you often see there is exactly the antithesis: they are very often the wretched of the earth, people who are mentally ill, illiterate, and cognitively impaired, people with neurological difficulties, people who just really can't manage to contain their behavior at times. The prison system tends to respond to this by punishment. Punishment tends to make their conditions worse and they tend to get into these vicious cycles where they continue to commit this disruptive behavior and they continue to go deeper and deeper into the belly of the prison system and get sicker and sicker. The courts have recognized that solitary confinement itself can cause a very specific kind of psychiatric syndrome, which, in its worst stages can lead to an agitated, hallucinatory, confusional psychotic state often involving random violence and self-mutilation, suicidal behavior, a lot of real agitated, fearful and confusional kind of symptoms.

L: Could it be said that, because of their lack of interaction with other human beings, that these people are incapable of seeing patterns in other people's behavior and are incapable of understanding what appropriate behavior is in order to elicit the desired response?

S: My best understanding is this: First of all, the social isolation itself, is going to then to lead to paranoia. That is one aspect of it. In fact, if you look at people who are, for example, hearing impaired, you find that there is a higher incidence of paranoia among that population of people simply because they can't read social signals. The person who is in solitary confinement is going to have an exceedingly difficult time understanding what's going on around him in terms of interpersonal interaction where there really is none. But I think that the most important level is the lack of an adequate level of perceptual stimulation. What we know is that, in order to maintain an adequate level of alertness a person needs some kind of level of external stimulation coupled with internal stimulation. If you deprive a person of either of these to a great extent, you're going to basically end up with an agitated, delirious, confusional, psychotic state. We've seen that obviously with people who have been overdosed on sedative medication. And we see it in conditions of perceptual or sensory deprivation, that people can really lose their capacity to maintain an adequate sense of relationship to their surroundings. They become confused, disoriented. There are a lot of perceptual disturbances, often hallucinations, very frightened, fearful kinds of experiences, eventually leading to this kind of agitated, impulse ridden, chaotic behavior. Very often, in fact, it is those kinds of behavioral disturbances which then lead to further punishment, further time in solitary. So once you get into this vicious cycle, you can't get out.

L: Let's assume for a moment that we have an individual who is dangerous to himself, to others as well. What would you propose then as an alternatlve to solitary confinement.

S: Well, first of all, you have to recognize that a lot of people who are really the most dangerous are people whose behavior is pretty calculating. These are not the kinds of individuals who generally end up in solitary confinement. They are smart enough and calculating enough to know when they are going to lose and they don't commit the kinds of infractions which cause them to end up in solitary confinement in these isolation settings generally. The people who do end up in those settings are often those whose dangerousness is the result of impulsive, chaotic types of behavior. These individuals, commonly, are those who have some type of psychiatric disturbance, whether it is a form of attention deficit disorder or some type of mood instability, affective instability which can respond to mood stabilizing medications. Many of these individuals have some subtle evidence of neurological dysfunction, whether it is manifested by seizure disorder or other forms of neurological illness. A number of those people actually respond very nicely to the anti-convulsant/mood stabilizing medication like tegratol, depracode.

There is really a large variety of psychiatric treatments which may be useful for this sub-population of people. The first thing you have to recognize is that what you are dealing with is a clinical problem that needs to be treated, rather than a problem which needs to be punished. If you look at it as a problem that's going to be responded to with punishment, you're basically going to make it worse. And that's generally what happens.

Now, in the prison setting, no matter how out of control you make people, and the prison setting makes some prisoners incredibly out of