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Bonus Episode: The Psychology of Solitary

Our interview with Dr. Terry Kupers delves into mental health and prison, specifically, the extreme conditions of isolation in solitary confinement and the effects of these conditions on the human psyche. This interview is by no means meant to compare what we are experiencing in quarantine with the extreme conditions that one experiences inside correctional facilities—let alone solitary confinement. However, it is meant to give us some perspective, help us better understand a bit more about the human condition, and perhaps give us a new lens with which to understand ourselves, each other, and systems in our society that need reform.

Sasza
Terry, thanks so much for joining us in this time of what people had been referring to as ‘social distancing’. But now, are referring to more frequently as physical distancing. So, to begin, I would just love you to give our listeners a bit of background on the work you do. And a couple of the more universal lessons it has taught you about who we are as humans.

Terry
Well, first of all, it is very good to be here with you. I am a psychiatrist and I do general psychiatry. I have a practice. I have recently retired from my office practice. I work in hospitals, I do community mental health. As one aspect of my work, I serve as an expert witness, often in class action lawsuits. That is, all of the prisoners in a jail, or a jail system, or a prison, or a prison system sue, because of a violation of their rights. Either the Eighth Amendment Cruel and Unusual Punishment, which is supposed to be prohibited. Or the Americans with Disability Act, because there is a huge proportion of prisoners with serious mental illness. So, they are entitled to disability treatment and I testify as an expert. In doing so, I tour the prisons. And lately, the last 15, 20 years that has focused on solitary confinement in prison. The reason for that is that solitary confinement has been used widely in the United States, in jails and prisons, and it causes a great amount of psychiatric damage.

So, I go into solitary confinement units, I interview a large number of prisoners and I assess the damage and come and tell the court about it. Then the court decides whether there is an Eighth Amendment violation. Part of that work, I publish, reports on my work. I have to keep prisoners anonymous. I cannot violate the confidentiality, or the privilege connected with a lawsuit. So, I make the cases anonymous, but I report on my cases. And I have written several books. The last being, ‘Solitary’, which the subtitle is, ‘The inside story of supermax isolation and how we can abolish it’, by the University of California Press. There, I summarize a lot of my experience and my conclusions from that experience.

Sasza
And what would you say are some of the biggest conclusions? Perhaps some of them are obvious, but one of the more surprising ones might be from that book and that compilation of your work?

Terry
Well, the turn in this country towards solitary confinement in jails and prisons occurred in the late 1980s. What was going on was there was a tremendous amount of violence in the prisons and they were basically out of control. There were hunger strikes, there were riots. So, I, and a number of experts in this field said to the powers that be, you have really made a mistake crowding the prisons. The first issue was crowding. We had quadrupled the prison population in very few years, in the 1980s. And a lot of that was because of the war on drugs. And we suggested that the sentencing reform occur, so that we could downsize the prisons, and then they would be manageable. At the same time, rehabilitation was being cut. All of the education programs and vocational training programs were being dismantled. So, you had a whole lot of idle prisoners crowded together.

And the result was a lot of violence, a lot of mental breakdown and a lot of suicide. And so, we recommended you should uncrowd the prisons by doing sentencing reform. And you should reinstate the rehabilitation programs. Well, correctional authorities did not listen to us, they said they had another idea which was that the violence was due to some bad prisoners. What they called the worst of the worst or the super predators. And they were going to lock them down even further, inside prison. And that was the advent of the supermax prison, which was a whole prison or a cell block, dedicated to solitary confinement. You have rows upon rows of prisoners in single cells, behind metal doors, often, and very little activity in the common spaces in these prisons. The hallways are practically empty. The yards actually, are little areas, not much bigger than a cell where the prisoner is supposed to do recreation by themselves.

And sure enough, people in those circumstances started to fall apart. And the damage was obvious. When I first started touring these places, I found some of the worst cases of psychosis and depression I had ever seen in my entire career. Even if people did not have a serious mental illness, and a lot of people did not become mentally ill, but they were damaged in less obvious ways. Anxiety was pervasive, very severe anxiety, panic attacks, et cetera. Difficulty thinking, the thinking process was distorted, and often it meant paranoia. And then, there was trouble concentrating. There were big memory problems. So, that a lot of prisoners in solitary confinement around the country, told me that they have stopped reading. And I would say, why do you stop reading? It seems to me if you are in a cell by yourself, it is the only thing you can do. And they would say, yes, but I forget what I read the page before, and it just becomes chaotic.

Despair was very widespread. People became depressed. Suicide occurred incredibly often. The suicide rate in prison is approximately twice what it is in the community at large. But 50% of successful suicides in American prisons occur among the three, or five, or 7%, of the prisoners who are in solitary confinement, at any given time. So, suicide is a very, very big problem. I think there is a causal relationship and that creates a mental health crisis in our prisons, which goes on to this day. So, in all these ways, all the prisoners in solitary confinement are damaged. People who have a mental illness, for instance, schizophrenia, bipolar disorder, or major depressive disorder, their mental illness is exacerbated. And that is what I mean when I say I saw some of the worst cases of serious mental illness that I had seen in my entire clinical career.

Sasza
Yes. I actually wanted to ask you, when you go in and talk to these people who are under such extreme amounts of stress, I think most of us can only very lightly, theoretically imagine what it is like. But I would love for you to kind of paint a picture of what it is like talking to somebody there. Because on one hand, I wonder if they try and cover up their feelings, or play tough. How much they reveal to you? How raw and authentically you are able to really get a perspective on where they are at and their struggle?

Terry
Well, that is a very good question. Typically, I get a very clear picture of what happens for them, both their daily routine, that their immediate experience and their thoughts about the whole process. I am an expert for their attorney. In other words, the prisoners, as a Class, are suing. In most cases, I do other kinds of cases too, but in the large cases it is the Class Action Lawsuit about all of the prisoners. They tend to be very intelligent. I think that there is a selective process by which very intelligent prisoners are overrepresented in solitary confinement. And I think that is because the staff, particularly the correction officers are intimidated by them. They are so intelligent. So, a staff member will criticize them for breaking a rule and they will say, I know that rule and it says such and such, and my action was not a violation. The next thing that happens is the officer hits them and throws them in solitary confinement.

It is not about the breaking of the rule, because they are often correct, that they have not broken a rule, and the officer is wrong about that. Rather, it is about intimidating the officer with their intelligence. In any case, a lot of people in solitary confinement are very intelligent. They are often self-taught, because they dropped out of high school before winding up in prison. And they have read a whole lot of material, and they can have very intelligent discussions with me. So, first of all, they trust me because I am working for their lawyer, or they know of my work. A lot of prisoners have read my books. So, when I come to see them, they say, well, I like what you are writing and here is what it is like for me. So, there is a kind of trust and honesty that develops and I think I do get a true picture. In contrast to the prison psychiatrist, in prison there is a lot of stigma about having emotional problems, or having a mental illness, or being suicidal.

So, prisoners on average clam up. They do not talk to the health and mental health staff. They do not trust them. They think that they tell something to mental health staff, the officers will learn about it and they do not want that to happen. Or, other prisoners will see that they are getting mental health treatment and then they will be stigmatized. Often they will be victimized, beaten, raped, et cetera. So, they tend to hold everything close. And then when I come in, it is like a relief, because they understand the confidentiality of our interaction and they also know which side I am on, in the lawsuit that they are involved in. So, there is an immediate trust. So, I get a pretty good picture of what is going on inside.

Sasza
And could you just to exemplify it or humanize it a bit, maybe just describe one case, or a moment, or a quote from someone that that impacted you in one of your hundreds, if not thousands of interactions with prisoners over the years?

Terry
Well, I have had well over a thousand interviews with prisoners. And I will give you an example. First of all, prisons are a window into our race dynamics in this country. And almost 50% of prisoners are African American and another 20 to 30% are Latinos. So, there is a great racial disproportion. People of color are overrepresented in prison and there are complicated reasons for that. At every step along the way in the criminal justice process, there is discrimination by race, so that black Americans are more likely stopped by the police and frisked. When they are stopped, they are more likely arrested. Whereas, a white counterpart might be released to their own recognizance at home. A black individual is going to be taken to jail. In court, they are going to get a more severe sentence. And then in prison, a greater proportion of them are going to end up in solitary confinement.

Terry
So, I met a black man who was about 40, had been in solitary for nine or 10 years, and this was in a Western maximum security prison. And I asked him what happened? How did he get here? And he said, well, I broke a rule. I admit it. I broke a rule. I was someplace I was not supposed to be, and they punished me with a term in solitary. I said, well, what was that term? Then he said, six months. And I said, well this is nine or 10 years later, why are you still in solitary? He said, I do not think I am ever going to get out of here. Now, this is a very stable, intelligent man. He is not seriously mentally ill. And he said, I do not think I am ever going to get out of here. And I said, why not? And he said, when you are in solitary, your anger builds up and it is irrational. You do not know why your anger is building up. Of course, you are angry that they put you in a hole, a cell by yourself. But that is a certain episode and you get over that. Instead, in solitary you keep getting angrier, and angrier, and then, one day it has to happen. You try very hard not to get in the wrong way with a guard, but one day you just get angry at them and you blow up, and then they write you a ticket. The result of the ticket is a longer term in solitary. So, that has happened to me over and over again. I admit I cannot control my anger in here. It just mounts and I do not know what to do about it. Now, I should mention that maybe 70, 80% of the prisoners in solitary that I have interviewed, have told me that exact thing about mounting anger.

It is a symptom of solitary confinement, but instead of treating it as a symptom, as part of the damage that solitary does. What the criminal justice system does, especially officers in prisons, is they punish people for getting angry. So, they give them a longer term. So, here is this man who is in solitary for nine or 10 years, has not really done much wrong. He has not been involved in any kind of violence. He has not made any serious rule violations, and yet he is stuck in solitary, he thinks for the rest of his life. And because of that, he despairs and becomes very depressed.

Sasza
You mentioned in the beginning that he was an intelligent and basically sane man. I just first want to acknowledge that I think there would be a 0% chance, I would be any semblance of sane, after one year, let alone and a decade. And so, really going into the resilience, but also not just the fact of having been there for so long, that I think could drive someone to some point of insanity. But that feeling of the unknown, of being trapped there and not knowing how long it will last. And I think obviously, again on an extremely small scale, we have no idea when the quarantine is going to end. When this physical distancing will will end. And I think that unknown is what gives people a lot of anxiety. But just trying to imagine that exacerbated on an unimaginably large scale. And so, I would love to talk a bit about how much of these situations are about the individual versus the circumstance. And first, by relating it to how perhaps it is not as much about the individual, as it is about all of us, and just a different and very wide range of experiences, and stress that we are put under.

Terry
Well, I think that is all very important. I want to make a distinction first, that solitary and confinement in prison is a whole other magnitude of damage, psychologically. The prisoner has absolutely no control over his life. Things are being done to him or her, and a solitary is sort of the worst of it. Or, although, a lot of prisoners die because they are beaten to death by officers and such.

Sasza
In the prison, they die from being beaten by the officers?

Terry
Yes, I have come across many cases of that. And it is often because they stand up for themselves. In prison you are supposed to be compliant, and the officers demand total control over the prisoners. If the prisoner talks back to an officer, I give the example of the prisoner being correct about what is in the rule book, and defending themselves and saying, I did not break a rule. The rule is such and such, I did such and such. And using logic, the officer is very likely to beat them. And the beatings can get pretty vicious, particularly if a prisoner does let his anger get the best of them, and he attacks an officer. A whole bunch of officers are going to swarm in and really beat him. And I have seen a lot of people die in that kind of situation. So, the extremity is just a whole other order of magnitude in the prison we are not experiencing out here.

Yes, it is true, sheltering in place is a form of isolation and it has a lot of negative effects potentially. Also, there are a lot of ways we can counter those negative effects. And in a lot of ways we can learn from prisoners in doing that. But we should not equate sheltering in place with solitary confinement in prison. The prisoner has absolutely no options. Their solitary confinement requires them to be almost entirely idle. Many do not have any television or radio. Some do not even have writing material. They get no exercise, because the exercise yard is just another space about size of their cell and there is no exercise equipment. So it . is an entirely different experience. I have described it as the decimation of life skills. That is when you spend a long time in a cell by yourself with really no meaningful communication with anyone. The correction authorities say, well, the officers communicate with the prisoners. That is really not true. The officers bring a food tray and pass it through a slot in the door, but they do not really have any meaningful communication with the prisoners. So, the prisoner is totally isolated, almost totally idle. Now, that said, and recognizing the qualitative difference and the degree of deprivation difference between sheltering in place and solitary confinement, there are similarities and you have mentioned several already. One of the things I think it is worth noting, and Dr. Craig Haney has described this in an [inaudible 00:18:59] in the San Francisco Chronicle recently. Is that prisoners work out ways to survive their isolation. And we could look at what they do and learn something. I will give you an example. I mentioned that a very widespread symptom in solitary confinement in prison is a inability to concentrate, and a memory problem. I have met a lot of prisoners who tell me that is absolutely true. That happens to them. Their memory is shot and they cannot concentrate. But they continue to read and what they do is, they take notes either in the margin of a book, or on paper as a guide to them. When they read a little further and they want to look back, and gather what they’ve already read so they can make sense of the current page they are reading. That is a wonderful tactic. It is a kind of work habit. It is a discipline that we would like people in school to learn, for instance. So, the prisoners who are successful at doing intellectual work, and some of them very courageously, they go to the law library, or in solitary, the books are brought to them. They cannot go out of their cell, but they study law and they work as a jailhouse lawyer, what is called, ‘pro se’. And they file lawsuits complaining about one or another constitutional violation. That is incredible, given that they are in solitary, they have no one to talk to. They probably came into prison without ever graduating high school. And they are writing legal briefs, which are very valid and often they win their cases. So, that is an amazing accomplishment against great odds. Now when we look at sheltering in place for the community at large, we can learn something from that. I think in order to do well during this current crisis, people have to be disciplined. The usual markers of our daily life are gone. We do not have to get to work at nine in the morning. We do not have our workmates to relate to, around cooperative tasks. We do not have specific work assignments on average. And therefore, we have to create a structure for ourselves, which gives meaning to our lives, but also marks the daily rhythm. That is, we start working on some project. At some point we finish it by say the evening. We switched from work to recreation and we do it in some kind of ordered way. All of those steps are helpful in while we shelter in place. Because if we do not organize our day, what happens is a kind of disorientation. I do not know what day this is, because I am not doing my usual activities. And I do not even know what time of day it is, so I get disoriented as to time, and place even. While the prisoner in solitary confinement works out ways to do that. Many have intricate calendars. They keep a chart of as the days go by, they know the date, because often there is no clock and there is no calendar allowed in the solitary confinement. So, they have to create their own calendar. We have seen it in cartoons, where prisoners is doing Roman numerals on the wall, to count the days that they are in prison. And prisoners do things like that, and they do it to maintain their sanity.

I think all of us need to maintain some kind of schedule, even when we are sheltering in place. So that we know the difference between morning and afternoon, and we know how the days go by. It is often difficult to notice that it is the weekend. Since all the days have become the same and we are not seeing anybody in person. And I think it is important to keep a record of that. Either in our mind or write it down, so that we have a sense of orientation and what our schedule is. And that is a help getting through the sheltering in place.

Sasza
And in terms of, it is interesting because the expression goes, “time flies when you are having fun”. But in some of the reading I have done, and I cannot cite any specific studies off the top of my head. But, that it actually goes a bit differently than that. And if you do not have this sense of time, if we spend a lot of days doing the same thing, or if we do not have, when you are busy, when you are having fun, when you are doing a lot of things, when you look back, time might fly faster, in the present moment. But when you look back, you have these landmarks. This happened that weekend, the following weekend I remember I went on this trip, or to this birthday party, or this hike. And you have all these different ‘landmarks’ that in a way, retroactively looking back, expand time. Versus if you look back, and all the days are the same, and you do not have these landmarks, it kind of compresses time in a way where it feels as though it has passed much more quickly. And it is much more difficult to know how much time has passed, what you have done, let alone, you know, remember the details.

Terry
That is absolutely correct. And philosophers note the difference between time and duration. Time is what we see on the clock or on a calendar. Duration is our subjective experience of the time. In psychiatry, we are very concerned about orientation. When we do a mental status examination of a patient, we want to know how is their orientation. Do they know what day it is, do they know what time it is, et cetera. And orientation is a matter of memory. The way that we are oriented. For instance, I know that it is morning now, because I remember eating breakfast and I do not remember eating lunch yet. So, I can say, Oh, it must be the middle of the morning, approximately. Our orientation as the place and time, depends on our memory just as you described of past events. When the past events get blurred together, which is what happens in sheltering in place or in solitary confinement in the prison, there is a disorientation that results. And the most successful prisoners, and I think the most successful of us out in the community, sheltering in place have some actual mechanism, some method for continuing to be oriented. And the more we do that, the healthier we feel.

Sasza
I read that Newton developed the Theory and the Laws of Gravity while he was sheltering in place, during the bubonic plague. So, lots of opportunity for innovation and creativity, it would appear.

Terry
Creativity and discipline. And you have to really work out alternative ways to keep a focus, when your usual mechanisms for knowing where you are and what time it is, are not available.

Sasza
I want to quickly jump back and just add one question. When you mentioned that 50% of the country’s successful suicides come from a range of three to 7%, but essentially, 5% of the population that is in solitary confinement. Is that 5% within the prisons it is itself?

Terry
Yes. Solitary confinement, which is usually called segregation, or administrative segregation is a punishment in prison. It does not involve courts, usually. It is what the prison authorities do inside the prison to punish someone for breaking rules. And approximately, 5% of prisoners are in solitary at any given time. That is just about a hundred thousand prisoners in the United States today, are in long-term solitary confinement. The suicide rate in prison is extraordinarily high. It is at least twice as high as the suicide rate in the population at large. So, the fact that 50% of successful prison suicides occur among the three, or five, or 7% of prisoners who were in solitary confinement is a stunning statistical finding. And really reflects that solitary confinement is a main cause of suicide behind bars.

Sasza
I am wondering when you mentioned that some prisoners died due to such severe physical abuse. And I am wondering one, if there are charges that are pressed? But as a very dark question, do you think that some of them would see that as a better option than living possibly the rest of their life in solitary confinement?

Terry
Well, I think that is a very good question. ‘Suicide by cop’ is what it is called in the vernacular. And that is some people, and I think it is relatively rare, but some people will get themselves into some kind of altercation with the police and that can be the correction officer in prison. And thinking that this is going to get me killed, and that’s a good way to commit suicide. As a very rare phenomena, more often the suicide is just about despair, just about a sense that there is nothing in the future for me. I am never going to get out of here and there is nothing I can do to change my situation. All of that, are sort of the elements of despair. When we treat depressed people in psychiatry, part of the depression is seeking isolation. So, the depressed person stays in their room, or buries themselves in their bed, or will not come out of the house. They isolate themselves. It is a symptom of the depression. And what we do in treatment in psychiatry is we try to counter the tendency towards isolation. For instance, on a hospital ward, if the depressed patient wants to stay in their room and keep the light off and be in the dark all day. We go and gently encourage them to come out of the room and join the ward activities. They either watch television with the other patients or join the group therapy that is going on. And the reason is, because we have to counter the isolation in order to treat the depression. Human beings are basically social animals. We get our sense of reality by talking to each other, by interaction socially. To deprive people of social connection, which is what happens extremely, in solitary confinement, in prison, and to a much lesser degree in shelter in place. It creates a situation that is not hospitable to human beings. So, just like in treatment, we try to counter the tendency of the depressed patient to isolate themselves in the sheltering in place. We want to encourage all social activity. You mentioned social distancing versus physical distancing. And it is really physical distancing, because we do not need to be socially distant. We have ways on the outside, in the community to maintain our social connection with others. And I think people need reminders that it is important to do so. So, for instance, watching television, which is a passive activity, but you find out what is going on in the world. Or a telephone and Zoom encounters. Zoom encounters are very popular among those who have a computer, it keeps you in touch with other people. And that is one of the ways that sheltering in place is just qualitatively different than solitary confinement in prison. The person in solitary does not have those options and, is drastically isolated. But while sheltering in place, those of us out in the community do not need to be isolated. The ways to connect with other people can be somewhat artificial. A Zoom conference is not the same as a in-person interaction, but it is better than nothing. And it keeps us socially connected. So that is very important. That is what is missing in prison. And that is why so many suicides occur among people in solitary confinement.

Sasza
In some of the other interviews we have done, some of our guests have talked about any trauma from earlier in life, or in the case of PTSD, or in general, how connection is the strongest healing mechanism. And so, when we did an interview about addiction, and there were countries such as Portugal who implemented, rather than directly drug-related rehabilitation programs, they created programs that gave people connection, and a sense of purpose. So, whether it was connection to other people in terms of community building, or connection to a purpose, or an existence outside of their current experience in helping them start a business or do meaningful work. And so, really just reiterating that human need for connection. And also, the need for connection as a healing mechanism and the power of that. And so, some of the other lessons that we could maybe learn about the human condition that I have picked up on, are you mentioning this need of ‘agency’. And I loved how a lot of your research mentions intimate relationships, and how that is one of the biggest things lacking. And one of the biggest problems with the lack of, versus presence of intimate connections, intimate relationships in our lives can be this game changing mechanism. And what that tells us about who we are as humans.

Terry
Well, I think you have outlined this important topic very well. In psychiatry and psychology, we talk about two key concepts in all of our theories about how people work. One is attachment, and the other is trauma. And they are interrelated. Attachment is the ways that we typically and repeatedly relate to other human beings. And it starts with the mother, infant and parent child relationship. Is it a good relationship? One of the elements of a good relationship is mutuality, caring, empathy, that kind of thing. And that creates an attachment pattern where both parties to the attachment have agency. That is the child can initiate various things with the parent. For instance, baby can cry when the baby is hungry or has a wet diaper, and the mother responds. That starts to build in the infant a sense that my actions cause effects in the world, particularly, in the world of object relations. And I can get mom to notice my needs and take care of me.

That is the beginning of agency. Trauma happens all along the way. That is, there are things that happen to us that are large, that are maybe life-threatening, that caused severe emotional reactions. And in those traumatic events, we do not have agency. They happen to us. Think about rape for instance, or child abuse, sexual abuse of children. The victim and eventual survivor of the trauma has no say about it happening. It is happening in direct contravention of their wishes and their actions, and it is happening to them. So, when we do therapy with someone who has been traumatized, we try to set up a situation where the person who survived the trauma will have more agency. So, they have, as you were saying, both the social connection and in those social connections they have a certain amount of agency. And we have this theory in the mental health professions that working on those two issues eventually helps people resolve traumas.

And what we are looking for, is not just to get back to a previous way of being, but actually to grow from the awful experience. So we talk about a trauma being an opportunity to change and become someone larger. So that is the background in the psychiatric literature about treatment. Now, when you take that into the prison situation, the prisoner in solitary confinement has no social connection. They are socially isolated. They also have no agency or very little agency. Their agency is greatly hampered because they do not control anything in their life. They cannot make plans, they cannot really envision a future, and they have lost a sense of agency while also being isolated. The double loss then, causes a great amount of psychological damage. Moving from that extreme situation to the shelter in place, I think the issues are the same. That is, we want to encourage social connection and meaningful social connection. And social connection where there is mutual agency, where both parties to a relationship have something to say about what is going to happen. The more we can develop that, healthier people are going to be as they go through the crisis. And then, thinking about the future, the more possible that becomes to make what could have been a massive trauma, this period of sheltering in place. And it is a massive trauma, for instance, to prisoners who are facing Corona virus. They are thinking I am going to die in here, because the walls are set. They cannot expand the walls. We have got crowding in here. We cannot do any social distancing. I am going to catch the virus. The medical treatment program is already oversubscribed. I am not going to get the treatment I need, and I am going to die. And that is basically the average sentiment of prisoners in this country today. And there are efforts to release as many prisoners as possible from the jails and prisons. For instance, people who are awaiting trial. And the only reason they are in jail is because they cannot afford bail. They should be released immediately. So, we reduced the population of the jails and prisons, and there are efforts to do that around the country. But the prisoner is facing a situation where, particularly, if they are in solitary confinement, they are isolated, and they have absolutely no agency. What we want to do out in the community is increase the social connectedness by any means necessary. And also increase agency so that while we hae lost the choice to go out to a restaurant or a movie, we cannot do that. We are being told we cannot do a whole large number of things. Meanwhile, we need to find new things where we do have some agency and can control our life, and therefore think about a better future.

Sasza
In thinking about the importance, you mentioned mutual agency in relationships. And it made me think of the importance of that in relationships of any context, but partnerships, romantic relationships, in everyday life. And having that, a lot of research now, showing egalitarian relationships are the happiest, most satisfying relationships and that equality and mutual respect. And in one of your research papers on toxic masculinity and the ways that is shaped and exacerbated by prison conditions. It gave the example of a man who physically abuses his wife, because he has no agency in the rest of his life. And so, this is not even in prison. This is outside in everyday life, but he has no control at work. He does not have a sense of purpose, he does not have connections to other people. He does not feel control over his own life. And so, then, he acts out to try and prove himself, or take advantage of the one place he thinks he can leverage power, control or agency, which is within that relationship. And when you mentioned mutual agency, it reminded me of that.

Terry
What we are looking for is, mutuality in relationships, all relationships. There is no reason why staff in a prison cannot treat prisoners with respect. There is a tendency to dominate them and give orders and that is becomes the only form of relating, and then punishing people who do not obey orders. That is not mutuality. Mutuality is bringing out, respecting the other person’s autonomy and individuality, and bringing out the best in them. That is not going on in our prison system, and needs to. Out here in the community, different people are experiencing shelter in place and social distancing in different ways. For some people, for those who are affluent enough to have savings and be able to sit out a period of shelter in place without bringing in income. They will survive just fine and they have the wherewithal to do social networking. They are going to do much better than people who were living paycheck to paycheck. For instance, in the hotel and restaurant industry, and have suddenly become unemployed with no real means of support.

The other very dark development in this context is domestic violence. Domestic violence is rising and it has to do with the dynamic that you implied. That is, for instance, take a couple who had tenuous mutuality. That is, there is an average of peace, but every once in a while there is an outbreak of domestic violence in usual life. Now, these two people are forced to stay within the walls of their home 24-hours a day, day after day. And what happens is a higher incidents of domestic violence or domination. Domination, typically occurs because somebody, the dominator has been dominated in the past and abused. And then they take it out on someone today, who they have power over. That is typically the way it works. Well, if you put two people in a house together and say they have to stay there. And the prevalence of domestic violence goes up, it must be the case that the person is feeling insecure,, or inadequate and then takes it out on a partner over whom they have some kind of power. So, that is on the rise and it is a very disturbing aspect of the shelter in place.

Sasza
I would love to go back a bit, and dive into how this plays a huge role in even people ending up in prison in the first place. And obviously, people can say you did the crime, you do the time, but to really on a much larger scale, understand the the impact of situation. And how a lot of these people who later ended up in prison have gone through great amounts of oppression, great amounts of isolation, great amounts of stress. Perhaps, as early as they can remember in childhood, did not have those loving relationships, did not have that cultivation of their own identity and purpose.

Terry
Trauma is one of the first pervasive background factors in the prison system. That is prisoners as a group are probably the most traumatized group of people that I know of. Prisoners have had a history of physical and sexual abuse as children, of domestic violence as adults, of the crime on the street where they have been victimized. So there is a tremendous amount of trauma in the background of prisoners. They go into prison and they are dominated by the staff. That is, they are not permitted any kind of agency. They are told they have to follow the rules. They will be punished harshly if they do not follow the rules. And essentially, prison becomes a new trauma which retraumatizes the person who is already had a lot of traumas in their life.

Sasza
I think this is a perfect point at which to dive into the concept of attribution and the attribution error. How you can either attribute an outcome, a vent or consequence to an individual, or to the situation they are in.

Terry
Here is what an attribution error is. I mentioned that practically 50% of prisoners in the United States are African Americans. What is the cause of that? In other words, to what do we attribute the high prevalence of African Americans in jail and prison? One way to think about it is, there is something inherent in African American people that makes them prone to break laws. The conservative political view includes that proposition. It is called racism. There is something about African Americans that makes them prone to violence or crime. Now, another explanation is there is something in our society, for instance, structural racism, which puts African Americans at a disadvantage in our criminal justice system. So, the reason that we have practically 50% of prisoners being African American is not that there is something, some quality in African American people that makes them prone to crime. Rather, there is something very biased and discriminate in our entire social system, but particularly the criminal justice system, which lands people of color behind bars. 
And indeed there is. If we watch the way that the police operate. Where they concentrate their stop and frisk and the way they treat people. They treat African Americans, particularly low income African Americans much more harshly. As will the courts, and the African American people are going to get harsher sentences and then in prison, they are going to have a harder time and more likely, end up in solitary confinement. It is not because of a difference in their attributes, it is because of racism in our system. The prison system grew out of slavery, and it continues to be the focus of racist sensibility in our society. So, the attribution error is to attribute the high prevalence of African Americans in prison, to qualities within the individual African American people who are in prison. Versus attributed to a social process, racism, which selectively arrests, tries, convicts and gives a long sentence to people of color. And depending on how you see that, you do different things to alleviate the problem. If the problem is racism. For instance, President Obama was working very hard to adjust sentencing. There was a discrepancy between people who were convicted of having crack cocaine, versus people who were convicted of having powder cocaine. The chemical is the same. That is usually a larger proportion of white middle class people use powder cocaine, and get arrested for that. And low income and people of color are more likely to use crack cocaine. And then, the sentences for crack cocaine were disproportionally long. So, there is a causality for so many people of color being in prison. And we, during the Obama administration passed laws that would somehow ameliorate that discrepancy. And there was an attempt to pardon some of the African American prisoners who had been given too lengthy a sentence, because of the possession or dealing of crack cocaine. President Trump of course, reversed that process and there was no longer an attempt to correct that inequity.

The last point is about trauma and prison. As I said, the prisoners, as a group are among the most traumatized in our society. In the past, they go to prison and there were a whole series of promise, that happens. Starting in a men’s prison, a man walks on the yard and he starts getting a proposition for sex by older, tougher prisoners, and has to fight in order to defend his honor. Well that is a new trauma. And then the individual is in a crowded facility where there is no room to do exercise, or to take part in programs. And then they are put into solitary confinement. And solitary confinement is a whole new level of trauma. So, they are retraumatized on every level. And that is really what is wrong with our criminal justice system. And it makes it no accident, that the recidivism rate is high. And once someone goes to prison, most people go to prison when they are young, when they are teenagers or in their early twenties. Usually for not a very serious crime, and they only have a year, or two, or three years to do. But what happens to them in prison is so traumatic that they’ ae basically damaged and unable when they get out, to succeed at going straight. And that is what begins their career of criminality. So, we are actually fostering criminality by the awful things we do to people in prison. And we have to reverse that.

Sasza
I just wanted to re-knowledge the fact that 50% of people in these, and I don’t know if it is different for male and female prisons, but are African American. And was it another 20%, are Latino or native American?

Terry
I would say 25, 30. Native American is interesting because they are a very small percentage of the prison population. However, there is a disproportionate percentage of the Native American population that is in prison. So, while they are a small percentage of the prisoners, it is a huge percentage of that community.

Sasza
So, to acknowledge something between, 70 to 80% being people of color in these systems. And the amazing point you made with the example of the difference in sentencing for cocaine versus crack cocaine, which I did not know, and it is extremely interesting and frustrating. But just the fact that if we look at this in an extremely objective way, and we say, okay. One, we acknowledge that these are people who have already lived through so much trauma. And that is part of the reason, if not all of the reason that they end up in these systems. But then, we put people into this place where they undergo escalating extreme cases of trauma. And the goal is to release them with the expectation that they will be rehabilitated. And in your work, reading up on this, it mentions a lot that how some places, or a lot of prisoners within certain systems, do not have access to, self-development programs, or educational programs. So, really putting people into this system, depriving them of any tools or resources to help them rehabilitate. Putting them through escalatingly, extreme trauma and then expecting them to somehow, without any agency, or control of their time and activities, rehabilitate themselves.

Terry
Prison is a window into what is wrong in our society. The first thing that is wrong in our society is a massive gap between the rich and the poor. Which is growing larger, and poor people are even more greatly disadvantage. And you see that today in the Corona virus epidemic. Lower income people are taking the brunt of the pain of this crisis. So, for more affluent people, that might mean that a vacation has to be canceled because the amount of reserve income is less. But, for a low income person, it means they cannot eat, or they are going to be homeless, or they cannot feed their children. Which is about one of the most painful things that can happen to human beings. And it is just tragic what is happening to people at the bottom of the socioeconomic ladder, through this crisis. The criminal justice system is not working, it is broken. It basically serves to disappear problems from our society. Consider a public mental health for instance. As a society, we are not doing our part to help the most disadvantaged among us. And we have been cutting the budget for public mental health successively and incrementally for 40 or 50 years. Ever since the community mental health center at of the early 1960s, that president Kennedy signed. Where there was money for federal community mental health centers. Since that time, if you follow the budgets, they have been relatively dismantled. They had been progressively shrunk, so that there is no real treatment available for people with serious mental illness, if they do not have a lot of money. And that population has wound up in prison. That is no accident. What has happened I believe, is that we have a society where we, the average person thinks we are a democracy. We are kind, we are gentle, we take care of people that they cannot take care of themselves. That is not true. That is not what our society is. Our society is a place of huge inequity, racism, and sexism and other problems. But we do not want to hear that. We do o’t want to see those problems. So, we have a large number of people with serious mental illness who are homeless. And they are in our face, and we look at them, we think they are really miserable, and we are not doing anything to help them. While we would like them to disappear. We would like to not have to look at them. So, we put them behind bars. And that is what I mean, we disappear the problems behind bars. Our public education system is not working. The discrepancy between what happens to a middle-class child and what happens to a low-income child, particularly, in the inner city is just massive.

The public schools are not working. They are failing the low income children. We do not want to hear about that. We certainly do not want to pay higher taxes, to have a better public education system, so that inequity would not be as great. What we do, and I am not saying people consciously do this, they do this as all kinds of indirect mechanisms, but what happens is we lock up a lot of the people who were failed by our education system. If you interview, and I have interviewed thousands of prisoners. As you said earlier, most of them dropped out of high school for one reason or another. And usually, it is because the schools they are in really could not manage to give them an education. It was not because the kids were bad kids. It is that the schools did not work for them. The classrooms were too big, the teacher was too impatient, and they did not do well in school. Well, we do not want to face the fact that our public education system is failing. So, they end up in prison. We say good riddance. The way we say that is lock them up and throw away the key. But the truth is, that we need to look at the way the inequities in our society have resulted in terrible education for the lower income kids. Racism throughout the system, so that people of color are disproportionately put behind bars. Non-treatment for people with serious mental illness. All of these things are social responsibilities. We should be doing everything we can to build a meaningful public education system instead of dismantling it, as we hve been doing. And we should build a public mental health system, and then, there would not be people with mental illness behind bars.

Sasza
One of the biggest parallels that came up in my head, as we have been talking about this attribution. Actually, is a parallel between prostitution and prison. Actually, another one of our guests, Benjamin Nolo, he does some amazing documentary films about rape culture in the U.S. Also some about human trafficking, and I think people often think about prostitution and human trafficking as, that sort of kind of modern day slavery. That people were forced into and then on the other side, people who have agency and make the choice to become what people refer to as sex workers, as if it were a choice. But their research shows that in the United States, women who have quote, unquote chosen to become sex workers, 95% of them had gone through previous abuse. And I believe it was even specifically sexual abuse. But in any case, probably a variety of different extreme forms of abuse. And so, we really need to question, is that a choice, when somebody is put through all of those experiences, they did not choose? And they only see one path as a result of having no agency. And so, they cannot actually be making what we understand and refer to as, a choice, without that agency. And so again, examining how people’s upbringing, the connections or lack thereof, that they had with other people. How that shaped… in this case, what we are talking about, men ending up in prison, or people in general, ending up in prison. And really acknowledging how strongly those early experiences shape us and how limiting they become. And it is almost as if, there is no other path and it should be no surprise that under those circumstances, this happens. And it being, a systemic issue. And so, when we, just to close out the attribution error, and to kind of really simplify it for a more everyday example. To really remind people how much, we are unconsciously attributing outcomes to what we see as choices versus circumstances.

People were forced into or experiences they had in which they did not have agency. And really forcing ourselves to question our perspectives much more often. And to question the way we think and talk about these things. And also, to question how much we attribute our own behavior or choices, to things that are inherent in us. Versus the circumstances and in our relationships. Whether it is our boss at work, and attributing things to his or her character versus the stress they may be under at home, or as a result of this pandemi,c or with their family. We never know what experiences people have been through. And so, we really need to try and remember to more frequently, not only question ourselves but question other people. In the sense of asking them questions and getting to know their story, and the things that have shaped them. And what their intentions actually are, and what they actually are feeling, because otherwise there is no way to know.

Terry
Well, you have touched on a bunch of very important themes. I totally agree. Attribution error is another way to describe what Hagle called, “The master-slave dialectic’ and certainly this applies with sex workers, with women in prison, a certain proportion of whom are arrested for sex working. And when you talk to them you do find a huge amount of trauma including sexual abuse and domestic violence, in their background. When we look at that, one way to look at it in terms of social attribution, would be what are the opportunities for these women who tend to be low income women? Who do not have a lot of a chance to succeed in the everyday job world. And we do not want to look at that, so, we blame these women for having some kind of moral turpitude or something like that. What Hegel said was, that there are two groups, the masters and the slaves in society, and he meant this in a abstract way. Symbolic in terms of our relationships with other people. Some of us are masters, some of us are slaves in different contexts. And he said there is a difference in the knowledge of the master and the slave. The master wants to believe, that the way things are is natural and the way things should be. Their being in a position of master has to do with their merit, and their good work, and their accomplishments. And they do not want us to know anything that contradicts that kind of perception of reality. The slave lacks education but is trying to figure out what is going on. And in terms of eventually really understanding our society, the master is hopeless because the master is so set on defending the worldview that justifies the master status. The slave merely has to gain an education, and gain some power in society, in order to be able to see how it really works.

So, the future belongs to the slave who is going to be able to perceive reality, once we adjust for the inequity that led to their not having an education. That is Hegel’s master-slave dialectic. And that is very true today. And what we have is the criminal justice system as an example. People do not want to know what is going on in prison and they certainly do not want to do anything about it. So, right now, we have a major, major crisis where I think a whole lot of people are going to die in jail and prison from Corona virus. And it is a reflection of the inequities of our society, of the racism in our society. Disproportionately, there are people of color who are going to die in jail, in prison. We do not want to see it. We do not want to look at that. We do not want to put the necessary resources into alleviating that problem. And therefore, we want to just deny that it is going on, or, say it is their own damn fault. They are bad people they are highness criminals and we do not care about them. That keeps us from having to challenge just how equitable, and how free of racism our society is. If we really take a serious look at what is going on here, the jails and prisons are a reflection of racism, structural racism in our society, and also class inequity. And we should be doing all we can to alleviate that. Instead, as a society, we are doing tax cuts for rich people and we are keeping low income people from voting around the country. So, that is the reality of our inequity and our racism in our society. And I think it is time we take a serious look. The way the Corona virus crisis gives us an opportunity, as I said in psychiatry, we look to find the opportunity in the trauma, in the wake of trauma. And I think what is happening today is that people are kinder to each other because of this shared crisis we have. You can feel it on the street, as you are walking across the street to avoid someone, so you can comply with social distancing. There is this shared view that we together are facing a crisis and we are working out the best way we can to do that. People are being released from jail and prison. Not enough by any means. There need to be… California, the Department of Corrections announced they would be releasing 3,000 people. They need to release a 40 or 50,000 people today. And they are not doing that, but they are releasing some people. Now, the question after the crisis is over is, if it was safe to release these people while the Corona virus was going on, if the safety of the community has not been compromised. And it is not being compromised by those releases, then why do we have so many people in prison in the first place? And what we need to do is de-carcerate. We need to get a whole lot of people out of prison. The United States has 5% of the world’s population, and 25% of the world’s prisoners. It is just massive over-incarceration, and we need to de-carcerate drastically. If people would look at their situation and see how they had been in denial about the inequities in the criminal justice system, I think there would be a positive support for that idea.

Sasza
You mentioned how kindness is one positive thing coming out of this pandemic. And I have also been very interested in the fact that this has given us all, something we can relate to, no matter where we are in the world. Everybody is having this shared experience. But, I think we could also outside of this context, realize that we all have a shared experience. Whether that is having obstacles in our lives, having important relationships, having issues that perhaps we have not dealt with or maybe we have. But either way, those experiences that for all of us, have shaped who we are, and the way we react to situations, and who we are in our partnerships, or friendships, or even in the workplace. But we all have this shared experience of being shaped trauma, micro trauma, happy moments, accomplishments. We all have the shared experience of being humans who need these close relationships, who need a sense of purpose and an agency. And who also need other people to help shape who we are. And so, as we get ready to close out the interview, I really wanted to touch on this aspect of how others help give us a sense of self. And how much it is that presence or relationships with others, either in the real world or the lack there of, in the context of prison, but how important that is in shaping our identity.

Terry
Well, I think that is all very important thinking. I personally, am having this problem in our current existential being in this society. I myself, I am a psychiatrist, I am comfortable. I am not facing unemployment because of this Corona virus epidemic. And my life is pretty good. I am absolutely horrified by what is happening in our prison system, what is happening with homeless people today, who are not getting any kind of help. Well, people are trying to help them, but it is not enough social resources. What is happening at the border with immigration, the separation of children from families. I really cannot live with that. It is absolutely traumatic for me, to be in a society which I thought was democratic with some attempt at equitable distribution of resources. Where the truth is so far from that, and so many people are in such miserable poverty and pain. And that creates a disjunction in my being. That is that I cannot really enjoy the benefits of my success in the world, because so many people are suffering. I do not think I’m alone in that perception. I think a whole lot of people feel the same way. Now, during the Corona virus crisis, we look at each other and we say to ourselves, well, I share this crisis with you. You may be a person of another color or another economic class, but we are both facing the Corona virus, which does not discriminate. It is going to come and get all of us. So, we have a shared problem, and a shared a need to share the resources to get through this. I would hope that there is going to be a carryover of that sentiment once the crisis is over. So, people will more about what is happening to the immigrant at the border, and the children of the immigrants. What is happening to people in prison? What is happening to the inner-city communities that are being destroyed by police, vamping on them and arresting young people. And that we will have more empathy as a result of this crisis and be able to fix some of these unbelievable inequities and lack of democracy in our midst.

Again, we are social animals and what we see right now, is people making unbelievable efforts to stay connected with each other. I really, as my general advice to the public, I applaud that effort and I think all of us, one of the biggest dangers is isolation. So, one of the things that is happening is, that people are looking in on elders who live alone. Or people with disabilities who live alone and bringing the meals. I think that is a wonderful development in the midst of a very dark crisis. So, we should be looking to those improvisations that we are doing in order to help other people. And therefore, make our social relationships more real, more kind. And I think people are doing that. And the trick is going to be, to continue that after the crisis is over.

Sasza
Well, thank you so much for your time and for joining us to share your work.

Terry
Thank you. It has been a pleasure talking with you.

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