xxAACP Newsletter, Volume 12,
Number 3, Summer 1998
The SHU Syndrome and Community Mental Health
"SHU" means "Security Housing Unit." Some states use that acronym for their supermaximum security prison units, where the prisoners are locked in their cells nearly 24 hours per day and are cell-fed. Other states use other initials, but "SHU" has become the generic term for supermax or "maximaxi" or "control units," such as the ones at Pelical Bay State Prison in California or Marion or Florence in the federal system. Thirty-eight states and the federal system currently operate such units.
These units are like "the hole" of the old days, except a prisoner who misbehaved was thrown in "the hole" for ten days, whereas prisoners are sent to the SHU for years. And instead of being a dark, damp dungeon: most SHU's are high tech, lights-on-all-night, doors open by remote control, video monitoring of prisoners, etc. -- i.e., the prisoners have very minimal contact with guards and other prisoners.
Psychiatrist Stuart Grassian coined the term "SHU Syndrome." He examined a large number of prisoners during their stay in segregated, solitary confinement units and concluded that these units, like the sensory deprivation environments that were studied in the Sixties, tend to induce psychosis. Even those inmates who do not become frankly psychotic report a number of psychosis-like symptoms:
- Massive free-floating anxiety.
- Hyper-responsiveness to external stimuli, including a startle response.
- Perceptual distortions and hallucinations in multiple spheres (auditory, visual, olfactory).
- Derealization experiences.
- Difficulty with concentration and memory.
- Acute confusional states, at times associated with dissociative features, mutism, and subsequent partial amnesia for those events.
- The emergence of primitive, ego-dystonic aggressive fantasies.
- Ideas of reference and persecutory ideation, at times reaching delusional proportions.
- Motor excitement, often associated with sudden, violent destructive or self-mutilatory outbursts.
- Rapid reduction of symptoms upon termination of isolation.
And why should we, as public mental health practitioners, be concerned about this widespread development? I can think of two very frightening reasons:
- Between a quarter and a half of the prisoners in all the
SHU's I have visited or read about suffer from serious and
long-term mental illnesses. They are, on average, the most
severely psychotic people I have seen in my 25 years of
psychiatric practice. There are two basic reasons for this:
inadequately treated prisoners suffering from mental disorders
break rules, get into fights (often as victims -- they are
called "dings" or "bugs"), and are punished with time in
"lock-up" or solitary confinement of one kind or another.
After they get sentenced to enough time in solitary, they are
sent to the SHU -- where "The SHU Syndrome" effect worsens
their psychotic symptoms and their prognosis.
- Increasingly, prisoners are "Maxing out of the SHU." Prisoners on fixed sentences have a release date, and their disciplinary infractions in prison do not extend that date, though they are sentenced to SHU time for the infractions. When their release date comes up, even if they are housed in a SHU at the time, they are simply set free. (Some states do some pre-release programming, but the ones I have reviewed are not adequate to the task of re-socializing someone who is psychotic and has been in solitary for a long time.)
I don't think I am being overly dramatic, and the phenomenon is spreading rapidly. There are three things interested persons can do: (1) Join the AACP and the Committee on the Mentally Ill Behind Bars, which Fred Osher and I co-chair; (2) Check on whether there are Supermaximum Security Unit(s) in the prisons in your state, and whether mentally ill felons are confined in them; and (3) Educate yourself. Come to a large conference in Berkeley, September 25 - 27, "Critical Resistance: Beyond the Prison-Industrial Complex." It aims to build networks for progressive prison reform. Contact me regarding any of these options at Terry A Kupers, 8 Wildwood Ave., Oakland, CA 94610; E-Mail: kupers@igc.org
Terry A. Kupers, MD
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