PSYCHOLOGICAL EFFECTS OF SOLITARY CONFINEMENT AND SECLUSION

Associate Professor Donald Grant

Forensic Psychiatrist

SOLITARY CONFINEMENT

CONFINEMENT OF A PRISONER ALONE IN A CELL FOR ALL, OR NEARLY ALL,

OF THE DAY, WITH MINIMAL ENVIRONMENTAL STIMULATION AND MINIMAL OPPORTUNITY FOR SOCIAL

INTERACTION

SECLUSION

THE CONFINEMENT IN A CLINICAL SETTING OF A PATIENT IN A ROOM

WITH THE DOOR CLOSED OR LOCKED WITH NO ABILITY TO LEAVE.

OFTEN PRECEEDED BY FORCIBLE “TAKE DOWN” AND INVOLUNTARY

MEDICATION.

WHAT MAKES SOLITARY CONFINEMENT HARMFUL?

SOCIAL ISOLATION - deprivation of meaningful, sympathetic social interaction

and physical contact. Can lead to further withdrawal, with ongoing discomfort in social situations after release.

REDUCED ACTIVITY AND STIMULATION - boredom, monotony, sensory deprivation, detachment

from the outside world. Brain activity slows.

LACK OF CONTROL – Others control everything, no personal autonomy,

complete dependency, If prolonged may lead to loss of self-reliance, subsequent dysfunction in society.

FACTORS RELEVANT TO THE EFFECTS OF CONFINEMENT

The individual prisoner or patient (resilience, attitudes).

The background of the person (unstable, deprived, dislocated).

Intellectual or psychological vulnerabilities (low intelligence, mental illness, personality disorder, history of abuse, PTSD).

Substance abuse history (drug/alcohol dependence, withdrawal, craving).

The context of the confinement (punishment, containment, safety).

The duration of the confinement and the knowledge of the prospective duration (more than 10 days, indeterminate length)

The conditions of the confinement (size, facilities, light).

The meaning of the experience to the person confined (Political prisoner / Maximum secure prisoner /Patient).

EFFECTS OF CONFINEMENT

Effects can arise from confinement alone, but are exaggerated by poor hygienic conditions, abuse or torture.

Effects are worse with increased individual vulnerability and increased duration.

Psychological effects compounded by possible physical effects – pain, GIT issues, urinary problems, headache etc.

Some individuals report no effects, the majority have some negative effects.

Short term, long term and permanent effects possible.

PSYCHOLOGICAL EFFECTS OF CONFINEMENT

ANXIETY DISORDERS - stress, anxiety, irritability, fear of impending death, panic attacks, PTSD

DEPRESSION - Emotional flatness, loss of feeling, mood swings, hopelessness, withdrawal, apathy, lethargy, Major Depression.

ANGER - irritability, hostility, poor impulse control, verbal and physical outbursts towards others and/or self, unprovoked rage.

COGNITIVE DISTORTIONS – short attention span, poor concentration, poor memory, confusion, disorientation in time and space.

PERCEPTUAL DISTORTIONS – hypersensitivity to noise and smells, visual distortions, depersonalisation/derealisation, hallucinations (auditory, visual, touch, smell, or taste).

PARANOIA and PSYCHOSIS – obsessional ruminations, vengeful and violent thoughts, persecutory ideas, paranoid states (eg, being poisoned), psychotic episodes, psychotic depression.

SELF HARM and SUICIDE – self mutilation, head banging, self-starvation, suicides more common than in general prison population.

What to do?

Be aware of the effects of seclusion Be aware of person’s vulnerabilities Provide explanations and be humane Use seclusion for the right reasons only Use seclusion as a last resort, for shortest time possible Provide therapy for patients affected by seclusion Use alternatives (time out, quiet room, medication, anger

management) Train staff in de-escalation and management of

aggression Provide extra resources and better facilities Recruit younger, capable staff