Wednesday, June 11, 2008

Leave Me Alone: Does SHU Syndrome Exist?

[Note: This is the second in a two part series discussing the effects of longterm segregation. The first part in the series can be read here.]

When you read legal opinions or listen to professionals talk about the psychiatric effects of longterm segregation you will sometimes hear them refer to something called the "SHU syndrome". The "SHU" stands for Special Housing Unit, another name for a control unit prison or a tier in a regular prison where inmates are kept in longterm segregation.

The commonly accepted definition of "syndrome" is a constellation of signs and symptoms that are common to all sufferers of a disease. Syndromes are validated by showing that the particular syndrome can distinguish between people who have the disease versus those who don't, and can distinguish one disease from others.

The SHU syndrome has had a variety of symptoms attributed to it, but they generally include some type of altered mental state, specifically changes in mood and cognition or orientation. It is presumed to be caused by the conditions of confinement in segregation. One of the earliest descriptions, and the one that probably gets cited most often by correctional experts and the judiciary, is in a 1983 article by Grassian,
The psychopathological effects of solitary confinement. He interviewed fourteen segregation inmates who had been confined from eleven days to ten months. These inmates reported heightened sensory acuity, affective disturbance (particularly anxiety), difficulty with concentration and memory, as well as illusions and misperceptions. All symptoms reportedly resolved within hours of release from segregated confinement. It should be noted however that all the subjects in this study were inmates who had filed a class action Eighth Amendment suit based upon their condition of solitary confinement. The author himself noted that he was required to “actively encourage disclosure of information” in order to obtain symptom reports, because the subjects initially denied problems. This aspect of the study is rarely (make that never) cited in legal opinions.

I could post a series of studies, using small sample sizes of actual prisoners, to detail things people have done to see if segregation actually does cause physiologic changes or changes in psychiatric symptoms, but that would basically end up being a tedious listing of article summaries (a big reason why my book chapter on the effects of segregation was never finished---I even bored myself!). The bottom line is that studies using control groups showed either no significant differences with controls, or only minor differences that disappeared quickly after removal from segregation.

If anyone really really wants me to post the draft of a book chapter I could but I'm not sure my co-bloggers would forgive me.

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Grassian, Psychopathological effects of solitary confinement, American Journal of Psychiatry 140: 1450-1454, 1983.