Torturing the Mentally Ill

I

Infants, children, and adults have a need to be in the company of others. This has been demonstrated repeatedly in human and primate infants. Less well appreciated is that adult humans have a distinct need for the company of others. This need in adults has been shown largely in anecdotal reports of interviews with released hostages and reports of prisoners subjected to solitary confinement. According to a New Yorker article by Atul Gawande, M.D, a professor at Harvard Medical School and distinguished author, reports from prisoners and released hostages confirm that solitary confinement for varying periods of time is an excruciating painful experience. John McCain, former presidential candidate and current Arizona U.S. Senator, who was in solitary confinement for the better part of five years as a prisoner of war in a North Vietnam prison camp, reported that his solitary confinement was more painful than his beatings and untreated war wounds. Gawande discusses reports from other well known hostages such as Terry Anderson, a reporter and Hezbollah hostage held in solitary confinement for several years, who confirms McCain’s report of the unbearable psychological pain of the deprivation of human contact found in solitary confinement. There are additional profound psychological consequences. As noted by Gawande, prisoners in the correctional system who are placed in solitary confinement become enraged. Loss of cognitive capacity within the first weeks often occurs with loss of ability to concentrate and remember the past. There is a loss of the ability to relate to other people. Prisoners released from solitary confinement after long periods of time tend to keep to themselves. They are socially isolated and confine their social interactions at most to a few individuals. There is variation in the severity of these symptoms; some prisoners are more resilient than others. About one third of prisoners in solitary confinement become psychotic. Among the least resilient are prisoners who are mentally ill at the outset. (http://www.newyorker.com/magazine/2009/03/30/hellhole)

The widespread use of solitary confinement to manage assaultive mentally ill patients in prison was reported by Samantha Melamed in the December 7, 2014 issue of the Philadelphia Inquirer. Melamed tells the history of Khasiem Carr, who suffered from constant auditory hallucinations since his early twenties and struck a customer in a drug store. A judge sentenced him to one and half to four years in a forensic psychiatric treatment unit in a prison. He was never placed in the psychiatric unit but was placed in the prison in solitary confinement for well over a year. He lost over one hundred pounds and continued to hallucinate.

In 2012-2013 over 1,000 seriously mentally ill inmates in Pennsylvania received solitary confinement for more than 90 days. 250 of them were in solitary confinement for over a year. Currently, there are 200 mentally ill prisoners in solitary confinement in Pennsylvania prisons. A lawsuit has been filed by The Disability Rights Network and the U.S. Justice Department to reduce or eliminate the use of solitary confinement for mentally ill offenders in Pennsylvania. Negotiations over the lawsuit suggest that one likely outcome is to limit solitary confinement to thirty days for mentally ill offenders. Most suicide attempts of mentally ill offenders occur during the first thirty days of solitary confinement and mentally ill offenders are responsible for 70% of suicide attempts in prisons. The data suggest that thirty days of solitary is far too brutal a management technique for the mentally ill offender.

Melamed further reports that according to the Pennsylvania Department of Corrections, about 20% of the prison population, or 10,000 inmates, is mentally ill. The Pennsylvania Department of Corrections attributes the increase in the mentally ill imprisoned population to the decrease in state mental hospital beds. http://www.philly.com/philly/gallery/20141207_State_prison_system_makin…

Copyright: Stuart L. Kaplan, M.D., 2014

Dr Kaplan is the author of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Disorder http://www.amazon.com/Your-Child-Does-Bipolar-Disorder/dp/0313381348