By Terry A. Kupers, M.D.

House Bill 3564, mandating limits to solitary confinement in prisons, jails and immigration detention facilities, has passed the Illinois House and awaits passage in the state Senate to become law. There is a growing national consensus, joined by the American Psychiatric Associated and the United Nations, as well as Presidents Obama and Biden, that solitary confinement is a gross human rights abuse and causes severe psychological damage.

The Illinois Bill grew out of a campaign by Anthony Gay, who spent 22 years in solitary confinement, to make certain that others are not forced to undergo the kind of torture he suffered. Writing letters from solitary helped Mr. Gay maintain a semblance of emotional stability but only after, alone in his cell, he repeatedly cut himself. Self-harm of this kind, more an attempt to alleviate the extreme anxiety bred of solitary confinement than it is an explicit suicide attempt, does not occur often in adult males. It is a worrisome problem in adolescent girls. But it is epidemic in prison solitary confinement units. Instead of recognizing Mr. Gay’s self-harm as the potentially fatal psychiatric crisis that it is, prison officials punished him with more time in solitary. The scars are visible on his arms. Mr. Gay explains, “It wasn’t something that I wanted to do, but it became a survival mechanism for me,… because psychologically, I couldn’t stand it – so the physical pain would alleviate the psychological pain.” Released from prison in 2018, Mr. Gay set about campaigning for a law limiting the use of solitary confinement.

HB 3564, like laws passed in Colorado, New Jersey and New York, is an important step toward the creation of a correctional system aimed at rehabilitation rather than harsh punishment for punishment’s sake. Solitary confinement causes great human damage, and actually does not have any benefits. After thirty years that have seen the construction of supermax solitary confinement units in 44 states and the federal system, the rate of violence in the prisons remains high and gang problems continue unabated. In solitary, relatively stable prisoners evolve very debilitating psychiatric symptoms, including massive anxiety, problems with thinking that too often takes the form of paranoia, great difficulty with concentration and memory such that prisoners report they no longer even try to read because they cannot remember what they read on the previous page, severe depression, mounting anger, and compulsive repetitive acts including pacing, counting and cleaning, and self-harm. Prisoners with serious mental illness evidence exacerbated mental illness.

As a psychiatrist, the most disturbed patients I have ever examined are prisoners I encountered in solitary confinement settings. Suicide and self-harm are epidemic in solitary confinement because of the despair the isolation induces. Fully 50% of suicides in jails and prisons occur among the 3% or 5% or 8% of prisoners in solitary confinement at a given time. Possibly the worst damage done by solitary confinement is the long-term harm, the large number of people who leave prison after years in solitary and fail to re-integrate into their families, fail to succeed in work, and eventually have to return to prison.

Widespread solitary confinement grew out of a historical wrong turn. In the 1980s violence was out of control in the nation’s prisons. There were riots and there were many deaths. Correctional authorities threw up their hands in dismay. I was among the experts who recommended downsizing the prison population because the crowding that was occurring by the 1980s is known to correlate with high rates of violence, psychiatric breakdown and suicide. And we advised re-invigorating rehabilitation programs that had been shut down or downsized out of fear of “coddling prisoners.” Correctional authorities rejected our advice and said the real problem was the bad apples among prisoners, “the worst of the worst,” and they would proceed to build entire cellblocks or prisons dedicated to solitary confinement. That is when the human damage really accelerated.

The alternative to solitary is healthy and educational programming including mental health treatment, vocational training, and rigorous educational programs. Rehabilitation must be the core of the mission of correctional departments. We have evolved an expertise in peacefully removing prisoners from solitary confinement and transferring them to the programs that will alleviate the behaviors that got them in trouble with the law.

HB 3564, the Isolated Confinement Restriction Act, also known as the Anthony Gay Law, limits the use of solitary confinement in prisons, jails, and immigration facilities by requiring everyone be allowed out of their cells at least four hours a day. If some individuals need to be kept in a cell for more than 20 hours per day, that can only last 10 days in any 180-day period. It is time to greatly diminish the utilization of solitary confinement, and many more states and the federal government need to pass laws like Illinois’ HB 3564.