By Bruce Western

A large social science research literature examines the effects of prisons on crime and socioeconomic inequality, but the penal institution itself is often a black box overlooked in the analysis of its effects. This paper examines prisons and their role in rehabilitative programs and as venues for violence, health and healthcare, and extreme isolation through solitary confinement. Research shows that incarcerated people are participating less today than in the 1980s in prison programs, and they face high risks of violence, disease, and isolation. Prison conditions suggest the mechanisms that impair adjustment to community life after release provide a more complete account of the costs of incarceration and indicate the performance of prisons as moral institutions that bear a responsibility for humane and decent treatment.

Journal of Economic Perspectives—Volume 35, Number 4—Fall 2021—Pages 1–27

By Keramet Reiter, Joseph Ventura, David Lovell, Dallas Augustine, Melissa Barragan

Objectives. To specify symptoms and measure prevalence of psychological distress among incarcerated people in long-term solitary confinement. Methods. We gathered data via semistructured, in-depth interviews; Brief PsychiatricRating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary filesfor 106 randomly selected people in solitary confinement in the Washington StateDepartment of Corrections in 2017. We performed 1-year follow-up interviews and BPRS assessments with 80 of these incarcerated people, and we present the results of our qualitative content analysis and descriptive statistics.Results. BPRS results showed clinically significant symptoms of depression, anxiety, orguilt among half of our research sample. Administrative data showed disproportionately high rates of serious mental illness and self-harming behavior compared with general prison populations. Interview content analysis revealed additional symptoms, including social isolation, loss of identity, and sensory hypersensitivity.Conclusions. Our coordinated study of rating scale, interview, and administrative data illustrates the public health crisis of solitary confinement. Because 95% or more of all incarcerated people, including those who experienced solitary confinement, are even-tually released, understanding disproportionate psychopathology matters for developing prevention policies and addressing the unique needs of people who have experienced solitary confinement, an extreme element of mass incarceration.

Am J Public Health. 2020, 7 p.