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.

9 comments:

Dinah said...

My co-bloggers have blogging mania.

I wouldn't do well in solitary confinement.

Max is going nuts over something.

ClinkShrink said...

This really has been Clink week on the blog, hasn't it? Sorry about that. Then again, you may enjoy a break from writing once in a while. Eventually my inspiration will dry up and I'll disappear again for a couple weeks.

Sorry about Max. Does he need his godmother?

I was told to stop by your house and eat crab dip on the way home. I wasn't sure if you really expected me or if someone we both know just wanted me to appear unexpectedly on your front steps.

Romeo Vitelli said...

SHU syndrome sounds an awful lot like Ganser syndrome. Or maybe a specialized form of it.

therapy patient said...

My thought is that being in solitary confinement for many years could not possibly leave a person without effect. We are social beings. Many dogs isolated in kennels in animals shelters get "kennel crazy" after 4-6 weeks. Why would there any doubt that the same would happen to humans, and especially after many years. It is a cruel thing to do to human beings. I can see the necessity at times in prison situations to house individual prisoners separately, but there should be systemic reform that would reduce the amount of solitary confinement. Perhaps the criminals who are too young to mix with the general prison population could mix with each other, for example. To need a specific set of symptoms that gathered together represent a generic human's response to isolation rather misses the point. It is devastating to be isolated in a small space whether you are a criminal or a psychotic. There should be a LOT less of isolation in use.

mindful said...

I must say that I have enjoyed hearing more from Clink and Roy this week. It's not that I don't enjoy reading Dinah's posts but the other two shrinks bring different perspectives and different issues to the blog.

ClinkShrink said...

Romeo: Some people have speculated that it is.

TP: That's exactly my point. You shouldn't have to use science to justify humane care, mercy and kindness, and science should not be distorted to support non-scientific issues.

Mindful: Thank you.

Psychiatry101 said...

I have no idea about solitary confinement.
You three Shrinks really rock!Co-bloggers are must I guess, for long term blogging success.

Zoe Brain said...

Taking my own case... assuming I was incarcerated pending trial...

The Birth Certificate saying "boy", and the vagina etc is a bit of a problem. Add to that the need for various drugs to control the Congenital Adrenal Hyperplasia (and suspected Androgen Insensitivity too) and I have real issues.

Depending on the jurisdiction...

I could be put in with the general run of female prisoners. As I'm not streetwise in the slightest, this could lead to some problems, but no more than any other middle-class middle-aged woman suddenly put in jail.

Or I could be put in solitary, but probably with no privileges, essentially a punishment block. This is quite usual in many jurisdictions. I don't think I'd cope well, and hope that the resultant psychosis would be temporary. With library privileges though, writing materials etc this would be ideal. I would be a model prisoner.

In some jurisdictions I would be streamed with the general run of male prisoners. This may even be preferable to a featureless cell, it depends on the social setup within the jail. I've talked to some who had been in this situation, and as long as you can find a protector, it's no worse than forced prostitution. Or an "arranged marriage" if you like.

Unfortunately... it's also common to put such "at risk" prisoners as myself with other "at risk" prisoners, usually sharing the same cell with a number of sex offenders. It's generally assumed that people like me are prostitutes, or ex-prostitutes, so it's no great hardship. Here's a typical result:

December 1997. After an appearance in a Local Court, bail was refused and Ms M. was remanded in custody. Late on 22 December she was transported to a remand and reception centre where that night and into the morning of December 23 she underwent induction assessment. She was identified as transgender by the welfare officer and it was determined she should go into a “protection” wing. Having spent December 24 in court Ms M. spent December 25 and 26 in “strict protection”. During this time she was brutally raped at least twice during daylight hours. The attacks were so vicious that two other prisoners took the unusual step of reporting the incidents and giving sworn evidence. On December 27 Ms M. was found dead in her cell hanging by a shoelace.

From:
Inquiry into a death, Coroner J Abernethy, Wednesday 21 July 1999. Ref: W308 201/99 JI-D1.


Survive and HIV infection is pretty certain. Under these circumstances, suicide as soon as possible is a rational decision.

I find it... incredible... that when I travel to the USA, I have to do research on exactly how people like me are treated in different counties and states along the route, just in case. And modify travel plans accordingly. It's a bit like being Black in the 1920's. Some Law Enforcement officers are, well, sometimes not that bright, even if not prejudiced.

Dr. Pink Freud said...

I'm a firm believer that extended period of SHU confinement can affect both an I/M's mental (i.e., Axis I) presentation, and behavioral/interpersonal, (ostensibly, Axis II) presentation. With respect to I/Ms with APD, some inevitably use other's bad behavior as justification for acting out. "It's the guys that bang their doors and flood their cells that get what they want." To some extent, their observations mirror reality, because their is seldom continuity in the way I/Ms are treated both within and across shifts. Their change in presentation is more an adaptive (albeit, usually ineffective) mechanism designed to get what they want, and exert what little control they can muster in the least controllable area of the prison.

Other I/Ms will feign (i.e., malinger) affective or psychotic D/Os in order to gain access to medication, so they can "zone out" in SHU and sleep their time off. I have noted a particular tendency among Hispanic I/Ms to complain of anxiety, which further probing usually reveals to be a primary complain of what is, in fact sleep disturbance. This is a fairly uniform complaint across the Hispanic population, so I don't think it's due to the increased number of Hispanics in prison.

Lastly, their are the legit cases. These are more rare, and in my experience, there is usually some documentation of preexisting Axis I disturbance in these I/Ms. The SHU is the straw that breaks the camel's back. Often, they haven't been on meds for a while, again, suggesting the additional stress as a major factor. And, some I/Ms due actually develop some form of emotional disturbance for the first time while in the SHU, again, for some of the previously noted reasons.

Certainly, insanity is not contagious, but confine I/Ms to small areas, add in the discomfort associated with facing disciplinary actions, or even additional charges, stir is inconsistency in Tx. by the C.O.s, leave some I/ms in for extended periods of time with little or no info on why they're there, or when they're getting out, and let simmer. See what you get.