Those who’ve experienced solitary confinement report lasting and debilitating effects from the isolation, and struggle to find programs to help them cope after release. At the same time, New York prisons are still isolating inmates.

Of the 36 years he was incarcerated, Nathaniel Jackson, 57, estimates he served 16 of those years in solitary confinement.

He remembers in detail the order of his stays in New York prisons; he went from Auburn to Clinton, Clinton to Great Meadow, Great Meadow to Wende, and on. He had four separate stints in Clinton Correctional Facility alone, three in Great Meadow, two in Auburn.

And he remembers each of his stays in solitary. His longest consecutive stay, he says, was four and a half years. He also did three and a half years, two and a half years, eighteen months at a time. Usually it was for a disciplinary violation, but sometimes he was put into “administrative segregation,” ostensibly for his own protection.

When he was released from Shawangunk Correctional Facility* in August of 2019, he went directly to New York City Human Resources, where he applied for emergency money and food stamps. Then he was sent to an intake homeless shelter, the 30^th Street Men’s Shelter, notorious for its dilapidated conditions and violence. After a few weeks he was sent to a homeless shelter in Brooklyn, at 1312 Atlantic Ave., where he remained for more than six months.

Like many who serve long periods in solitary, Jackson is reckoning with more than just material problems—mentally, emotionally, and socially, he’s been struggling with the long-term effects of extreme isolation. In a few months after his release, his relationship with his wife had dissolved, and he is going through a divorce. Because he lives in New York City, which is more resource-rich than less populated parts of the state, he has been able to find some help, commuting from the  shelter to therapy in downtown Brooklyn four days a week. But finding therapists who can relate to his plight is difficult.

“I catch panic attacks, I catch tremors,” Jackson says, sitting on a park bench in Brooklyn, crowds walking by. “Even sitting here, this feels funny.”

Post-incarceration, Jackson found himself in a common situation for those who’ve been through solitary, with few resources available to help them cope despite the mental health-related disabilities that result from the experience. City Limits could not identify state-funded resources in New York specifically diverted for solitary survivors, who suffer from a unique set of pathologies. At the same time, New York is still isolating people in prisons — including those with serious mental health issues — despite the efforts of advocates who’ve been pushing for years for laws to curb the practice.

Jackson receives therapeutic counseling through a non-profit called Bridge Back to Life, but the group therapy sessions are for people who are experiencing substance abuse, some who have caught DWI’s and are there for court-mandated sessions. He sees a one-on-one counselor on Fridays, but he doesn’t expect them to understand his experiences.

“How can they relate? I can’t even relate,” he says.  “I’m trying to understand this as it goes.”

Anxiety and isolation

The long-term impact of solitary confinement on the mind has been understood for well over a century. In 1890, the Supreme Court acknowledged the harm, observing that some subjected to it, “became violently insane; others, still, committed suicide; while those who stood the ordeal better were not generally reformed, and in most cases did not recover sufficient mental activity to be of any subsequent service to the community.”

More recently, the UN’s Special Rapporteur on Torture declared in 2013 that “if the resulting pain or suffering are severe, solitary confinement even amounts to torture.”

Evidence of early morbidity is also growing: A study published in 2019 out of North Carolina showed that people held in solitary there were 24 percent more likely to die in the first year after release from incarceration than someone incarcerated who spent no time in solitary. The highest risk increases were for suicide, homicide and opioid overdose, which solitary survivors were a staggering 127 times more likely to die from within two weeks of their release.

While no specific diagnosis is sanctioned by the American Psychiatric Institution for solitary survivors, Dr. Terry Kupers, author of “Solitary: The Inside Story of Supermax Isolation,” coined the term “SHU Post Release Syndrome” for the unique constellation of mental illnesses that befall survivors. “I have never before found a pattern at this level of specificity described so universally by a group of similarly situated individuals,” Kupers writes.

Dr. Stuart Grassian, an expert on solitary confinement, has interviewed hundreds of people who experienced solitary and found symptoms including panic, delirium, hallucinations, extra-sensitivity to sights and sounds, and self-harm. In nearly every case, Grassian says, the person had not experienced those symptoms before solitary.

Solitary may produce tangible, physical harm to the brain as well, though no brain imaging has been produced. Kupers has hypothesized, based on lab experiments on mice conducted by earlier researchers, that extensive isolation causes deterioration in the myelin sheaths which coat the axons of cells in the frontal lobe, where cognition and judgment are processed.

Jackson, who suffers from panic attacks and anxiety stemming from his confinement, has fared better than some. Despite a discomfort with fast movements, he is able to stand in crowds and can leave his shelter for therapy sessions if he needs them. He says it helps to tune out everything but the one thing he’s focused on.

But many aren’t so fortunate, and are faced with crippling anxiety. Grassian says that the panic and anxiety are a result of the restriction of stimulation prisoners experience during solitary, which causes a hypersensitivity to small stimuli that they become obsessively fixated on.

“People can’t tolerate noise, the hustle and bustle of life,” he says. This also results in a lack of tolerance for social stimulation, which in turn makes people increasingly isolated.

“You find people who were gregarious individuals, they just can’t be with other people,” he says. “They find themselves isolating, as though they are reproducing confinement by hiding.”

In the absence of real-life stimulation, some people turn inward and rely on their imagination to remain stimulated instead. While he was in prison, Jackson imagined all the family on the outside whom he missed: his children, mother and family. Once released, he had to deal with the reality that those relationships were frayed as a result of his incarceration, and the lasting effects of solitary made it harder to interact with people he cared about.

“That’s another rude awakening I had to come to realize: I don’t know nobody, even my family,” he says. “They don’t know me and I don’t know them.” He was told by a member at a group therapy session that he likely didn’t know his wife well, and vice versa, which he didn’t want to believe at first. Jackson met his wife when he was younger, but they became involved when he was incarcerated and went on to have a child while he was locked up. When he came home, the arguments began. Jackson was overly sensitive to small questions and scoffed at having to reveal where he was going, what he was doing— something he associated with the tracking and controlling of his movements while in prison.

“Nobody has a relationship, everybody is f–ked up,” says Five Mualim Ak, a solitary survivor who now runs support groups for formerly-incarcerated people. Many of them, he says, have trouble maintaining relationships because of the constant panic, self-isolation and deteriorated life skills that stem from their solitary experiences.

Kupers says this “decimation of life skills,” is common among people who’ve experienced solitary.

“It’s not only the isolation, it’s the idleness,” Kupers says. “Human beings need to be involved in productive activities.” People in solitary only interact with other people briefly: an officer dropping off a food tray, or talking to another person through an air vent. The lack of interaction gets people out of the habit of relating to others, Kupers says.

“You lose social skills, you lose the ability to interact,” Jackson agrees.

The desperation for human contact is so great that people have been known to self-harm in order to get the attention of guards. Sometimes being accosted by a guard is the most interaction they are going to get for the day.

For Jackson, that need to interact with others was so great that he once woke up in solitary and told a guard he needed a hug. “I’m a social being, I need to interact with someone,” he told the prison’s superintendent, who he says laughed at him at first. The administrators requested a psychiatrist to see him, and he repeated the request.

“I’m a social being, you see anything wrong with that?” Jackson asked her. “Quite frankly no,” Jackson said she responded.

A week or two later, he says, he was told he was now permitted to take pictures with loved ones during the one visit he was allowed each week, something typically not permitted in solitary, where visits are usually contactless. While he didn’t understand at first, he thinks the change was at the prompting of his psychiatrist — a loophole meant to allow him some physical contact.

A lawsuit, a loophole and lagging legislation

Jackson spent his 36 years in New York State’s prisons, the result of a murder and related gun charge conviction which he admits to and says he regrets, describing the violence as senseless. “I didn’t value my own life and so I didn’t value some else’s life,” he says.

The state prison system uses its own labyrinthine categories of solitary, and its use is subject to fewer regulations compared to New York City jails. In the state’s system, people can be held in Special Housing Units, or SHU, a small cell where they are kept for 23 hours a day with only one hour of out-of-cell time. SHU cells have solid, as opposed to gated, doors, and only a small slot to see outside, which can be closed by guards. SHU punishments are meant only for the most severe disciplinary infractions, according to the state’s Department of Corrections and Community Supervision (DOCCS).

Another type of confinement in state prisons, called Keeplock, is meant for less severe infractions, but the conditions are similar. People are still kept inside a cell for 23 hours but are permitted to keep their personal belongings. Confusingly, Keeplock sanctions can be served either in dedicated Keeplock cells, in general population cells or in SHU cells. When these ostensibly less severe punishments are served in SHU cells, the most restrictive by design, every two days served counts for three days within DOCCS’ system.

In 2012, the New York Civil Liberties Union (NYCLU) sued DOCCS over its use of solitary. The lawsuit, Peoples v. Annucci, ended in a court-ordered settlement in 2016 which curtailed the use of solitary for petty offenses, limited the length of stays and provided administrative options for early release into the general prison population. Prior to the lawsuit, the average stay in SHU was five months, and 20,000 people were placed in SHU for six months or more between 2007 and 2011. Since the settlement took effect, the average stay has been reduced to 105 days, according to data given to NYCLU as part of the settlement.

But DOCCS’ porous categories for solitary have allowed it to circumvent the spirit of the requirements. While the use of SHU punishments decreased by 2,400 incidents per year thanks to the settlement, it was made up for by the use of Keeplock punishments, NYCLU’s data found. In fact, according to NYCLU’s report, “when taking Keeplock sanctions into account, the total number of disciplinary solitary sanctions has actually increased, from 37,600 in 2015 to 38,249 in 2018.”

The state’s regulations also lag when it comes to those in the most severe states of mental decomposition. In city jails, people who are diagnosed with a serious mental illness, or SMI, can not be kept in solitary. In New York State’s prisons, however, they can be kept in SHU for 30 days before they must be transferred to a rehabilitative mental health treatment unit. Of those who received SHU punishments in 2018, 7 percent had an SMI, as did 9 percent of those punished in Keeplock. Combined, this meant a total of 3,142 people with SMI were in solitary throughout the year. More broadly, 32 percent of those in SHU had any kind of mental health need, as did 36 percent of those in Keeplock.

In an email to City Limits, DOCCS spokesperson Thomas Mailey said the department “is proud of the significant progress made since it entered into a multi-year agreement with NYCLU in 2016,” including reforms not stipulated by the settlement, such as a monthly review process for reducing Keeplock time. As of Dec. 1, there were 287 people serving Keeplock in all of DOCCS’ facilities, Mailey said.

Mailey said DOCCS has instituted more changes that would be published in the coming weeks, including allowing five hours daily out-of-cell time for those serving Keeplock (he did not say if this would pertain to those serving Keeplock in a SHU cell.)

“The shift from SHU to KL should not have been unexpected to NYCLU as through negotiations a number of disciplinary infractions were no longer eligible for confinement in SHU,” Mailey added.

A bill called HALT Solitary has been floated at the state level for years, and would greatly limit the use of solitary, including banning the practice for people under 21 and over 55, and capping stays for all forms of isolation at 15 days. It would also ban the practice for those with a mental health disorder or any other kind of disability. The Democrat-controlled Senate and Assembly have yet to put it up for a vote this session, even after a year of uprisings against police violence. In 2019, when it seemed likely to pass, Governor Andrew Cuomo said he would veto it, arguing the state couldn’t afford to construct new facilities to house inmates in lieu of SHU.

Advocates disagree, saying the bill would save money: A report released this month by the non-profit Partnership For The Public Good estimated that the HALT Solitary Act could save the state $132 million annually by closing existing solitary wings in prisons, which have dedicated correctional staff. It estimated that the state would save another $32 million associated with the other costs that come with solitary, including lawsuits against the state and increased recidivism stemming from the prolonged effects of isolation.

The union representing the state’s correctional officers opposes the legislation, saying the changes to SHU would lead to increased violence in prisons. A similar debate is currently underway on the city level, as lawmakers debate a bill, introduced by Councilman Daniel Dromm, that would end the use of solitary confinement in New York City jails.

In lieu of HALT’s passage last year, Cuomo instead introduced an executive order to limit the practice to 90 days in 2021 and 30 days by 2022, well over the 15-day threshold that the U.N. report calls torture. DOCCS has proposed its own, much less rigorous regulatory changes instead of the HALT bill, which would still allow people with mental illness and other protected categories to be put in isolation. Even those changes have yet to be implemented and may not go into effect until 2023.

Some co-sponsors of the HALT bill are hopeful it could pass in the upcoming session.

“The real travesty is we already solidified a majority base that’s willing to vote for this and pass it,” says Jerome Wright, an advocate with the Campaign For Alternatives to Isolated Confinement (CAIC), which has lobbied for the bill.

Wright is himself a survivor of solitary, saying he spent an aggregate seven and a half years of his prison sentence in isolation. He says he still finds himself withdrawing and needing to isolate to recreate the conditions of solitary, something that was initially difficult on his marriage.

“She couldn’t understand, and I didn’t understand all the ramifications,” he says.

Few resources for survivors

While prisons produce immense trauma even without factoring in solitary, the state’s use of severe isolation has amplified the mental health crisis on the outside, experts say, and there is no support geared specifically for solitary survivors as they return to their communities.

Neither Correctional Health, which monitors mental health in city jails, nor the NYS Office of Mental Health, which does so in state prisons, makes any indication in their discharge planning that the person being released has spent any time in solitary. DOCCS says it does keep records of the amount of time a prisoner has spent in SHU, but this doesn’t factor into discharge planning.

One of the few state-funded programs that may yield some specific, contextual support for survivors of solitary is the peer-specialist program run by the New York State Office of Mental Health. The program is not restricted to the formerly incarcerated — peer specialists are one-on-one counselors who have directly experienced a range of mental health and substance abuse issues. After completing certification courses, they are paid directly by the state, rather than a hospital or other intermediary, to meet with people in person, on the phone or online, as has been the case since the COVID-19 outbreak.

The idea originated as part of the community mental health movement in the 1960s. In 1963, President John F. Kennedy passed the Community Mental Health Act, intending to deinstitutionalize mental health, closing psychiatric institutions and bringing care under the direction of community members at mental health centers. Those mental health centers were never fully funded, though psychiatric beds at hospitals were largely emptied.

Funding for peer specialists increased with Cuomo’s 2011 Medicaid redesign. While the program is not specifically geared for solitary survivors, it includes them among its ranks.

Marty Gromulat is a peer specialist who aids other solitary survivors in New York, having spent several months in solitary while serving time in prison while in Arizona— the result of a mental health episode at a community pool that led to nine separate charges, which he pleaded down to four. He was released with three years probation, then moved to New York to live with his mother, who suggested he look into the peer specialist program.

He completed the state’s training and currently deals with a caseload of four or five people at a time who are survivors of solitary confinement. Most of his clients come to him as a result of referrals, typically a loved one calling an agency, like the National Alliance for Mental Illness, for mental health help. But it can be a difficult task for those just coming out of prison to locate and connect with services like his.

“You don’t even know what resources are available,” Gromulat says. “You have to find, and apply to those resources, you’re starting off in a really bad position.”

The most common problems he sees in people after solitary is the loss of basic life skills.

“You lose some of those social skills because you haven’t done it in months or years,” he says. “I know for me, it was a struggle to go to a supermarket, I didn’t want anybody to see me or look at me.” Even picking up his medications was a chore.

Talking to peer specialists helps people, he says, along with group therapy and medication. But he says no one is ever fully recovered from the trauma of solitary. “Healing is a tough word,” Gromulat says. “I would say people are making progress, positive progress.”

The benefit of the peer specialist approach is that it keeps lines of communication open with very isolated people, which is vital for those who have been in solitary. It keeps them in the practice of interacting with others and processing what they’ve experienced, both important for survivors.

“The most important thing is just having somebody listen to them, having somebody to talk to. When you’re in solitary all you have is your thoughts,” Gromulat says.

Need for new programs

Critics of the peer specialists program, however, say it’s sometimes used for people with severe issues who would be better helped by more comprehensive services. It’s unclear what a formal program to deal with the impact of solitary would look like. Stuart Grassian, one of the experts on solitary, says he doesn’t know of any existing form of therapy to address the specific needs of survivors. Helping to erase the stigma and deal with the shame of diminished social skills would help, as would perpetually reaching out to people so that they don’t self-isolate. He’s cautious in appraising the chance for healing. “I’m not sure it’s always going to be successful,” he says.

For Jackson, acknowledging or articulating what happened to him in therapy does provide some kind of reprieve. “They’re making me aware of certain things, and it’s good to know what I’m going through,” he says. “To some degree, I tried to deny it.”

Advocates and survivors agree that the mental health needs of formerly-incarcerated people are generally treated as secondary, and often, people are over-prescribed medication in lieu of more thorough diagnoses or therapy.

“If you go to a clinic, they don’t have staff for individuals for psychotherapy. Instead they prescribe medications,” Kupers says.

One thing that could help are support circles for survivors. Mualim-Ak participates in one such group, part of a program at the New School called the Institute for Transformative Mentoring. The program is meant to provide both healing and professional development in the form of training “credible messengers”— anti-violence mentors who were themselves caught up in the criminal justice system. The Institute trains messengers to work at social service nonprofits throughout the city.

Program assistant Benjamin Wilson, who was himself incarcerated for 25 years, says that while the group doesn’t specifically focus on solitary confinement, many members have experienced it, along with other traumas that occurred before, during and after imprisonment.

Wilson experienced solitary for several periods during his own time behind bars, the longest of which lasted a year, he says. Like many other survivors, he says the experience left him hesitant to interact with other people. Wilson says that many people who come home from prison often have trouble acknowledging their struggles—those who have trauma or mental deterioration from solitary will rarely admit it, let alone seek help.

“That’s like a needle in the haystack,” he says.

Those who come home after incarceration face other, more tangible challenges, like housing, with some immediately ending up in homeless shelters that can mirror the restrictions of prison.

That is where Jackson has spent the bulk of his time since his release. Even as COVID-19 swept through New York City’s homeless shelters, Jackson remained, first in a dormitory city-run shelter where people smoked K2 and shot dope around him, against shelter regulations, he says.

He tried to isolate from other shelter residents, both to protect himself from the virus and because of sensory overload, which can be unbearable to someone who has spent long periods in solitary. “I begged them to put me in the corner, I isolated myself to try to create some form of privacy,” he says.

Jackson was eventually moved over the summer to a hotel being run by the city’s Department of Homeless Services, where he has been for months, doubled-up in a room with a stranger. He says stable housing would do wonders for his mental health. “Part of my therapy is being in my own place,” he says.

He awaits a voucher, called a shelter allowance, that the city pays to help people find housing. But in the year since his release he hasn’t received it. He has applied for disability, based on the mental issues he acquired in solitary as well as other illnesses. His application was initially denied, he says, but he was told it’s normal to get denied twice.

Jackson still attends his group therapy sessions, and checks in with a group of formerly-incarcerated people once a week over Zoom. He is taking classes through the state’s Access VR program to provide support to others. But his mental health, despite his considerable work and effort, is tenuous, he says.

He is still able to pursue connections with family, something he doesn’t take for granted. He is in touch with his three daughters and with his grandchildren, but has chosen not to describe the conditions of the shelter or its effect on his mental health, so as not to worry them.

He says he’s still not sure that he’ll ever feel healed from his experiences in solitary.

“I would like to think I’m normal, but when you look at it, I ask you, I did 36 years. I did 16 years in the box,” he says. “Am I normal?”

This work was supported by a grant from the Solitary Confinement Reporting Project, with funding from the Vital Projects Fund.

*An earlier version of this story misstated the name of the prison Jackson was released from in 2019. It was Shawangunk Correctional Facility, not Auburn. The story has been updated.