PlutoPress London, 2011
The Impact of Isolation on Mental Health
Ruchama Marton
In his book The Carrot and The Stick, Israel's first Coordinator of Government Activities in the Occupied Palestinian Territory (1967-1974) Shlomo Gazit states that since the earliest days of the Occupation, solitary confinement has served as the most important strategy for breaking the spirit of Palestinians and coercing them to collaborate. Gazit writes: "The great advantage of defense regulations and administrative measures was the creation of circumstances in which the detainee was 'broken', confessed his guilt and cooperated with his interrogators. Here the most important means for 'breaking' interrogated persons (at a time when there existed strict instructions to avoid exerting physical pressure during the interrogation) was the absolute isolation of the interrogated person (from his family, his attorney, Red Cross personnel and even other detainees) during the initial phase of detention and interrogation."
The Occupation is the broader context in which solitary confinement of security/political prisoners as well as its reasons and effects, should be viewed. Social, national and individual aspects are all relevant. For the purposes of this discussion, we are referring to the Occupation which began in 1967 and that includes the Gaza Strip, East Jerusalem, the West Bank and the Golan Heights. The detention of most political/security prisoners begin with periods of solitary confinement of varying lengths. Psychologists employed in the service of security agencies and the accumulated experience of detention in isolation in Israel and world-wide have all served as the scientific and particularly the practical foundation for use of this type of detention. An examination of the psychological impacts of solitary confinement can fill Gazit's statement with concrete content, and explain why isolation has served as such a central strategy in "breaking" Palestinians since the earliest days of the Occupation.
Human beings seek to achieve equilibrium among the needs and demands of their external and internal worlds. This process continues throughout the life span and is guided by one's ego, which uses perceptions for this purpose. It is through perceptions that one develops and forms one's lifestyle, behavior and occupation. Therefore, perceptions represent the tools for building cognition and judgment of reality. Some people require more stimulation, while others require less. Stimulation can be positive or negative, but in any case is an absolute human need. In a state of sensory deprivation, disequilibrium occurs between the internal and external worlds, producing extreme anxiety and loss of control over one's ego, judgment of reality, activity level, regularity of behavior and thought. We need to receive information through our senses in order to maintain our sanity.
It is precisely the damage that solitary confinement causes to the prisoner's psyche and personality that is often viewed by the detaining authorities as its most useful aspect. According to Haney and Rhodes, one of the destructive effects of solitary confinement is the transformation of the detainee into an asocial, shattered being. In this essay I will demonstrate how the psychological, physical, and social damage of solitary confinement is employed in the service of the Occupation, owing to its horrific effects, while it earns the official backing of "security grounds".
Many studies have been conducted on the psychopathological effects of solitary confinement and their findings are unequivocal. Solitary confinement produces:
- Deep psychotic reactions such as visual and auditory hallucinations, paranoid states, disorientation in time and space, states of acute confusion and thought disturbances.
- Emotional instability and extreme emotional disturbances, the experience of depersonalization and derealization, rage and anger, negative attitude and affect, compulsiveness, memory loss, attention and concentration difficulties, fear, panic, fear of death, depression, hopelessness, apathy, loss of joie de vivre.
- Disturbances of body image, self-mutilation, experience of suffocation, excessive masturbation, startle reaction.
- Physiological states created by the anxiety that results from solitary confinement: prisoners develop symptoms of the gastroenterology, vascular and sexual/urinary systems. Sleep disturbances and extreme fatigue. Tremor, recurrences of heart palpitations, recurrences of excessive perspiration.
- Long-term effects: Solitary confinement frequently produces permanent mental disturbances and a feeling of insecurity. In fact, each of the pathologies described above may become chronic both in prison and outside.
- Social pathologies: The total social isolation sometimes causes prisoners to withdraw and fear relationships with other people. It may be said that the prisoner's social personality is obliterated or distorted to such an extent that prisoners have lost the ability to handle themselves and live their lives in the company of others. This may be manifested in prisoners' preference to remain isolated even when they are given the option to leave solitary confinement. Prisoners may also suffer attacks of irrational violence and rage.
Psychotic Reactions
There are several types of psychotic reactions to solitary confinement: Visual and auditory hallucinations, disturbances of thought and concentration, and memory loss.
A large percentage of prisoners in solitary confinement suffer from hallucinations: one study reports 38.4% while another indicates 50%. In a study of 31 persons, Siegel indicated that such hallucinations were liable to occur despite a conscious effort to avoid them, and they are typically considered to be a conscious reaction to stressful and traumatic situations. Often the initial images, which may occur after only 15 minutes in solitary confinement, are flashes of white light, followed by the appearance of geometrical forms. More complex visual hallucinations of insects, small animals, people or places, may occur several hours or days into isolation. Hallucinations of tunnels and the experience of floating through them have also been reported, particularly in cases in which isolation has been accompanied by the threat of death.
Several explanations have been offered as to the cause of these hallucinations. Williams suggests that the brain may require a certain quantity of stimuli in order to function, in the absence of which it creates its own stimuli.
Most people who were placed in solitary confinement described an experience of thought disturbances as well as the inability to control their thought processes. One described tasteless, odorless, confused thoughts. The appearance of thought disturbances creates fear and panic. One person said he thought this meant he was going mad.
Following a few days in solitary confinement, states of acute confusion have been reported. In a research made at the Massachusetts Correctional Institute at Walpole, one prisoner cut and injured his elbow while completely disoriented, and was unable to recall what had happened during the few days when the event had occurred. Nor could he remember the thoughts or feelings he had experienced at the time. Another prisoner described difficulty concentrating and memory loss:"I can’t concentrate, can’t read….Your mind’s narcotized…sometimes I can’t grasp words in my mind that I know. I get stuck; have to think of another word. Memory is going. You feel you are losing something you might not get back." They attempted to retain their cognitive capabilities by using self-discipline techniques. One said, "Got to try to concentrate. Remember list of presidents, memorize the states, capitals, five oceans, seven continents, nine planets.”…
The importance of an environment with varied stimuli on the development of intellectual abilities such as thought, concentration and memory has been demonstrated in a great many studies and experiments on human and animal behavior. It is understandable how a person held in solitary confinement where the level of stimuli is significantly lower may suffer from various forms of thought disturbance and loss of control over thought processes.
Emotional Disturbances
Extreme, deep anxiety is the most common feeling among prisoners in solitary confinement. Gradually, fear and despair take over and break down the prisoner's mental and physical soundness. The feeling of deep anxiety and total abandonment along with thought disturbances and hallucinations produce an ongoing state of doubt and insecurity. All of these cause the loss of self-confidence and self-worth and bring about the loss of identity. An example may be that of the Palestinian prisoner A who has been held in individual isolation in the Israeli prison for about six months, as she did not get along with other prisoners. She was held in individual isolation during her previous three-year sentence as well. When the prison authorities wished to remove her from isolation, she refused: "I no longer believe in anything or anyone… I feel alone and am trying to survive the rest of my sentence", she said. The Israeli Prison Authority's psychiatrist wrote about her need to talk, just in order to shatter her loneliness, that she clearly uses her visits to him as an opportunity for conversation: "The prisoner agreed to have a conversation. She does not want to be examined [and] is interested only in conversation." Yet he was unresponsive: "During the examination she speaks in a stressful manner about many things, many topics… It is impossible to speak with her… She talks about how she is being harmed and not treated… goes into long, irrelevant explanations, asks for help."
It is important to add that in many cases isolation produces violence and rage, so that while it is intended to "restrain" the prisoner, the result of confinement may be the reverse.
Physiological Symptoms
The extreme anxiety caused by solitary confinement may produce acute physiological disturbances. Victims of solitary confinement suffer from symptoms affecting their digestive, vascular, urinary and sexual systems, as well as tremor, migraines, headaches, sleep disturbances and extreme fatigue. According to Hocking, these symptoms may persist long after confinement and even become permanent. Symptoms such as recurring heart palpitations, excessive perspiration and shortness of breath have been described.
Long-Term Effects of Solitary Confinement
According to Williams, solitary confinement "is designed to induce disorientation and confusion… [and thus]…isolate the individual from his or her sense of self in such a way that it will prove very difficult for the victim ever to recover and function normally again.”…" Persons who were placed in solitary confinement have reported that symptoms continued after their release. They often suffer from dependency; limited concentration, attention and memory; and confusion. Research has shown that these long-term symptoms do not disappear over time, but rather become worse if left untreated.
Social Pathologies
Solitary confinement requires the prisoner's maximum adaptation in order to survive under the difficult, abnormal conditions. Sometimes adaptation is total, transforming the prisoner's mental structure into a replacement of his/her previous one. Thoughts, the manner of organizing life's activities and the emotional system all undergo complete transformation to enable survival in solitary confinement. The prisoner suffers from flattened emotion, shallow thought, inability to withstand minor external stimuli, irrational rage, inability to plan and initiate normal activity, dependence on external systems to organize one's life, loss of ability to control one's behavior, anxiety triggered by the presence of another human being. For some prisoners, these symptoms become permanent and do not enable them to re-adapt to life within a social system. Most importantly, in some cases it is impossible to heal these social pathologies.
One of the presumed objectives of imprisonment is the prisoner's rehabilitation and return to society as a better citizen. Solitary confinement stands in stark contrast to this possibility.
In fact, prison not only denies basic human rights during confinement, but may even prevent prisoners from conducting new lives outside of prison. It eradicates and reshapes their personality, rendering it inappropriate for "normal" life.
Mentally ill prisoners in solitary confinement
Some prisoners have suffered from emotional problems prior to their detention, some from mental illness such as schizophrenia. For these prisoners, adapting to life in prison is especially difficult. They become the "unsolvable problem" of prison authorities and other prisoners, due to the behavioral disturbances they manifest as a result of their mental illness. Subsequently, they are placed in solitary confinement. The prison thus punishes prisoners for their mental illness. Prison authorities do not know what to do with them, there are no budgets for psychotherapy, and solitary confinement is a practical “solution” for these prisoners. Certainly, solitary confinement is not a substitute for the psychotherapy that mentally ill patients so desperately need. Solitary confinement irreparably shatters whatever is left of these prisoners' personality.
Over the years of PHR-Israel’s activity, we have found that schizophrenic prisoners are often systematically given a wrong diagnosis. Although they are typically on anti-psychotic drugs, the commonplace diagnosis is 'manipulative', 'malinger', 'hysterical' and the most common diagnosis is ‘imposter’ or some other odd diagnosis that does not exist in the diagnostic manuals, such as 'anxiety of imprisonment'. All these misdiagnoses fail to define Palestinian prisoners as mentally ill, placing them outside the realm of mental illness. Subsequently they are perceived as responsible for their actions, and specifically, fit to stand trial and carry out prison sentences.
I recall a clear-cut example elucidating this method:
Prisoner M. from Gaza was accused of attempting to run over an IDF soldier. During his trial, the military judge was impressed by M.'s mental state and ordered a psychiatric exam for him. M. was examined at a psychiatric hospital, where the psychiatrist who examined him found him to be mentally ill, chronically schizophrenic. The judge then determined that M. was unfit to stand trial. At this point Major-General Matan Vilnai, Commander of the Southern Command, intervened. He sentenced M. to three years in prison, by power of Vilnai's authority as Commander, under article 36B of Security Provisions Order (No. 378) of 1970.
In other words, the army disregarded and canceled out the psychiatric opinion as well as the military judge’s ruling, so that a Palestinian prisoner would not escape a prison sentence.
In prison, the authorities could not find a solution to M.’s difficult behavior, and he was soon placed in solitary confinement. When I examined him some time later, M. was devoid of humanity. He spread feces on his cell wall, was unable to identify his family members and could not utter a single coherent sentence.
Solitary confinement and the occupation
In his book, Imagined Communities, Benedict Anderson argues that a nation is an "imagined political community" (p. 6). It is imagined because for the most part, its members do not know and have never met each other. The important point for our purpose is that according to Anderson, despite the differences among the different individuals who make up the community, it is founded on a deep affinity among its members: "The nation… is always conceived as a deep, horizontal comradeship. Ultimately it is this fraternity that makes it possible, over the past two centuries, for so many millions of people, not so much to kill, as willingly to die for such limited imaginings" (p. 7).
In Israel, solitary confinement should be viewed as one of the practices of the Occupation, whose objective is to shape submissive, compliant subjects who will fail to develop a national consciousness, a community as defined by Anderson.
Another reason for holding Palestinian prisoners in solitary confinement is that the GSS or IPS have determined that the prisoner would put Israeli security at risk if allowed to be in contact with other prisoners. The case of Marwan Barghouti who has been held intermittently in solitary confinement, is just one example of how security grounds are sometimes used merely as an excuse to exert pressure on the confined individual or others to act in a manner desirable to Israeli agencies. The grounds for placing in solitary confinement notwithstanding, its impacts on one’s mental and physical condition may be severe and permanent, as I have described.
One of the most basic stimuli that we need and which is indeed essential to our very existence is the feeling of solidarity, that we are accepted by others, the need to hear, speak to and touch another human being. All of these essential needs are denied prisoners in solitary confinement. As a result, development of a powerful sense of the loss of ability to feel is unavoidable. An individual who suffers from a feeling of emptiness and hollowness feels nothing. To lose the ability to feel means risking the death of the psyche.
Charles Dickens wrote of confinement: “I hold this slow and daily tampering with the mysteries of the brain to be immeasurably worse than any torture of the body”. I believe that solitary confinement is equal only to lobotomy – except that the process of solitary confinement is longer and crueler. Solitary confinement is nothing but a specific form of torture. People do not die from solitary confinement; they only lose their minds.