Notwithstanding any minor differences, this review uses the terms ‘isolation’,
‘segregation’, ‘separation’ and ‘seclusion’ interchangeably with ‘solitary
confinement’, as defined above. It should be noted that in some health and
disability facilities, confinement occurred in a physical setting that included
more than one room, but in circumstances which still constituted isolation and
segregation from other patients and members of the wider community and the
usual routines of the facility. These circumstances have been considered for the
purpose of this review.
c. Seclusion and restraint: health effects and human
rights standards
Solitary confinement typically involves three elements: social isolation and
limited, if any, 'meaningful human contact' (as defined in Mandela Rule
44); monotonous physical environment, offering reduced access to sensory
stimulation; and, increased institutional control of all aspects of the individual's
daily life, affording them limited personal autonomy. As social beings, each
of these elements is potentially damaging to us. Together, they create a toxic
mix which has been shown by studies dating back to the 19th century to
adversely affect the health and wellbeing of those subjected to it. The reported
psychological effects of solitary confinement range from acute to chronic and
include anxiety, panic, chronic depression, rage, poor impulse control, cognitive
disturbances including poor concentration and confused thought processes,
perceptual distortions including depersonalisation and hallucinations, paranoia
and psychosis.4 Studies have demonstrated physiological symptoms and
effects too, including migraine headaches, heart palpitations, back and other
joint pains, gastro-intestinal and genito-urinary problems, excessive sweating,
insomnia, deterioration of eyesight, lethargy, dizziness, weakness and profound
fatigue, feeling cold, poor appetite, weight loss, diarrhoea, tremulousness and
aggravation of pre-existing medical problems. 5 Emerging research in the field
of neuroscience demonstrates that solitary confinement disrupts brain activity,
potentially leading to changes in the structure of the brain.6 Rates of self-harm
4
Shalev, S. (2008) A Sourcebook on Solitary Confinement, Mannheim Centre for Criminology: London;
Grassian S. (2006) Psychiatric effects of solitary confinement. Journal of Law and Policy, 22:325Ð383; Haney
C. (2003) Mental health issues in longterm solitary and supermax confinement. Crime & Delinquency,
49(1):124–156.
5
Shalev, S. (2014). ‘Solitary Confinement as a Prison Health Issue’. In: Enggist, S., Moller, L., Galea, G. and
Udsen, C., (Eds.) Prisons and Health: a World Health Organisation (WHO) guide to the essentials in prison
health (2nd edition), Copenhagen: WHO Regional Office Europe. pp27-35; Grassian S. (2006) Psychiatric
effects of solitary confinement. Journal of Law and Policy, 22:325–383.
6
Pappas, S. (2012) Mystery of How Social Isolation Messes with Brain Solved. Life Science, September 13,
2012.
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