From The Michael Slate Show:

Interview with Psychiatrist Terry Kupers on the Devastating Effects of Prison Isolation

June 20, 2013 | Revolution Newspaper |


This is a transcript of a November 2012 interview on The Michael Slate Show (KPFK FM Los Angeles) with Dr. Terry Kupers, psychiatrist and expert on the psychological effects of prison conditions, including isolated confinement in supermaximum security units. He has pointed to a shocking increase in suicides among California prisoners subjected to solitary confinement in so-called Security Housing Units (SHUs). Dr. Kupers is Institute Professor at The Wright Institute and Distinguished Life Fellow of the American Psychiatric Association.


Michael Slate: What are you talking about there when you say solitary confinement pushes many prisoners to suicide?

Terry Kupers: It's really sort of the tip of the iceberg. What we've got is an imprisonment binge in this country. We've got almost two-and-a-half million people in prison. And they have not been able to build prisons fast enough, and building prisons isn't the solution, but what we get is a lot of crowding. Crowding causes an increase in violence, an increase in psychosis, an increase in suicide. And as a false solution, what I call a historic wrong turn in the '80s, when the population was already five times what it had been in the '70s, they started building entire prison units dedicated to solitary confinement. And these became known as "Supermax" prisons, in California, at Pelican Bay or Corcoran, or Tehachapi in Southern California.

Pelican Bay State Prison

So what happens is that people spend 24 hours a day in their cell by themselves with nothing to do. They have no activities. And they have very limited visits. That kind of conditions, considered torture in the international community and by the human rights groups, causes psychiatric symptoms. And one of the most serious, or the one that becomes public the easiest, is when someone actually kills themself. And we have an epidemic of suicide in the prisons. It's more than twice as frequent as it is in the community.

But in any prison system, and this includes California's Department of Corrections, 50 percent of the actual completed suicides, where someone dies, occur among the 6 or 7 percent of the population who are in solitary confinement. So it seems to me that makes it clear that solitary confinement plays a large part in causing suicide. And then we get this memo from the Director of the Bureau of Prisons, which is the federal prison system, to all of the inmates, telling them not to kill themselves, instead of, for instance, dealing with the conditions that cause people to kill themselves.

Slate: Just incredible and repulsive. I tell you. Terry, you once wrote that three months, just three months, giving people a sense of the impact of solitary confinement on prisoners' mental health, and the fact that this could roll over into suicide easily, you said that three months of solitary confinement can in fact mean lasting emotional damage. Let's talk about that a little.

Kupers: Yes, it's actually very impressive. I'm an expert witness in class action lawsuits, and I give psychiatric testimony, both about the mental health damage and about the conditions that cause damage. Solitary confinement—crowding is one such condition which causes psychiatric damage—but solitary confinement definitely causes a long list of symptoms, including anxiety, paranoia, problems thinking, problems with memory. And one of the main symptoms is despair. That what happens is, people in solitary confinement with no one to talk to and nothing meaningful to do, just lose all hope for the future. And they just think they're going to be in solitary until they die, and they make the choice that they'd just rather die now.

So they attempt suicide. The mental health care for people who attempt suicide is terrible. They're put in an observation cell typically, which is just a cell with a transparent side to it so everybody can see them. They're in there naked. And they're left there until essentially they cry "Uncle," and say, "I'm not suicidal any more. Take me back to my cell." Then they're taken back to their cell and unfortunately a large number of them do kill themselves.

Slate: You know, you just have to ask that question about what kind of system is this that would rely on this, this barbaric torture, as their means of rehabilitation. Clearly it's not rehabilitation. And actually one of the things that you said in an article that I read, that you wrote a couple of years ago, continuing along this line, you said that this solitary actually breaks prisoners down and practically guarantees that they will never function normally in society again. That's a pretty heavy statement.

Kupers: Well, and it's true. I mean, watch any of the rates that we measure: the recidivism rate—when people get out of prison they're most likely to go back, do a crime and go back to prison—or the parole violation rate. Both of those rates have been climbing precipitously in California over recent decades. And in the same period of time, what we've done is turned away from rehabilitation, even though the California Department of Corrections is called, "corrections and rehabilitation," very little rehabilitation goes on.

The Supermax prison sort of typifies the anti-rehabilitation concentration. It's just punishment. The worse and worse punishments, the more that people break down under the awful conditions. So a large proportion of the prisoners—6% to 8% of prisoners are in solitary right now, but actually most prisoners rotate through solitary and they'll do months or years in solitary sometime in their prison term. And then that makes them less capable of functioning, either in a program inside prison, like a rehabilitation program, if they're lucky enough to find one, and in the community when they get out. So that basically what's happening is our system is breaking people so that they'll never function again. This is especially the case with people with mental illness, which society has been kind of shunting into prisons for decades.

Slate: One of the things you make a point about in another article—you make a point about the direct connection between the increase in mentally ill people in prisons and jails, and the fact that there's more mentally ill people in prisons and jails than in psychiatric hospitals today, and you talk about the relationship between that and solitary and suicide. Let's talk about that a little bit. The system creates madness in prison, and exacerbates madness that already exists.

Kupers: You know, Michael, we have been disappearing people with mental illness. What's going on in the community, if you look around, there's very little in the way of public mental health services. In the '60s, with President Kennedy, we had the Community Health Centers Act, and there were public clinics where people who didn't have a lot of affluence could go and get treatment for their serious mental illness.

Over the decades since that time, the funding for public mental health, like all social safety net programs, has been diminishing, as has support for housing, low income housing and such. And what that's done is left people with serious mental illness, who tend to be the lowest income bracket, it's left them without services, without a place to live. A lot of them become homeless, and then for one reason or another, sometimes laws the city makes against panhandling or something, they get thrown into jail, and then eventually find their way into prison.

So what society has done is disappeared the population of people—those with low income who are suffering from serious mental illness—inside the prisons. And then the attitude is, "Lock 'em up and throw away the key." No one really pays attention to what happens to them in there. And I think people conveniently think, "Well, probably they're getting mental health care in prison." Well they're not. The budget for mental health care in prison is as bad or worse than it is in the community proportionately. And so they're getting very little care. And selectively, they get thrown into solitary confinement, because they don't quite know how to behave in such a way that you get on the good side of the guards. The guards don't know what to do with them, because they're a little unusual, and sometimes bizarre. So the guards end up punishing them, which is all they know how to do. They put them in solitary confinement. And in solitary confinement—there's very good research about this, or very frightening research—their mental illness get worse, and they're more prone to suicide.

Slate: Just amazing. I keep saying that because the more you talk, and the more I uncovered in reading your material—people need to investigate this and actually start giving a damn about what the hell is happening behind these prison walls. And one of the things, Terry, you talked about, and this really struck me because the movie The Snake Pit always stuck in my mind. And it seemed to be a point where people's social consciousness began to develop, or at least develop some consciousness of the horrors that were going on in supposed mental health hospitals. You talk about the conditions that prisoners are facing in jail now is actually worse than the kind of situation that was described in that movie The Snake Pit

Kupers: Well, yes, we've actually reproduced the conditions The Snake Pit was about. Erving Goffman was a sociologist, a sociologist of deviance in the '50s and '60s, and wrote a book called Asylums, which a lot of us sort of grew up on. In that book he describes a young man who is taken by his parents to a hospital because they think that he's crazy. He complains he's not crazy and he gets louder and louder protesting that he's sane. They take him to the emergency room and a psychiatrist hears him protesting and says, "Well, you're absolutely right. He must be crazy to be protesting so loud," and locks him up in the hospital.

The kid then gets increasingly inappropriate and angry and throws a chair through a window and they lock him up in a little solitary seclusion room. They take away his clothes and all writing materials. And in that seclusion room he starts smearing feces on the wall. And what Goffman says is that if you look at that, we are progressively taking away every human method of communicating from this young man. We're not listening to his protests. And he's becoming more and more extreme in his attempts to communicate.

Well that's exactly what's going on in the prisons today. And in these solitary confinement units, we have prisoners, grown men, smearing feces on the wall. And they're naked. They have nothing in the cell with them and they're left there for months alone. And the staff then say, "Well, they're manipulating to get out of solitary." They're being driven crazy by the conditions.

Slate: The excuse that's always given to the public in general is that, "Look, you don't understand. We are dealing with the worst of the worst. You want us to stop solitary confinement? This is simply punishment. This is simply behavior control. This is simply preventing the worst of the worst from unleashing massive amounts of violence in the prisons." What do you say to that?

Kupers: Well, we should have a longer discussion about that. It's absolutely false, and research is showing that. I was involved in a class action lawsuit the ACLU brought in Mississippi, where there was a Supermax prison at Parchman, Mississippi State Penitentiary: a thousand cells of solitary confinement. And in the course of the lawsuit, the Department of Corrections in Mississippi agreed with the ACLU and our experts that they had too many people locked up in solitary and they agreed to let them go. So they let 800 prisoners of the thousand that were in solitary confinement—released them into the general population.

Now, according to the logic that you just put forward, that is, that solitary confinement is necessary because they take care of the worst of the worst, one would think that if you released them out of solitary, the violence rate would go up, not just in that prison, but elsewhere in the system. In fact, the violence rate went way down, precipitously, when they released those individuals from solitary, in the entire prison system. And the individuals that were released received very few disciplinary infractions.

That's just one piece of evidence. There are many disproving the idea that this decreases violence. It actually increases violence, and not only at the time that people are put in solitary, but afterward, because eventually you have to let them out. And say a person has an eight-year sentence to prison. If they spend the entire eight years in solitary, at the end of the eight years, they're supposed to be released because the court only sentenced them to eight years,. Now they're coming out of prison having no social interactions, just angry exchanges with guards, and absolutely no meaningful activities for eight years. How well are they going to do out in the community, and how safe is the community going to be?

Slate: Exactly. I kept thinking about this. I read your piece about Mississippi and I thought that was extremely important, and that was one of the reasons I wanted to get into this question. And I kept thinking too, here we're talking about the prisoners unleashing violence. If you think in California—remember the way they set up the gladiator bouts between prisoners? And the intense violence that's unleashed on the prisoners by the guards themselves, including setting up things where people were actually encouraged to kill each other for sport. To me this is the kind of thing when you talk about that and then—and I have one more quick question. You kept mentioning that mental health doesn't exist in prison. What is the state? Let's just give people—we talked about all these horrors—what is the state of mental health care available to prisoners today?

Kupers: Well, there's a fallacy in public thinking about this, and that is that we think we have mental health services in prisons that we don't have in the community. The truth is, the mental health item in the corrections budget—corrections budgets tend to stay flat. That is, while everything else, including education and roads is being cut, the budget for corrections in the state budget process tends to stay flat. But actually what's happening is that the guards' salaries and the administrators salaries are going up, and the construction costs are going up, but if you check the item for mental health services within the corrections budget, it keep going down, approximately like it does in the community.

So there's less and less mental health services. And what you get in solitary frequently is a psychiatrist who's working very few hours. He's got hundreds of patients who are in a cell by themselves. He walks around to the front of the cell and says to the prisoner, "How are you doing? Are you hearing voices? Are you still feeling suicidal?" In prison there's a huge stigma about being weak or having a mental illness, so the prisoner is not going to admit to a psychiatrist standing at his cell door, "Yes, I'm hearing voices." So he's just going to nod him away. He's going to say, "Go away. I'm fine."

And so what happens is a prisoner essentially gets no care. The psychiatrist is coming to see if he needs to change his medication. The prisoner is refusing to talk to him because he'll be badly stigmatized and probably beaten or killed by other prisoners because he has a mental illness. So nothing happens in the way of mental health care. And that's approximately average.

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