Part 2 of a Series

This two-part article was originally published on MindSite News. Part 1 examined a survey of solitary survivors about the mental health impact of isolation. Part 2 looks at elements of effective care and support for people who have experience solitary confinement.

Every year, thousands of people who have spent significant amounts of time held in solitary confinement in prisons and jails gain their freedom and reenter society. What do these solitary survivors say they need to adjust to life outside once they’ve been freed from both isolation and incarceration? And what kind of mental health services and supports are available? 

In a survey of 21 survivors, more than half denied receiving any meaningful mental health treatment after incarceration. Asked about the biggest challenge for survivors who want help, Deuce, who spent 22 years locked up in Virginia prisons, said it was public indifference towards the experience of incarceration. He compared the standards of treatment that exist for foreign prisoners of war to the absence of real “standards for our own people” incarcerated in American prisons and jails. People might see solitary confinement as problematic, but “until people see it as a crime, as torture,” Deuce doubts that those subjected to it will receive meaningful treatment. 

“Even if you scream at the top of your lungs, ‘Hey, I’m suffering from the effects of solitary!’ no one’s really going to take you seriously, minus the select few,” he said.

Asked how they would design mental health services for other survivors, many respondents described components of trauma-informed care. “The trauma of solitary confinement is not just about isolation; it is about the constant threat of harm,” said one of the survivors. The trauma is real, several said.

Although there is growing interest in trauma-informed reentry services, there is little attention to the trauma of solitary confinement. Solitary confinement is not even included as a traumatic event in the DSM-5, the diagnostic guidebook for mental health professionals in the U.S. Dr. Judith Herman, a professor of psychiatry at Harvard Medical School and a pioneer in the field of trauma, said that while many new clinicians are “hungry” for a deeper understanding of trauma, the trauma education they receive is largely inadequate.  

As a result, trauma-informed treatment for solitary survivors is limited.

To Herman, the DSM’s definition of trauma, which emphasizes violence, serious injury and death, “doesn’t quite take into account the situation of being under coercive control”—the kind of control that prisoners are subjected to. “Violence is only one of the tools of coercive control,” she said.  “One of the other most powerful tools is isolation of the victim.” 

Because people are social creatures, she explained, our sense of safety depends on connections with others. “So then when you isolate someone and deprive them of all sense of connection with other people, that also compromises a sense of safety. It’s a form of terror.” 

Making Connections Eases Impact of Isolation

In this climate, survivors have found some of the most powerful healing in authentic, empowering relationships with each other. Thirty percent of survey respondents identified peer support as a priority for solitary survivors. Michelle Ramos, who was incarcerated for 27 years in Texas prisons and spent seven of them in isolation, finds support in a group of women she first met while inside prison walls. They have since formed a justice advocacy organization. 

Ramos said she can be transparent with these women, even calling them to say things like: “If I was brave, I’d probably take my life right now. But I’m not. So all I gotta do is deal with the sadness and cry.” Her friends, she said, “just say things to remind me of who I am…that I’m a fighter.”

Rupa Khetarpal, a trauma therapist and professor of social work at Rutgers University who has worked with torture survivors, said torture disconnects people from themselves, and paradoxically, one of the best ways to reconnect internally is to connect with others. For Deuce, even connecting with survivors whom he never knew before has been helpful. The conversations “make me realize that I’m not alone,” he said, and sometimes give him hope that “there is a way out of this.”

But how can survivors access the healing power of relationships when talking to others is a monumental challenge? Shawanna Vaughn started by first connecting with animals. After her release from prison, Vaughn “was very broken” and “didn’t have any communication skills.” She knew she couldn’t isolate in her house forever, so, having grown up on a farm, she decided to start riding horses. “I tried to therapy myself that way.” she said. “Nobody will ever understand how empathetic a horse is.”

‘I believe in rituals and the dirt’

Vaughn, who eventually transitioned to talk therapy, has taken her experience and is pioneering a program to help other formerly incarcerated individuals recover through farming. “I believe in rituals and the dirt,” she said. If there “was a place in the wilderness I could take every incarcerated person, I would.”

Khetarpal and her team have discovered other nonverbal ways of creating connection. A jewelry making workshop, for example, began with torture survivors sharing a bowl of beads, which led to sharing designs; this then led to helping each other out and making things for each other. “And then they were talking to each other about their lives,” Khetarpal recalls. “Then they started talking about what happened to them…There was no talk therapy. We never even called it therapy.”

Among more than 34 torture treatment centers in the U.S., there is exactly one for survivors of torture that takes place on American soil. The federal definition of torture applies only to acts that occur outside of the U.S., so federal grants for torture treatment preclude services for individuals like Deuce, White and Ramos. In Chicago, however, city reparations have made such treatment available through the Chicago Torture Justice Center (CTJC).

Born nine years ago, CTJC describes its work as “politicized healing.”  It was founded using funds for reparations approved by the Chicago City Council for a particular era of police violence, but the center now serves anyone who has been the victim of violence or torture at the hands of police, ICE, or corrections officials. 

Mark Clements, the center’s senior community organizer, was arrested at age 16 and tortured to confess to a crime he didn’t commit. He was incarcerated in Illinois state prisons for 28 years—including stints in solitary confinement—until his conviction was overturned in 2009. Asked why he thinks officials have acknowledged police violence as torture but not solitary confinement,  he said the government has a double standard for incarcerated and free individuals. 

Politicized healing challenges this idea. Dr. Nate Gilham, who recently retired as the center’s clinical director, worked alongside survivor-advocates like Clements to integrate psychotherapy, re-entry support and advocacy. In a society where the prison population is disproportionately poor and non-white, Gilham believes that advocacy is a central part of the therapist’s work. 

“Imagine providing mental health support for people who are victims of apartheid,” said  Gilham. “It’s much broader than just counseling services. You’re dealing with many other systems that impact their mental health, and so just treating symptoms and providing diagnoses and treatment plans really does not address the issue.”

The Justice Center provides the kind of care that many survey respondents envisioned. Staff members show up for survivors at all stages of system involvement and incorporate multiple types of therapy, including peer support groups. Carl Williams, another survivor-advocate who now serves as CTJC’s community engagement specialist, found the center’s flexibility and creativity crucial to his recovery. 

When he first received services at CTJC, Williams and his therapist met for walks around the city, which reminded him that “you’re a free man.” Walking and talking, Williams explained, leads back to “functioning amongst and in the midst of the very society that has you closed off, or that you felt closed off to.”

When Traditional Therapy Isn’t Enough

To Williams, the therapy he received as a client was about “connecting from one human being to another”—not just applying knowledge from textbooks. He thinks traditional therapy—“just talking in this quiet place on someone’s couch”—can be difficult for survivors of solitary because it replicates the feeling of confinement. 

In Washington State, a program run by the independent nonprofit Collective Justice, helps incarcerated individuals heal from the trauma they have experienced and take accountability for the harm they have caused over 15 months of restorative circles. The program, Healing Education for Accountability and Liberation (HEAL), is not focused on solitary confinement, but it provides a unique example of meaningful trauma treatment in prison. Matthew Kama’aina is a facilitator for HEAL who spent five years in solitary confinement during his 15 years in prison. He first experienced the HEAL program as a participant and said that what he learned in that process helped him make sense of his experience in solitary.

Still, he is reluctant to talk about HEAL’s potential for helping other survivors because he fears doing so might make it “palatable” to hold people in solitary confinement. “I’m fearful (of) the way the system takes things, co-opts them,” he said. Officials might decide “we can have a hole; we’ll just go ahead and put people in this class before they get out.” 

The Hidden Impact of Isolation

Even when survivors are able to connect with a therapeutic community that gives them the safety, empowerment and authentic connection they need to heal, the healing itself is still painful. For some, it even feels hopeless. Several survivors suggested that while they may  learn to cope, they never heal from solitary confinement. 

Although they haven’t given up hope, neither Deuce nor Ramos has attempted more than one session of therapy. Neither felt like it clicked. But as he relearns how to express himself and open up, Deuce often volunteers to do interviews like this one. “They are therapeutic in their own way.” 

Ramos does not regularly do interviews, and when her community of friends arranged group counseling, she couldn’t bring herself to attend. Sometimes she thinks it was the social anxiety that stopped her and that she might be able to do individual counseling. But then she thinks she just doesn’t “want to get into all that”—the trauma, the anxiety, the impact of isolation.

Sometimes the pain of remembering trauma is too much. When Shawanna Vaughn progressed from self-guided equine therapy to more intensive talk therapy and “really, really, tapped into all (her) pain,” she tried to end her life. “I said, ‘This is overwhelming, and it’s too much, and I’d rather not exist.’” 

Today Vaughn is grateful that she survived her suicide attempt and continued to work through her trauma. She remains active in her own therapy and in advocating for mental health treatment for others, but she is honest with people about how much healing hurts. “Really healing,” she said, “was the hardest, worst moment of my life.” 

No one can truly know the depths of the pain that solitary confinement causes unless their body, mind and soul has been trapped within the isolation of those four concrete walls—in the prison within the prison. Survivors’ accounts tell us that the principles of trauma-informed care offer the building blocks for meaningful treatment. 

We have the knowledge and the tools to help people who have survived solitary. Now we need to make helping a priority.