Hell Is a Very Small Place

Hell Is a Very Small Place is an impactful book written about the experience of solitary confinement within the United States penal system. The book focuses on the experiences of those placed in solitary confinement and the lasting effects this experience has had on their physical, mental, and social well-being. The stories told are not for the faint of heart, providing uncensored, graphic details about harsh topics including mental illness, self-harm, suicide, abuse from guards, and sexual assault. The book aims to provide an authentic look into everyday life in these “secret” parts of our prisons.

The book starts with an introduction outlining the history of solitary confinement, beginning with incarceration and torture in medieval dungeons to the modern-day practice of “secure housing” in America's prisons. The authors liken the practice of solitary confinement to being “buried alive” and a “secret punishment” sometimes used for an inmate's ίί · V“own protection.”

This book openly denounces the practice of solitary confinement and seeks to persuade the reader through two avenues. First, the editors have provided an anthology of stories written by individuals who have experienced solitary confinement during their incarceration. Second, they have compiled a review of the data and evidence supporting the eradication of solitary confinement presented by experts from various disciplines.

Part one, titled “Voices from Solitary Confinement,” includes the writings of 16 individuals who spent some part of their prison sentence in solitary confinement. This section includes powerful stories about what life is like in solitary confinement and the psychological impact they experienced before and after solitary confinement. Many of these writings discuss the individual's inner thoughts, feelings, and vulnerabilities. Each writer provides a different perspective on what it is like to live in that setting; some focus on the everyday happenings, others focus on their own mental and physical anguish, while others focus on the lasting impact of their time in solitary confinement.

The editors subdivided these writings into three themes, enduring, resisting, and surviving, that walk the reader through the stages experienced by each individual. First is enduring, which is a feeling of helplessness and hopelessness about what they are experiencing and how they survived it. These stories focus on the experiences these individuals had in solitary confinement, including the overwhelming noise, the lack of company during recreation, and bizarre behavior like learning to file their nails on the cement cell wall. The second theme, resisting, chronicles first-hand the individuals' efforts to change the conditions and ultimately end the practice of solitary confinement. The final theme is surviving the lifelong effects of solitary confinement. These stories are written by individuals following release from incarceration and highlight the daily struggles they face in social, romantic, and occupational settings.

Part two, titled “Perspectives on Solitary Confinement,” contains summaries of research that support the authors' assertion that the practice of solitary confinement should end. Each summary is written by a subject matter expert and includes perspectives from psychiatry, law, political science, and philosophy. The first chapter is a description of the “solitary confinement syndrome” described by psychiatrist Dr. Stuart Grassian and a brief summary of his work in this area. In the next chapter, Dr. Terry Kupers outlines his research and many writings on the correlation of de-institutionalization and the rise of mental health concerns within our nation's prisons. Next, attorney Laura Rovner approaches the topic from a constitutional-law perspective and describes and analyzes some of the legal challenges to solitary confinement that have taken place since its inception. Fourth, Professor Jeanne Theoharis tells the story of her former student, Syed Fahad Hashmi, who spent many years in solitary confinement and describes her experience of seeing her once young and active student change into someone unrecognizable after years of solitary confinement. Finally, Professor Lisa Guenther discusses the civil rights abuses taking place in solitary confinement, how the courts have supported its use, and society's ignorance of the way these individuals are treated.

The book closes with an afterword by one of the editors calling for action from the reader and other advocates. He calls for increased access to information about the impact of solitary confinement and the need to support and treat those who have endured it. He also argues for changes to solitary confinement from the court system, state and federal legislatures, and advocacy groups across the nation.

This book approaches the topic of solitary confinement by giving the reader a glimpse into the experience of individuals both during and after their incarceration. The first-hand accounts from these people provide a human perspective about the struggles experienced during and after solitary confinement. The second part, detailing the objective data about solitary confinement, acts as a backdrop to these human experiences and calls for reform of this practice.

Forensic psychiatrists frequently have interactions with those involved in the criminal justice system and will, at some point, see an individual before, during, or after solitary confinement. Psychiatrists practicing in a correctional setting are most familiar with this practice and play a role in evaluating and treating these individuals. These psychiatrists are perhaps the ones most familiar with the conditions of solitary confinement and its sequelae; however, many psychiatrists, including forensic psychiatrists, have no or limited first-hand experience in these places. This look into daily life in solitary confinement provides a much needed perspective to psychiatrists who do not routinely encounter it.

This book provides a look into the secret world of solitary confinement, its daily routines, and its lifelong impact. It is generally an advocacy piece and from beginning to end uses multiple perspectives to support the editors' conclusion that solitary confinement should no longer be used in our nation's prisons. It is an easy read that provides an in-depth perspective on this topic, and it is well-suited to those looking for the human perspective of life within our correctional system.

• © 2019 American Academy of Psychiatry and the Law