III. Supermax Prisons and the Psychological Effects of Isolation
Conditions at Camps 5 and 6 are in many ways akin to those at supermaximum-security prisons in the United States. (This also seems true for Camp 7, to the limited extent conditions at Camp 7 are known.) Prisoners in US supermaxes are generally held alone in small, often windowless cells with solid steel doors for more than 22 hours a day. Their opportunities for social interaction or other meaningful activity are dramatically limited.
Numerous studies have concluded that extended periods of detention in supermax-like conditions can cause significant psychiatric harm. The absence of social and environmental stimulation has been found to lead to a range of mental health problems, ranging from insomnia and confusion to hallucinations and psychosis. Stuart Grassian, a psychiatrist specializing in conditions of confinement who has evaluated hundreds of inmates in different prisons, warns that even inmates with no prior history of mental illness can become "significantly ill" when subjected to prolonged periods of isolation.
Predictably, the isolation common in supermax facilities has been found to produce a higher rate of psychiatric and psychological health problems than imprisonment in units where inmates are allowed group recreation, communal meals, and other regular interaction with each other.
This research has been cited by several federalcourt opinions warning of the negative psychological impact of isolation in prison. In 1995 a federal court examining the Security Housing Unit (SHU) of the Pelican Bay State Prison-a California supermax-found that "many, if not most, inmates in the SHU experience some degree of psychological trauma in reaction to their extreme social isolation and the severely restricted environmental stimulation in the SHU."
The SHU inmates were, according to prison authorities, "the worst of the worst" and represented the "greatest threat to prison security and safety." The inmates were confined to their 80-square-feet cells for 22½ hours a day. There were no outside windows, and the only natural light that filtered through to the cells came from a skylight in the area outside the cell door. Five times a week prisoners were given the option of spending an hour-and-a-half in a small exercise pen with cement floors, which had 20-feet-high walls and provided some access to fresh air through a roof screen. They could send and receive mail, but were not permitted to make telephone calls.
The court concluded that the severe deprivation of human contact and lack of environmental stimulation at the SHU "press[ed] the outer bounds of what most humans can psychologically tolerate" and constituted cruel and unusual punishment for those inmates who were already mentally ill or who were at risk for suffering very serious or severe injury to their mental health. As the court explained: "[I]t is well established that severe reduction in environment stimulation and social isolation can cause serious psychiatric consequences."
Other courts have similarly warned of the negative effects of isolating conditions of confinement, in which detainees are deprived of occupational and social stimulation.
It should be noted that prisoners held in high-security units at Guantanamo-none of whom have been convicted of a crime-in some ways endure even more draconian conditions than do convicted criminals housed in supermax prisons in the United States. For example, prisoners at the California SHU were able to leave their pods to go to a law library, where they were able to read in individual library cells. They were also allowed to buy radios and televisions for their cells, and could request counseling, prayer, or Bible study visits. Two-thirds were double-celled, and they were allowed visits from family members.
Even prisoners at ADX-Florence enjoy certain privileges that are denied detainees at Guantanamo. The country's only federal supermax prison, ADX-Florence houses convicted criminals believed to pose the greatest national security threats-men like Zacarias Moussaoui, the September 11 conspirator; Richard Reid, the would-be shoe bomber; and Ramzi Yousef, the terrorist operative responsible for the 1993 World Trade Center bombing; all of whom are serving life sentences.
Because these men have been determined to pose specific security threats, they are subject to what are known as "special administrative measures" on top of the regular restrictions that all inmates face. Yet, even they-like all other inmates in ADX-Florence-are provided televisions in their cell, which offer limited outside programming (including The Discovery Channel), as well as educational and religious materials that are broadcast over in-house TV channels. All inmates' educational needs are regularly evaluated so that detainees can be provided educational programming in accordance with their needs.
All ADX-Florence inmates, even those who raise heightened security concerns, are allowed one to two phone calls per month, in addition to legal calls. In fact, even those subject to special disciplinary measures are allowed a phone call every 90 days. All inmates-even those under special administrative measures-are also allowed up to five monthly visits by family members and friends, as long as the visitor has been pre-approved. Those subject to specific disciplinary measures are still allowed their monthly visits, albeit via non-contact video visiting. The contrast with policies at Guantanamo is stark.
 See, generally, Human Rights Watch, Out of Sight: Super-Maximum Security Confinement in the United States (New York: Human Rights Watch, 2000), http://www.hrw.org/reports/2000/supermax/; Human Rights Watch, Ill-Equipped: US Prisoners and Offenders with Mental Illness (New York: Human Rights Watch, 2003), http://www.hrw.org/reports/2003/usa1003/; Human Rights Watch, Cold Storage: Supermaximum Security Confinement in Indiana (New York: Human Rights Watch, 1997), http://www.hrw.org/reports/1997/usind/. Prisoners in some supermaximum security prisons are only allowed five hours of recreation time per week, even less than allowed at Guantanamo, and have even fewer opportunities for social interaction with other prisoners. A few supermaxes, however, hold inmates in two-person cells.
See, for example, Peter Scharff Smith, "The Effects of Solitary Confinement on Prison Inmates: A Brief History and Review of the Literature," Crime and Justice, vol. 34 (2006); Lorna Rhodes, "Pathological Effects of the Supermaximum Prison," American Journal of Public Health, vol. 95, no. 10 (2005); Brief of Amici Curiae Professors and Practitioners of Psychology and Psychiatry, Wilkinson v. Austin, 545 U.S. 209 (2005) (No. 04-4995); Jesenia Pizarro and Vanja Stenius, "Supermax Prisons: Their Rise, Current Practices and Effect on Inmates," Prison Journal, vol. 84 (2004); Craig Haney, "Mental Health Issues in Long-Term Solitary and 'Supermax' Confinement," Crime and Delinquency, vol.49, no. 1 (2003); International Psychological Trauma Symposium, "Statement on the use and effects of solitary confinement," Istanbul, December 9, 2007.
Stuart Grassian, "Psychiatric Effects of Solitary Confinement," WashingtonUniversity Journal of Law and Policy, vol. 22 (2006), pp. 327, 352-53.
 Smith, "The Effects of Solitary Confinement on Prison Inmates: A Brief History and Review of the Literature,"Crime and Justice, p. 456; Rhodes, "Pathological Effects of the Supermaximum Prison,"American Journal of Public Health, p. 1693.
Madrid v. Gomez, 889 F. Supp. 1146 (N.D. Cal. 1995), p. 1235.
 Ibid., pp. 1155 and 1227.
Ibid., p. 1228.
 Ibid., pp. 1228 and 1230.
 Ibid., p. 1230.
 Ibid., p. 1267.
 Ibid., p. 1232.
Jones'el v. Berge, 164 F. Supp. 2d 1096 (W.D. WI 2001), p. 1101 ("Confinement in a supermaximum security prison such as Supermax is known to cause severe psychiatric morbidity, disability, suffering and mortality [even among those] who have no history of serious mental illness and who are not prone to psychiatric decompensation (breakdown)"); Koch v. Lewis, 216 F. Supp. 2d 994 (D. Ariz. 2001), p. 1001 (noting that even the government's expert "agreed that extended isolation… subjects the inmate to heightened psychological stressors and creates a risk for mental deterioration"); McClary v. Kelly, 4 F.Supp.2d 195 (W.D.N.Y.1998), p. 208 ("[the notion that] prolonged isolation from social and environmental stimulation increases the risk of developing mental illness does not strike this Court as rocket science"); Ruiz v. Johnson, 37 F.Supp.2d 855 (S.D.Tex.1999), p. 907, rev'd on other grounds, 243 F.3d 941 (5th Cir.2001), adhered to on remand, 154 F.Supp.2d 975 (S.D.Tex.2001) (describing administrative segregation units as "virtual incubators of psychoses-seeding illness in otherwise healthy inmates and exacerbating illness in those already suffering from mental infirmities").
Madrid v. Gomez, 889 F. Supp. 1146 (N.D. Cal. 1995), p. 1229.
 Human Rights Watch telephone interview with Chris Synsvoll, legal office, ADX-Florence, Florence, Colorado, May 15, 2008.
 Ibid.; United States Penitentiary, Administrative Maximum Facility, Florence, Colorado, "Telephone Regulations for Inmates," Institutional Supplement, FLM 5264.07D, April 20, 2007, pp. 3-4; United States Penitentiary, Administrative Maximum Facility, Florence, Colorado, "Visiting Procedures," Institutional Supplement, FLM 5267.08A, March 5, 2008, p. 1.
United States Penitentiary, Administrative Maximum Facility, Florence, Colorado, "Visiting Procedures," p. 5.