The Systematic and Institutional Drivers of Abuse and Lack of Safety: Expert testimony on Isolation

These are transcripts from the hearings conducted in 2006 by the Commission on Safety and Abuse. Read the full report here.

The text on abuse and solitary confinement is a good example of what needs to be learned by those in powers in Nevada´s prisons and Ndoc.

Commission on safety and Abuse in America’s Prisons, Day 2:

The Systematic and Institutional Drivers of Abuse and Lack of Safety (July 19-20 2006): Expert testimony on Isolation

This panel addressed the forms of isolation, when it’s used and for whom, and the effects of living in isolation and working in an isolation unit. The panel also offered ideas about how to limit the use of isolation and how to create a safer and more humane use of this extreme form of confinement.

Dr. Stuart Grassian, Chestnut Hill, Massachusetts — A psychiatrist and former faculty member of the Harvard Medical School, he described the damaging psychological effects of prolonged isolation—what he calls the Security Housing Unit “SHU” syndrome.”

Fred Cohen, Tucson, Arizona — An expert consultant and court-appointed monitor in several states, he addressed the rise of isolation and the special case of the supermax prison and discussed why mentally ill prisoners often end up in isolation and its caustic effects on them.

James Bruton, White Bear Lake, Minnesota — Former warden of the supermax prison in Oak Park, Minnesota, and author of “The Big House: Life Inside a supermax Security Prison,” he discussed how he restricted the use of isolation—relying on it only for protection, never as punishment—and what he did to make that experience more humane and less damaging.


DR. GRASSIAN: Thank you. Thanks to the commissioners for allowing me to address you today.
I wanted to start by saying very clearly and very simply, the evidence is overwhelming and conclusive that solitary confinement, housing an inmate alone 22, 23 hours a day, in a small cell, with minimal environmental stimulation and opportunities for social interaction can cause and does cause severe psychiatric harm.

It’s also been, I think at this point, pretty clearly established that part of that harm is a very specific syndrome associated with these kinds of conditions of confinement which in its most severe cases can result in an overpsychotic state, agitated delusional, hallucinatory psychosis with great deal of confusional elements. Actually, it’s a form of delirium that can occur. We often think of delirium as being a product of an absence of adequate internal alerting systems, or particular activating systems parts of the brain not functioning properly, but for individuals who are deprived of an adequate level of external stimulation, the same phenomenon can occur, and the prison system is a particularly toxic environment for producing it. In one part, because prisoners who end up in solitary confinement are very commonly precisely the same group of people who are the most vulnerable 8 to getting these kinds of very severe psychiatric affects.

The prisoners who end up in solitary confinement tend to be affectively labile, labile, impulse ridden, people with poor internal controls. You very often see people with one or another sign of subtle central nervous system dysfunction, people who have had childhood histories of severe attention deficit hyperactivity disorder; these are the types of 16 individuals who are not going to be able to tolerate prison conditions very well, they are going to have difficulty and if the prison’s response is one of putting them in solitary confinement, you can predict, quite clearly, that they’re going to get sicker, they’re going to get more agitated and they’re going to, very often, be stuck in this vicious cycle where 23 the more agitated, the more out of control they become, the more the prison response is to put them in these very stringent conditions of isolation, for extremely long periods of time.

Fred was talking about the comparison between psychiatric seclusion and solitary confinement. Well, psychiatric seclusion, in most jurisdictions, there are very stringent controls on how long a person can be kept there with monitoring every number of minutes, psychiatric review every hour. And now we’re having a situation where people are being kept in solitary confinement and literally mentally rotting, becoming psychotic, paranoid delusional and they’re being kept there for years.

This is not just a problem with people who have had serious mental illness prior to incarceration. There are many people, documented cases, many documented cases of people who develop this very characteristic, psychiatric syndrome, associated with solitary confinement during periods of incarceration in solitary, people who had no prior history of serious mental disorder but had vulnerabilities factors, such as attention deficit disorder, central nervous system dysfunction, things of that sort.

So this is not — I want the commissioners to understand, I don’t think this is a question that’s open to debate. I have provided you with a very large statement on this issue, citing about 100 references in medical literature. This is a problem which has become a very important problem in a great variety of settings, not just prison settings. It’s become a problem that we identify with polar exploration, with concerns of NASA with space travel, submariners. It’s a problem that’s existed in a great number of medical situations, people in prolonged traction, people who have impairments of their sensory apparatus causing some degree of sensory deprivation, the same syndrome is described in all of these phenomena, and, as I said there’s a fairly extensive body of literature on it. As Fred mentioned, solitary confinement was, in fact, almost the exclusive mode of incarceration was the penitentiary began in the United States.

The penitentiary was a distinctly American invasion and it was initially begun in the early 19th 19 century as an element of great social progress and reform, a repudiation of punishment, an optimistic belief in the ability for people to change. People freed from the constraints of the evils of modern society being sent to a monastic cell with a bible and with work that they would naturally heal. It was a very open system, open to review, and the review was very clear and it was also catastrophic and the system eventually fell into disfavor. People like Tocqueville and Dickens and a whole variety of other people saw that system and spoke about it, wrote about it.

In 1890 the United States Supreme Court in a rather dramatic case commented specifically about the effects of solitary confinement in prisons.

Mr. Medley, there was a case — it was a case Mr. Medley had killed his wife in Colorado and he was duly tried, convicted and sentenced to death by hanging. In the interim between the commission of the crime and the trial and sentencing, the law in Colorado had changed. It used to be that prior to being executed, prior to being hung, you would be in the county jail for 30 days. The new law called for the person to be in the state prison in solitary confinement from anywhere from zero to 60 days prior to being hung. Mr. Medley claimed that he couldn’t
possibly be prosecuted under the new law because the hardship of zero to 60 days of solitary confinement was so severe that as an additional punishment to the punishment of death, it was too great, it was ex post facto. He also claimed, correctly, that Colorado legislature had made a mistake. When they passed the statute they didn’t have a bridging statute, a bridging clause that would allow your old statute to remain in effect, so you couldn’t be sentenced under the old statute that was no longer in effect, so he asked to be released. The United States Supreme Court ordered Mr. Medley to be released. They ordered the warden of the prison to bring him to the gates of the prison and release him because the additional punishment of zero to 60 days of solitary consignment was such an arduous, additional burden that they couldn’t possibly impose it.

They recognized in 1890 that solitary confinement had such a tendency to cause severe mental suffering and psychosis, it couldn’t be added to the sentence of death. And I just assert to the commissioners that we’ve come a long way downhill since 1890. Thank you.

MR. MAYNARD: Thank you, Dr. Grassian.

Mr. Bruton.
MR. BRUTON: Again, I also thank you and I’m honored that you asked me to come and speak to you.

I am a former warden, retired. I spent 34 years in the corrections business, not just in prisons, I spent a lot of time in institutions, I ran two facilities, and I also worked on the streets for years as a probation officer and was in our central office as a deputy commissioner, a member of the state parole board, and so I’ve seen inmates and criminals at just about every level in the institutions, as well as in the field and as well as in the juvenile end.

And I also teach in five colleges and universities and many of the things I’m going to say today I try to teach people coming into the business about a philosophy that Minnesota has had that’s worked, that’s been effective and is, clearly, the foundation of managing prisons in a proper fashion. Dignity and respect. I haven’t heard those words in — a whole lot today, I think I heard them a couple of times, but it’s something that’s almost forgot in institutions. The public certainly doesn’t want to hear it. The public is more interested in us continuing to punish people as they go to prison, they go down every day and I will embellish it a little bit, and poke people with a hot stick and make their life miserable so they won’t ever come back to prison, but they forget about what you’ve said many times today, that 95 percent of the people who come to prison get out some day.

I had a book that was published last year and a chapter in the book is called “With Dignity And Respect,” and it’s about the importance and the fundamental process of running a prison, whether it be a high security prison or whether it be a minimum security prison, inmates need to be respected and they respect respect and it works. And it’s not because we’re trying to molly coddle inmates or we’re trying to make everything wonderful for them or we feel bad
for them; it’s for two reasons.

Number one, it’s the right thing to do — actually, three reasons. Number one, it’s the right thing to do, the way you treat people.
Number two, as we mentioned, 95 percent of the people are going to get out some day, and, number three, we’ve got a lot of staff, a lot of good people that go inside those institutions every day and must be safe and you have to find a way to make them safe.

When I went to work every day managing Oak Park Heights as the warden, I walked around the halls and spent a lot of time inside that institution and one half of the people I walked by in the halls had killed somebody. 95 percent of the people had hurt somebody in their crime. And when you have a very distilled population like that, where half of the people that you work with every day have killed somebody and 95 percent have hurt somebody, you better find a way every day for them to get up in the morning and look forward to something positive or you got big trouble.

Now, when Oak Park Heights opened in 1982 it was really the prototype of the supermax
design. There really wasn’t anything quite like it. There had been a lot of things — institutions that have been formed off of it, but it’s certainly not as big as some of the larger institutions, like Pelican Bay and others that I have been to and toured through the years, but it set the tone for security, high security.

But what made a difference and what made — I think the count is something like over 50
foreign countries have now come to see, is not the security and not the control, because it’s all of that, in fact, I truly believe, and I’ve seen many of the high security prisons and Oak Park Heights, I believe, is the most secure institution ever built anywhere in the world, I truly believe that, especially with a newly designed unit that came on within the last couple of years, but they came to see how it’s managed. How you can not have a population locked down 23 out of 24 hours a day, how you can manage that type of population with the majority of the inmates out of their cells, because that’s the way it’s managed. Most of those inmates, high security inmates with that type of a distilled population are out of their cells most of the day and in a couple minutes I’m going to tell you the effectiveness of it and how it’s worked.

There’s some basic fundamental philosophies that seem to be forgotten in a lot of states around this country and it appalls me to come back and go to states where I see it done properly and to go to other states where no one seems to care. Satisfy the politicians in some states by locking people up and throwing away the key. Let’s build more prisons to incarcerate more people and find ways to keep them in their cells so they don’t hurt anybody, it’s just simply wrong and it doesn’t work. And in a second, as I mentioned, I’m going to tell you some things that prove that we have been effective. Now, I have heard all the of the things about, well, California is bigger and we have prisons as big as your whole population, and that’s very true and there’s some things that work in Minnesota that may not work in California and may not work other places, but the basic fundamental way of how you manage a prison and how you manage people does work and it is effective and it’s been very effective for us.

We have a responsibility, whether it be a high security prison or a low security prison, and maybe even more so in a high security prison, to create an environment conducive to rehabilitation for people who want to make a change in their life. Why wouldn’t we do that? Remember, 95 percent are getting out some day. If somebody wants to learn how to read, why wouldn’t we teach them? If they have a chemical problem, why wouldn’t we find a way to solve that chemical problem? You know, in our society we don’t go out and blame doctors who don’t cure cancer patients, unless they don’t give that cancer patient everything in the medical profession to try to ease their pain or solve their medical dilemma that they’re facing. We don’t do that. We shouldn’t go out and blame wardens for not rehabilitating people, unless that warden or administrator or commissioner doesn’t give that opportunity for a person to change, because I think we have a responsibility to blame that in our system. We have to create a safe and secure environment for people to live in every day, our staff and the inmates, and it’s absolutely essential and we have to do it, and dignity and respect is where it starts.

We’ve got to find a way for these people — and there are people who need to be locked up and should never get out, no question about that. There are people who need to be locked in segregation units, controlled and confined for long periods of time without human contact because they’re so dangerous that they will kill, and I have known some of those who have killed inside institutions, but they still need to have incentive-based programs, and when I mean human contact, I’m talking about being out with the general inmate population because they kill people, they’re just very dangerous and we haven’t found a way to stop that from happening, but they need the human contact.

When I was warden we developed a program in our segregation unit of the most secure prison in the state, and I think the most secure prison ever built, where we had volunteers from a program called AMICAS that came in and walked the cell blocks in segregation so that those inmates had an opportunity to communicate and talk with somebody that wasn’t wearing a uniform or a suit and it was a very effective program. It gave them something to look forward to, somebody to talk to. The people were screened, they were obviously trained and it was very effective.

And the training of the staff is something that’s extremely important as we get into these high security prisons. When you look at an inmate — I’m going fast because I have a lot of points that I want to make for you and I don’t want to run out of time if I can help it.

But when you look at some of the sentences that these people have, and they have no hope, I mean they look ahead at 30 years — I talked to a young man 17 years old, his first eligibility for parole he will be 47. That’s a long time. You better find a way for these people — and this was a very violent inmate — to get up every day and look forward to something positive.
I remember walking into a cell one morning, Saturday morning — and I spent a lot of time in institutions, a lot of time talking to inmates, a lot of time showing that we will respect them and I expected the same back from them, and, in most cases, I got it.

But I walked into a cell one morning when we were housing a long term federal inmate that had come to us. Oak Park Heights had one of the biggest contracts in the country, taking high
security, very dangerous and violent, high profile federal cases. And I walked into this cell on a Saturday morning because I hadn’t had a chance to talk to this guy when he first came in and I asked the officer, pop the cell door when I get down to his cell, and the cell door made a loud click. It was like 8:30 on a Saturday morning and inmates didn’t have to be at work and so forth. This guy had only been with us a couple days.

The cell door clicked and I walked in and this guy flew out of his cell with his fists clenched and he started to come at me and I backed up and I said, hey, hey, stop, what are you doing? And he said, well, who are you? And I said I’m the warden, I’m Jim Brutan, I just want to talk to you for a minute. And he backed off and I said what was that all about, after I calmed him down. And he said, Warden, I’m sorry, it will never happen again, but you need to remember that in other institutions that I’ve been in when somebody opened my door in the morning and I didn’t know who was coming, I was getting a beating or I was going to segregation or I was going in chains somewhere, and I have never forgotten that. Another inmate said to me one time — and I know inmates don’t always tell the truth, but sometimes it’s hard to make some of this stuff up, said to me thank you, Warden, for the way I was treated last night when I came in. I said, how were you treated? He said the staff put me in a cell and said good night, we’ll see you in the morning. I said, what’s so unusual about that? He said, the last place I was in the staff said where would you like your body sent if you are murdered here, and I have never forgotten that type of statement because that did set the tone for many of the involvement that
inmates had in the programs that they were involved in, or lack of programs. Incentive based program is important no matter what type of population you have. You may have inmates serving short term isolation in segregation for maybe 20 days, 30 days or whatever. You might have inmates in segregation serving a year or more for possibly a serious assault or you might have, as you’ve talked about, high security control type institutions where there is simply lockdown and in some cases they haven’t done anything wrong in institutions.

There are states in this country that lockup prisoners simply because they have a gang affiliation, whether they have done anything in the prison right or wrong, and I happen to think that’s wrong. And so there’s a lot of things that go on every single day in institutions around the country that are counterproductive.

Food, phones, medical and visiting. If you can solve your problems around food, phones, medical and visiting and you are on top of it every single day, you are probably going to have a fairly decently run prison without a lot of violence. I’m within my last minute so I am going
to really speed up here a little bit.

Institutions need to be managed properly and it starts at the top. It starts in the commissioner’s office and it starts with wardens and if there’s any erosion of any of four words and any of four actions that go around those four words, it’s honesty, integrity, credibility and trust. You’ve got to have it, you’ve got to be in those institutions every day, you’ve got to be talking to inmates and they’ve got to look forward to something. I know inmates that will never get out of control-type environments for the rest of their life and I don’t believe they ever should, but I also believe they’ve got to find a way that their good behavior is going to get them something positive; a visit, a magazine, a television set, or whatever it is, and it all goes along with the different type of confinement that they’re in.

I’m a very big believer in control and security, you have to have it, but it also goes with dignity and respect. And the last thing I want to say is I’m very pleased to be here and I hope sincerely, and I say this with all due respect, I hope this isn’t just another Commission. I hope it’s something that you really can do because this country is in sad shape when it comes to managing prisons. And I think we have to do it in and we have to do it right and we have to have influence upon your report. I think it has to have some monitoring, maybe some funds attached to it, there have to be fines, there have to be penalties and things have got to change in this country because we’re in pretty sad shape when it comes to how we manage high security prisons.
Thank you very much.

JUDGE SESSIONS: What did your peers in other states adopt or did they say about the Minnesota experience?

MR. BRUTON: Well, a lot of them think we’re crazy. A lot of them think that you can’t possibly take high security people that are management problems and not lock them up all day and have problems with them, but I have never had an institution warden or an administrator from another state come, tour the institution and come back and not say this is really something.
And we’ve given a lot of presentations to wardens and so forth around the country and been
supported by ACA when we talk about no drugs in the institution and they say — and the American Correction Association or the National Institute of Corrections will say he’s not lying, we’ve seen the documents, they don’t have a drug problem.

And so it’s a lot of very strong belief in a philosophy and a lot of good people through the
years that believe it, but I truly believe it’s in all of our institutions, it’s been very effective. I just am very saddened that it isn’t in a lot of the states. I’ve been around prisons a long time.
I’ve never been afraid, until I walked into some prisons in other states and then I couldn’t wait to get out because I was terrified, and that’s pretty sad.

JUDGE SESSIONS: Do you think those training manuals are available to the Commission?

MR. BRUTON: I’ve got two things I’d like you to look at. One is a manual of the American
Corrections Association put out a couple of years ago, it’s called “Supermax Prisons, Beyond The Rock,” I don’t know if you have seen that, there’s about eight wardens, I was one of them that wrote a chapter in there. I don’t agree with everything in there. I agree with my chapter, but most of it is really good. This is a very good document.

Another one came out last year by the American Correction Association called “Becoming A
Model Warden, Striving For Excellence.” A lot of this is about my friend Frank Wood, it was written by a professor from Northern Iowa University. I think you really need to see these documents, they’re very, very outstanding. And then, of course, you’ve got to buy my book, that’s called “The Big House.”

JUDGE SESSIONS: What about teaching manuals, are those available?

MR. BRUTON: Well, of course, the policy manuals in the institutions have been copied and modeled in many states, I don’t know how many have followed them through the years. They have been – I think they’re very, very well done and effective because of the accreditation process that has enforced that and so forth.

So I thank you for your comments.