Abstract
We examine how solitary confinement correlates with self-reported adverse physical health outcomes, and how such outcomes extend the understanding of the health disparities associated with incarceration. Using a mixed methods approach, we find that solitary confinement is associated not just with mental, but also with physical health problems. Given the disproportionate use of solitary among incarcerated people of color, these symptoms are most likely to affect those populations. Drawing from a random sample of prisoners (n = 106) in long-term solitary confinement in the Washington State Department of Corrections in 2017, we conducted semi-structured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for these subjects. We also conducted a paper survey of the entire long-term solitary confinement population (n = 225 respondents) and analyzed administrative data for the entire population of prisoners in the state in 2017 (n = 17,943). Results reflect qualitative content and descriptive statistical analysis. BPRS scores reflect clinically significant somatic concerns in 15% of sample. Objective specification of medical conditions is generally elusive, but that, itself, is a highly informative finding. Using subjective reports, we specify and analyze a range of physical symptoms experienced in solitary confinement: (1) skin irritations and weight fluctuation associated with the restrictive conditions of solitary confinement; (2) un-treated and mis-treated chronic conditions associated with the restrictive policies of solitary confinement; (3) musculoskeletal pain exacerbated by both restrictive conditions and policies. Administrative data analyses reveal disproportionate rates of racial/ethnic minorities in solitary confinement. This analysis raises the stakes for future studies to evaluate comparative prevalence of objective medical diagnoses and potential causal mechanisms for the physical symptoms specified here, and for understanding differential use of solitary confinement and its medically harmful sequelae.
Highlights
The health implications of solitary confinement have received increasing attention in recent years [1, 2]
Among our participants 42% were white; 12% were African American; 23% were Latino; 23% were “Other.” There were no significant differences between our participants and all people held in Intensive Management Unit (IMU) at the time of our sample
We identify three categories of physical symptoms people experience in solitary confinement, each associated with different aspects of IMU housing: symptoms associated with deprivation conditions, symptoms associated with deprivation policies limiting access to healthcare, and chronic musculoskeletal pain exacerbated by the intersection of deprivation conditions and deprivation policies
Summary
The health implications of solitary confinement have received increasing attention in recent years [1, 2]. While initial studies focused on the effects of sensory deprivation [9,10,11], recent work has examined the impacts of social deprivations [12, 13]. Such studies have found that placement in solitary confinement has been associated with symptoms of increased psychological distress, such as anxiety, depression, paranoia, and aggression [14,15,16]. The analyses on which such opinions rely have, in turn, been criticized for neglecting existing literature and for other serious methodological concerns, including an inability to isolate exposure to solitary confinement, lack of specificity about variability and comparability in actual conditions of confinement, and the inapplicability of psychological assessment scales in the prison context [1, 20]
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