There are indisputable proofs that solitary confinement makes serious impact on health and well-being of people, especially before suffering mental frustration and that it can cause active development of mental disease. Degree of the caused psychological harm is various and depends on the individual factors (for example, personal vital circumstances and existing before problems with health), environment factors (for example, physical conditions of the maintenance and maintenance of prisoners), a mode (for example, time spent out of the chamber, level of contact with other people), an isolation context (for example, in the form of punishment, with a view of own protection, voluntary/non-voluntary, political/criminal character) and its durations.
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Despite distinctions concerning individual shipping and environment factors, and also the factors depending on the context of conclusion, in result of the researches concerning influence of the solitary confinement on the health within decades the surprising constancy is marked. They show negative influence of solitary confinement on health, and in insignificant number of rare researches in which it was informed the absence of negative consequences, and actually there was not any research in which positive consequences would be noted.
Wide application of a solitary confinement in prisons in the beginning of 19th century is well-known, and its consequences for prisoners have been in detail described in medical magazines of that time. Grassian and Friedman (Grassian and Friedman, 1986) quote thirty seven reports and articles published in Germany between 1854 and 1909, in which the solitary confinement is called as the unique major factor which has caused development of psychotic diseases among prisoners. Examples include the report of the head physician of prison of Halle, Germany for 1854, which observed that he named “a prison psychosis” among prisoners containing in isolation, and has come to conclusion that, “long full isolation has very harmful consequences for a body and soul and, most likely, contributes to hallucinations” and consequently should be immediately stopped (Nitsche and Williams, 1913). In the report for 1863 it is informed on bright hallucinations, delirium, a sensation of fear and the psychomotor excitation, noticed at 84 prisoners, suffering that its authors named “a solitary confinement psychosis”. In 1881 in a report of diagnostic inspections of 186 prisoners containing in the “branch for insane persons” of Waldheim Prison, also in Germany, has been specified that more than a half of prisoners had jet conditions connected with a solitary confinement (Grassian and Friedman, 1986). Similar results of supervision have been received in England, where in 1850 for example, 32 out of every 1000 prisoners should be translated from single chambers of Pentonville prison owing to insanity, in comparison with 5.8 prisoners per 1000 in the prisons which were not practicing a solitary confinement (McConville, 1981:208-9). In the USA the Prison Discipline Society, Boston, which took part in working out “separate” or “Pennsylvanian” solitary confinement systems, in 1839 informed of serious mental problems among prisoners isolated in single chambers, including hallucinations and weak-mindedness (Scharff-Smith, 2004). Some years later, referring to similar messages, the American Supreme Court has noticed that consequences of solitary confinement were that “considerable number of prisoners has run into a condition close to a condition of an embryo... And others have become violently obsessed” (Medley Case, 1890:167-8). Really, comprehension that solitary confinement instead of intent to treat for a “criminal illness” led to the development of mental diseases in the inmates, became one of the main reasons of dismantlement of isolation prisons in Europe and the North America by the end of 19th century.
Nevertheless, though large-scale application of a solitary confinement has stopped, this practice remained an integral part of prison systems, and as it has been noted above, in the last decade the solitary confinement use has increased in many jurisdictions. For many years researchers have continued to inform on the negative consequences connected with a solitary confinement, and results of their researches are amazingly similar to the results their colleagues received in the past.
Evidence of Prisoners
Researchers have found out that the prisoners, who are in a solitary confinement, often appear to be incapable to understand clearly their mental condition, are inclined to minimize their reaction to a solitary confinement and to underestimate any problems of mental health (Grassian, 1983; Haney, 2003). Such prisoners living in the conditions of isolation, most likely, have negative opinion of psychiatric treatment in prison and are reluctant to turn for help (Coid, etc. 2003 1:315). Problems of mental health are considered as a shame, in particular among Muslim prisoners, who are averse to asking for the help (Robbins et al. 2005). At inspection of the small center for the Muslim prisoners, detained according to the immigration law on the ground of national safety in Great Britain, for example, it has been established that five of eight prisoners had serious mental health disorders. However, very few people addressed for psychiatric help (Inspection of a place of holding in custody of "A" category in Long Lartin, HMCIP, 2007). Nevertheless, reports of the prisoners speak about variety of the extremely adverse consequences for health. The following data were received from interrogations, conducted among the prisoners in the conditions of isolation, or after their release from a solitary confinement. One of problems the prisoners in isolation most often mention is that it was difficult for them to distinguish a reality from their own thoughts, or they considered a reality so torturous that created the own invented world. Researchers explain that such cases take place because of the absence of external incentives that make the brain itself starts generating stimuli that is shown in the form of imagination and hallucinations. One of the researches of the prisoners who were in conditions of isolation for the period from 11 days to 10 months, revealed acoustical and visual hallucinations. One of the respondents described, how “the walls of cell start to shake... Everything in the cell starts moving; you feel that you lose the ability to see”. Others informed of acoustical hallucinations: “Suddenly I hear conversation of security guards. Did they say it? Yes or not? I understand nothing. Have I really gone mad?” Prisoners also informed of high sensitivity to noise and smells: “you become sensitive to noise. The plumbing system... Water rushes on the pipes. It is too loud and irritates me. I cannot stand. Food – I cannot bear its smell... The only thing I can stand is smell of bread” (Grassian, 1983).
Though most often psychological consequences prevail, physiological consequences are also mentioned. Some of them can be physical symptoms of psychological stress. However, the limited access to fresh air and natural light, in addition to the long periods of passivity most probably also have physical consequences. Grassian and Friedman (1986) inform of gastroenteric, cardiovascular and urogenital disorders, migraine and extreme tiredness. Other signs and symptoms, noted in some researches mentioned above, include:
- Tachycardia (sensation of strong and/or fast palpitation at rest);
- Panhydrosis (sudden perceptible and excessive sweating);
- Sight deterioration;
- Loss of appetite and weight, attacks of diarrhea;
- Apathy, weakness;
- Deterioration of health problems that existed before.
- Psychological consequences
Most widely mentioned consequences of a solitary confinement are its psychological consequences.
The following symptoms (from sharp to chronic) take place:
1. Alarm condition, starting from sensation of tension to the full-blown sharp panic attack:
- Irritability or uneasiness;
- Disturbing symptoms of panic reaction (panic attacks);
2. Depression varying from suppressed mood to clinical depression:
- Emotional flattening/dullness – the loss of ability to have any “feelings”;
- Emotional lability (frequent changes of mood);
3. Anger, varying from irritability to sharply expressed fury attacks:
- Irritability and animosities;
- Insufficient impulse control;
4.Cognitive disorder, varying s from lack of concentration to psychosis:
- Attention instability;
- Lack of concentration;
5. Perceptual distortions, varying from hypersensibility to hallucinations:
- Hypersensibility to smells and noises;
- Perceptual distortions (for example, the walls are closing in);
6. Paranoia and psychosis, varying from obsessive thoughts to sharply expressed psychosis:
- Obsessive and persistent thoughts (rumination) often of violent and vindictive character (for example, directed against the prison personnel);
- Paranoid ideas - often connected with prosecution;
International legal tools in the field of human rights define supervising principles and the minimum standards providing humane treatment of the prisoners. The daily running of prisons is subordinated to the interstate laws and prison rules which include detailed practical instructions. These instructions in all cases should correspond to the universal international standards in the field of the human rights, guarantee the humane treatment of the prisoners, maintenance them in healthy conditions and meeting the sanitary requirements. Surely, supervising bodies and courts pay special attention to the physical conditions in which prisoners held, and will definitely notice violation of human rights first of all there, where these conditions are below the minimum necessary standards.
In view of existing economic, legal and cultural distinctions between countries, Article 2 of the Standard Minimum Rules of the United Nations provides that standards “serve to stimulate a constant endeavor to overcome practical difficulties in the way of their application, in the knowledge that they represent, as a whole, the minimum conditions which are accepted as suitable by the United Nations”. In the General Comment ? 21, concerning interpretation that means that all persons deprived of liberty should be treated with “humanity and with respect for their inherent dignity” (ICCPR, article 10). The Human Rights Committee of the United Nations has expressed clearly and definitely that such treatment is basic and “cannot be dependent on the material resources available in the State party” (the General Comment ? 21, Article 10 of the Committees on human rights, of the International Covenant on Civil and Political Rights (44th session, 1992). That is to say, these minimal requirements should be observed, “even if economic or budgetary considerations may make compliance with these obligations difficult”.
Isolation in the single chamber causes harm to the prisoners who had earlier no mental disorders, and leads to deterioration of mental health condition of those prisoners who are already mentally sick. For this reason isolation in the single chamber in prisons should be kept to a minimum. In all prison systems the maintenance in the single chamber - in special cells or prisons – is meant for those persons who are considered as threats for safety and order in prison. However, irrespective of concrete circumstances and whether single chamber is used in connection with disciplinary or administrative segregation or prevention of collusion between remand prisoners, it is necessary to make efforts to increase the level of fruitful social contacts of prisoners.
It can be reached in different ways; for example, by increasing the level of contacts between the prison personnel and prisoners, by providing access to social activities with other prisoners, permitting more visits and organizing more frequent consultations with psychologists, psychiatrists, prison priests and volunteers from the local community. Particularly important are possibilities for maintenance and development of communications with an external world, including spouses, partners, children, other family members and friends. Besides, it is rather important to provide the prisoners of the single chambers with possibilities to be engaged in reasonable activities. The researches show that isolation of a small group of people under some circumstances may have similar consequences to the maintenance in a single chamber, and such modes should not be considered as appropriate alternative.
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