Dr. Terry Kupers: “Solitary confinement in El Chipote is torture, it is much worse than in US prisons.”

Forensic psychiatrist warns: "The purpose of the State is to kill prisoners, but they kill them leaving them alive without visible scars."

Terry Kupers, forensic psychiatrist, an expert on the health of prisoners in the United States | Photo: Courtesy

19 de septiembre 2022


The kind of solitary confinement to which four political prisoners --Dora María Téllez, Ana Margarita Vijil, Tamara Dávila and Suyen Barahona-- have been subjected for more than 460 days in the El Chipote jail, and the level of isolation in which at least 30 more political prisoners are being held "is much worse than in the prisons of the United States; it is torture," says the forensic psychiatrist Terry Kupers, an expert on the health of prisoners in the United States.

Dr. Kupers has testified more than 30 times in U.S. courts about the psychiatric and physiological effects of the system of confinement in U.S. prisons on prisoners, and specifically on those who have spent long periods in solitary confinement. He has assessed more than 500 prisoners who have been held in solitary confinement.

Professor Kupers has been a consultant to mental health centers and the US Department of Justice, and is the author of five books and several specialized reports on the effects of solitary confinement on the health of prisoners, among them: Solitary: The Inside Story of Supermax Isolation and How We Can Abolish It (2017), and Prison Madness: The Mental Health Crisis Behind Bars and What We Must Do About It (1999).

In an interview with Esta Semana, Kupers analyzed the situation of political prisoners held in isolation in Nicaragua in the context of international prison systems and commented: “First of all, there should be no political prisoners. There is no reason to put someone in jail for what they believe or what they say. There are other countries that do that and it is a great tragedy worldwide, but in Nicaragua the torture is more severe.”

How do you define solitary confinement in the US prison system or internationally?

By consensus, we've agreed that 22 or more hours in a cell, either alone or with a cellmate, with relative idleness, a lack of meaningful activities. Some solitary confinement situations are called segregation or restrictive housing units. In the United States, there are often lockdowns in prisons, when the prison is out of control and the authorities are trying to figure out what's going on and who is committing the violence. So they lock everybody in their cell 24 hours a day. It's very common in the US but it's not counted as solitary confinement by the authorities.

What are the main findings of your medical and forensic psychiatric evaluations of the impact of solitary confinement on prisoners in the US prison system?

I have interviewed and examined over 500 people. There are some symptoms that are just about universal. For instance, very high anxiety. People tell me that they have never been so anxious in their life, as soon as they're placed in a solitary confinement cell, and it builds over time. Panic attacks are very common. Severe insomnia. There are noises in these units –the clanging of doors, the footsteps of the guards– but there's also a lot of agitation and anxiety which keeps people from sleeping. 

There are disturbances of thought that often become paranoia. And that's because they have no feedback from anybody about their thoughts. So they have a thought, "Well, the guards are going to come here and kill me." And usually when we have thoughts like that –most people have paranoid thoughts off and on– but we reality test them with other people. If you're in a solitary confinement cell, you cannot reality-test, and therefore, the anxiety builds and you become paranoid. Also, compulsive acts [like] pacing, cleaning the cell, counting the cinder blocks are very widespread.  Despair: People feel even if they're only in solitary confinement for a limited amount of time, they feel that they're never going to get out and they're going to die. Their anger builds up. And it's an irrational anger. There's anger about being in solitary and the awful conditions. But the anger they feel is even greater than that. And people tell me that they can't control their anger and they're afraid they're going to get in trouble with the officers. 

Concentration and memory are big problems. I asked people, why don't you read if you're able to, if they give you something to read? And people in solitary tell me: "Well, I can't remember what I read the page or even the paragraph before." So it's no use reading. They have trouble concentrating. Suicide is very prevalent in the United States, and suicides in prison are much more prevalent than in the community at large, but 50% of prison suicides occur in a solitary confinement setting, even though maybe 5% of the population is in solitary confinement. Those are the main impacts. 

In the El Chipote jail in Nicaragua, there are four women political prisoners –Dora María Téllez, Tamara Dávila, Margarita Vijil and Suyen Barahona– who have spent more than 460 days in solitary confinement cells, just by themselves alone. None of them have ever had the right to communicate with others, or to read a book or to write. They are only taken out of their cells once a week to receive fresh air and sunshine for a few minutes. And they have only received family visits every 45 days. What can you say about the possible short- and medium- term impacts on their health of this kind of solitary confinement?

What you're telling me is just horrible. And the solitary confinement in Nicaragua that these women are subjected to is much, much worse than solitary confinement –mostly– in the United States, although solitary confinement in the United States is very damaging to human beings. But for instance, consider the door: if the door has bars on it, you can look outside, you can see the hallway, maybe you can talk to somebody in the next cell by talking out into the air. But if there's a solid door, you're even more in isolation. If there's no window to the outside, you're cut off from nature. And human beings need some interaction with nature. If it's cold, or it's hot, that makes the conditions worse. And particularly with these women, I understand that they're not permitted reading materials or permitted to write. And that's another extreme deprivation, which increases all of the symptoms and psychiatric disability that I've described.

There are more than 30 other political prisoners in Nicaragua who are also isolated in their cells, but with a cellmate. Some don't even have the right to talk to each other. They don't have access to books, very little access to fresh air and sunshine. Some are in very small punishment cells of two meters by two meters. What could be the short- and medium-term impact on their health in this kind of isolation?

You're describing torture. This is torture by all definitions. In the United States, there are space requirements. I think the requirement for a single cell is eight feet by 10 feet, so 80 square feet. By Court precedent, in the United States, prisoners in solitary confinement must be given five hours a week of exercise, of recreation. And generally, that's done five days a week, an hour in a recreation area. The recreation areas are none too good. They don't give them any equipment to exercise. They don't have enough space to exercise big muscles, but at least they get out of their cells for five hours. As I understand it, the [prisoners in isolation] are not allowed out of their cell, are not given anything to do in their cell, and then are not even allowed to talk to a cellmate. What we have found by research is that having a cellmate actually on average is no help: you still suffer the effects of solitary confinement. Sometimes if you have a simpatico cellmate, you're able to talk and that lessens the deprivation. But that the authorities don't even let two cellmates talk to each other? I've never heard of that kind of level of cruelty. All of these things would magnify the harm. So the psychological damage would be even greater and longer lasting.

Invisible wounds

You have described several cognitive, psychological and emotional impacts of isolation. How can you identify the damage and the wounds that are not externally visible?

They're not externally visible, but there are physical changes in the brain. And the body decays, and decays rapidly, so we can identify that. We have to actually talk to someone who's been in solitary to find out what's going on. Universally –and I've never met anybody who did not say this– their personality changes. 

People tell me that before being in solitary confinement, they were gregarious, they enjoyed social events, they sought out other people. But since being in solitary confinement, they have closed down, they've turned inward, they don't even enjoy talking to their [prison] neighbor, if they're allowed to talk to the [prison] neighbor, and in Nicaragua, they're not even allowed. They become a different person. 

If you talk a little about what's going on in their thinking, they will tell you that they've turned inward, they will tell you that they feel numb. Some people describe it as a zombie effect. That is, my theory, and I've written about this, is that people in solitary confinement work so hard to dampen the anger that springs up in solitary, because they don't want to get in trouble with the officers guarding them. So they work very hard to suppress their anger. As they suppress their anger, they really are suppressing all their other feelings at the same time. So they become numb, or they say "I feel dead." 

Lisa Gunther, a philosopher in the United States has talked about "social death", that in solitary confinement, someone becomes less than a human being. And this is, first of all, a long lasting and a very damaging effect. She says, "Although such people are physically alive, their lives no longer bear a social meaning, they no longer count as lives that matter." That is the purpose of the State, to basically kill people, but they kill them while leaving them alive with no scars visible.

In February of this year, one political prisoner, Hugo Torres, died in a hospital while in the custody of the jail police after he had spent six months in isolation. How dangerous is this prison system for prisoners' lives?

That's terrible, it's really a tragedy. He was murdered. He was tortured and murdered. And there's been some very good research in the United States that the morbidity –that is, the likelihood that someone will die within one year of being released from prison– is very much higher for people who have been in solitary confinement. There are physical reasons for that: you're in a cell by yourself, you don't get much exercise, you don't get aerobic exercise, the food is usually horrid. And so by all measures of physical illness, you become sick and you don't get good medical care, so you're likely to die sooner. But also, there's the psychological damage and a loss of a will to live. And so either suicide or just not caring after you've been broken down by solitary confinement leads to a much higher mortality rate.

Political prisoners and the Mandela Rules

Even with the cruel treatment and long periods of solitary confinement and isolation, all the political prisoners in Nicaragua declared their innocence in their sham trials. They have gone on hunger strike to demand the right to have a visit from their children, and they have become symbols of national resistance. Do political prisoners have or do they develop any intellectual or psychological resources that help them to endure long periods of torture and isolation?

Absolutely. We just lost a national hero in the United States, Albert Woodfox, who was one of the "Angola Three". Angola state prison in Louisiana is an old slave plantation that was converted to a prison. He spent 44 years in solitary confinement. Then he was released several years ago, wrote a wonderful book called Solitary, and he just died. And it's really a tragedy, he was in his early 60s. 

For political prisoners, there's actually a reversal of the symptoms that I've said. I’ve written: "The aim of torture is to destroy the individual's will, to break the individual down and obliterate a sense of autonomy and agency, thus turning that individual into a shell of a person who lacks the will to resist or even to be human in the sense that being human requires personal agency." [But] I have found an amazing number of political prisoners and political people in solitary confinement, and they tend to be the healthiest people in solitary. And they do things [because] you know that you're in a situation of torture, and you're going to be destroyed by it unless you do something. So they train themselves in discipline, they do physical [exercise], they do exercises for their mind, because they realize that if they do nothing, they're going to lose their mind. So they work very hard on staying stable. And for political prisoners, there's the understanding that "I'm here as a political act, as a repressive political act, to destroy me." And they vow, "They're not going to destroy me, I'm going to survive." It's the knowledge of what's going on socially. And it's the insistence on agency: "I will resist, and the people I know out in the world, including the public that I don't know personally, are going to support my resistance because this is wrong." And that kind of conviction tends to counter the destructive effects of solitary, not entirely, but it helps people stay stable and stay sane.

Are you familiar with the United Nations Nelson Mandela minimum rules for the treatment of prisoners? Do you have any recommendations for the families of political prisoners in Nicaragua or for human rights organizations and the international community about what they can do regarding the situations of political prisoners in Nicaragua?

Yes. First of all, there should be no political prisoners. There is absolutely no reason to put someone in jail or prison because of what they believe or what they say. That is just absolutely anathema to the democratic process. So there should be no political prisoners. The prisoners who are in prison, we have to first of all, release most of them. 

The Mandela Rules in the United Nations come from a worldwide campaign to end solitary confinement because it's torture. [Juan] Méndez, the special rapporteur for the United Nations on torture – recently he stepped down from that role –, but he said that any period in solitary confinement greater than 15 days, first he said it's a human rights abuse and a year later, he said it's torture. And I agree. And that is a worldwide consensus right now. The World Health Organization – in the United States it's the National Commission on Correctional Health Care which accredits jails and prisons– has taken the position that nobody should be in solitary confinement for more than 15 days. Several states in the United States have passed laws. California is now considering one that's on the governor's desk to end solitary confinement and to limit the time in a cell alone to 15 days. So there's an international movement. The Mandela Rules are very, very important in the United States. And obviously in Nicaragua, there's non- compliance with those rules.

Dr. Kupers, you have also been a consultant for Human Rights Watch and Amnesty International. Do you know of other countries where prison conditions like the ones we're seeing in Nicaragua –with more than one year of isolation and solitary confinement– are also happening?

Yes. There are countries that are known for it, for instance, the United States, which claims not to practice torture, that's actually not true. The United States tortures plenty of people. And solitary confinement is torture. The United States has more people in solitary confinement than any country in the world. But [also] countries like Egypt, Saudi Arabia, Russia. The United States sends political prisoners to those countries to be tortured, because of the fear that if the torture occurred in the United States, people would be upset by it, but if Egypt is doing the torturing, then they're not so upset. There are horrible situations in many countries. And I'm very upset to hear that this is going on in Nicaragua, where we for decades supported the Sandinistas to change this kind of repressive society. But in Nicaragua there is some of the worst solitary confinement in the world. 

Everything that I have said, as a basic standard, for instance, the eight foot by 10 foot cell in the United States, the five hours of exercise a week, is not done in Nicaragua. The conditions are much, much worse –the solid doors, the lack of a window to the outside– all of these things are more deadening to people. The torture is more severe. There are other countries that do that and that's a great tragedy worldwide. And I think, mostly, it's invisible. Mostly the public doesn't know about it. And that's why the oppressors are allowed to get away with torture. But I think the more that the people who are in that situation, including political prisoners, who are the leaders of this movement, make public the awful things that happen in public institutions in the name of the people, the more people are going to get upset about it and say “We can't let this go on.”


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Carlos F. Chamorro

Periodista nicaragüense, exiliado en Costa Rica. Fundador y director de Confidencial y Esta Semana. Miembro del Consejo Rector de la Fundación Gabo. Ha sido Knight Fellow en la Universidad de Stanford (1997-1998) y profesor visitante en la Maestría de Periodismo de la Universidad de Berkeley, California (1998-1999). En mayo 2009, obtuvo el Premio a la Libertad de Expresión en Iberoamérica, de Casa América Cataluña (España). En octubre de 2010 recibió el Premio Maria Moors Cabot de la Escuela de Periodismo de la Universidad de Columbia en Nueva York. En 2021 obtuvo el Premio Ortega y Gasset por su trayectoria periodística.


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