personal opinions of the authors, and do not necessarily represent the position of their organisations. 18 Reyes, H. The worst scars are in the mind: psychological torture, International Review of the Red Cross, Volume 89 No. 867, September 2007 pp 591-617. See also: Human Rights Watch report: Locked Up Alone: Detention Conditions and Mental Health at Guantanamo, June 2008; Physicians for Human Rights (PHR): Break them down: systematic use of psychological torture by US forces. Physicians for Human Rights, USA, 2005. 19 Principle 7 United Nations Basic Principles for the Treatment of Prisoners, adopted and proclaimed by General Assembly resolution 45/111 of 14 December 1990 20 This chapter is only intended as a brief and selective review of the literature. The studies examined in this review vary greatly in scope, location, context, factors examined and methodology. For a comprehensive review of the literature on the health effects of solitary confinement and a discussion of methodological issues see ScharffSmith (2006). 21 With the exception of Suedfeld & Roy (1975) who suggested that short-term, non-punitive solitary confinement of volunteer participants may have beneficial effects (though these are not elaborated). 22 Reported in the Canadian Medical Journal 1977:408-416 23 Researchers reported emotional disturbances, disturbances in comprehension and ability to think, infantile regressive changes and difficulty in making social contacts, as well as sleep disturbances, headaches and severe digestive problems (cited in Amnesty International, 1980). 24 The authors note that many of the prisoners in both samples suffered prior mental health problems. 25 As Toch (1992:152) noted “personal breakdown in isolation does not square with manly self-images and reputations”, so prisoners may find it easier to refer to others ‘losing it’. 26 The symptoms listed in this section have been consistently reported by the studies discussed above. For a more detailed review of research findings see, Grassian & Friedman (1986); Grassian (2006); Haney & Lynch (1997); Haney (2003); Scharff-Smith (2006). 27 Mottram, P. 2007. HMP Liverpool, Styal and Hindley Study Report, University of Liverpool 28 “Health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right ...” World Health Organisation, Declaration of Alma-Ata, 1978. 29 ‘Meaningful’ is emphasised because it cannot be argued that regular contact with custodial staff whilst being fed, restrained and escorted constitutes meaningful contact. 30 See Mead (1934). For a review of social learning theories and their application in situations of social isolation see Haney & Lynch 1997:503-506 31 A prisoner in Florida’s Supermax, cited in the Campaign to Stop Control Units Report, 1997 32 See Sutherland & Cressey (1955); Sykes (1958); Goffman (1961); McCleery (1961). See also Cohen & Taylor’s ([1972] 1981) study of prisoners in Durham prison’s maximum-security wing in the late 1960s and Toch’s (1992) study of prisoners’ reactions to the “psychological strain of imprisonment”. 24 Sourcebook on solitary confinement: The health effects of solitary confinement