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"Fatal Flaws" in the Colorado Solitary Confinement Study, Solitary Watch, 2010

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"Fatal Flaws" in the Colorado Solitary Confinement
Study

SOLITARY WATCH GUEST AUTHOR | November 15, 2010 at 1:11 pm | Tags: administrative
segregation, American Psychiatric Association, Colorado State Penitentiary, Colorado study, Stuart Grassian
| Categories: Colorado, Eighth Amendment, guest posts, mental illness, physical effects, prison health care,
psychological effects, solitary confinement, supermax prisons | URL: http://wp.me/pKbGK-ES

Guest Post by Stuart Grassian, M.D.
Editor's Note: The Colorado Department of Corrections recently released the controversial results of
a year-long, federally funded study of conducted at the Colorado State Penitentiary, a supermax
prison in Cañon City where more than 700 men are held in solitary confinement. Entitled "One Year
Longitudinal Study of the Psychological Effects of Administrative Segregation," the study found that
long-term solitary confinement had no detrimental effect on the mental health of inmates--including
inmates with pre-existing mental illness. In fact, some prisoners were found to "improve" in 23-houra-day lockdown under conditions of extreme isolation.
Solitary Watch asked Dr. Stuart Grassian, one of the world's leading experts on the psychiatric
effects of solitary and other extreme forms of confinement, for his reactions to the study. Grassian, a
Board-certified psychiatrist and former faculty member of the Harvard Medical School, has lectured
extensively on this subject. He served as an expert in individual and class-action lawsuits addressing
solitary confinement, and his conclusions have been cited in a number of federal court decisions. He
has provided invited testimony before legislative hearings in New York State, Maine and
Massachusetts and the Commission on Safety and Abuse in America's Prisons. Grassian has also
been retained and consulted by public advocacy groups, including the Innocence Project, the
National Prison Project of the ACLU, Massachusetts and Maine Civil Liberties Unions, the Capital
Defense Fund of the NAACP, and the Center for Constitutional Rights, among others. Much of his
work on the subject is described in “Psychiatric Effects of Solitary Confinement” (Washington
University Journal of Law and Policy, 22: 2006).
Dr. Grassian reports that he was invited by the authors of Colorado study to participate in the
presentation of their research at the 2010 annual meeting of the American Psychological Association
(APA). "In reviewing their research," he writes, "I found there were several fatal flaws in their
methodology, and so stated during the presentation, including their choice not to incorporate into

their analysis data that squarely contradicted their conclusions. This research has now, without any
further analysis or correction, been submitted for publication to the National Institute of Justice."
We are publishing in full a version of the critique that Grassian provided to the authors of the study,
which he has adapted to be more accessible to general readers. He writes that the critique "is based
upon the report itself, discussions held publicly at the presentation at the APA Meeting, as well as
the written transcript of the deposition of the lead author, Maureen O’Keefe, in Dunlap v. Zavaras"-a federal suit by a death row inmate Colorado State Penitentiary, alleging that his conditions of
confinement constitute cruel and unusual punishment.
1. Research Subjects, Control Group.
Basically, the research subjects are Colorado inmates who were subject to disciplinary hearings that
might result in their referral to Solitary Confinement (Ad Seg) in Colorado State Prison. They are
categorized as either having a mental illness diagnosis (MI) or no mental illness diagnosis (NMI).
Those referred to Ad Seg thus have a close comparison group (similar to what is termed a “control
group” in research); that is, those who were returned to General Population, with some sanction short
of Ad Seg. Thus, the MI Ad Seg have a “control group” – the MI GP – and similarly, the NMI Ad
Seg’s control group is NMI GP. The authors pride themselves on having thus obtained in this
manner a controlled study. (Controlled studies are able to isolate one variable – in this case, housing
in Ad Seg – while leaving other variables constant in the groups studied.)
Naturally, the greatest focus will be on those having a diagnosis of some mental illness, the most
vulnerable individuals, presumably those most vulnerable to decompensate as a result of Ad Seg
confinement.
2. Data Collected – the Problem of Validation.
The researchers must establish some means of determining the mental health status of the inmates
being studied. They choose to use various self-report rating scales, in which the inmates check off
symptoms and generally describe their severity, usually on a five-point scale
The question, of course, is whether these self-report scales have any meaningful relationship to the
inmates’ actual psychiatric difficulties, that is, whether are validated as a means of inquiring into
psychiatric status. Well, they are validated, but not for people in the position of inmates. They

have been validated for college student volunteers and for outpatients in psychotherapy (that is, for
these groups, their self-reports actually do correlate with other, objective measures of psychiatric
symptomatology). Especially in regard to outpatients, this is not surprising; it is intuitively
reasonable that people seeking help are likely to try to be accurate in their self-report.
But inmates are in no way similarly placed. Revealing weakness is dangerous, potentially subjecting
the inmate to harassment, possibly even to physical danger. Moreover, in the present study, the first
author revealed at a deposition that the subjects were told that the research was intended to study how
inmates were adjusting to prison life. Well, quite clearly, how unwise it would be for an inmate to
declare he was adjusting poorly; that is not the kind of information he would like to present, for
example, at a parole hearing.
There are other problems as well. For example, the graduate student, Alyusha, who actually met
with the inmates was apparently an attractive young woman, talking with inmates who had virtually
no contact with such young attractive women. Even the research group itself noted the likely
distorting effect of this fact, referring to it as the “Alyusha Effect.” The inmates were likely to be
reluctant to reveal weakness to this attractive young woman.
Thus, it cannot be assumed that inmate self-reports are a valid means of assessing psychiatric status.
It would not at all be surprising if these self-reports in fact bore little or no relationship at all to
psychiatric status.
3. The Attempts Made to Validate the Self-Reports.
The authors made token attempts to validate the inmate self-reports against reports (filling out brief
check-the-box forms) of corrections officers and of clinicians. However, by their own admission at
public forum and at deposition, the authors acknowledge these reports are not of value. They have no
idea who or how the corrections officers filled out their forms; no specific instructions were provided,
and over half the forms were never filled out at all. Similarly with the forms filled out by the
clinicians, the authors gave no guidelines or requirements as to how the forms would be filled out,
and had no information whatsoever to suggest that the clinicians did more than they would normally
do in a screening interview – that is, attempting to speak to the inmate through the cell door, either by
talking through the crack between the edge of the door or else opening up the food slot, and bending
down in an uncomfortable position to speak through the slot. In any event, as the authors
acknowledge, both officers and clinicians are already burdened by their routine paper work, and it

would not be surprising to find that they put minimal or no effort at all in checking off these forms.
And indeed, while the inmate self-reports revealed no psychiatric symptomatology associated with ad
seg housing, the clinician forms found even less symptomatology than that of the inmates.
The authors acknowledge that little use can be made of the officer and clinician reports. The problem,
simply, is that for these individuals, their mission (be it security or clinical treatment) is elsewhere; it
is not in filling out these forms.
4. The Authors Chose to Ignore Data That Squarely Contradicts Their Conclusions and
Moreover Would Assess Validity of the Self-Report Data.
The most important comparison groups are the two groups of inmates with mental illness diagnosis
referred for disciplinary hearing – those then housed in Ad Seg versus those then housed in GP. Now
since they all have psychiatric diagnoses, there will be records of mental health contact – symptoms
noted in clinicians notes, medications prescribed, and so forth. None of this data was reviewed at all.
For example, did those in Ad Seg end up requiring more medication than those in GP? Absolutely
no information, no attempt made to discover this data.
But, there was one piece of data recorded in the DOC files. DOC files record incidents of emergency
psychiatric contact (e.g. suicidal or self-destructive behavior) and emergence of psychotic symptoms.
Among the MI in Ad Seg (N=59) there were 37 such episodes (an average of .62 episodes per inmate
– almost 2 for every 3 inmates). Among the MI in GP (N=33), on the other hand, there were only 3
(.09 per inmate – less than 1 for every 10 inmates). Could this have been random – i.e. not a
reflection of some significant difference in the result? Statistically, the chance of that is entirely
minute, approximately p=.0002; i.e. a chance of 1 in 5,000, a mighty small number. (In research,
statistical significance requires only a probability of randomness of .05, i.e. as much as 1 in 20!)
Thus, this objective data squarely contradicts the authors’ conclusion that Ad Seg does not produce
significantly more psychiatric difficulties than does GP housing. The authors simply declined to
perform this straightforward statistical analysis, even after the oversight was explicitly pointed out.
This data is critical in another way as well, as a proper means of assessing validity of the selfreports: If the self-reports were a valid measure of psychiatric distress, we should see each crisis
episode reflected in the inmate’s corresponding self-report. But if in filling out his self-report, the
inmate responds so as to indicate he is doing just fine, then the self-reports are worthless. They are
garbage; they are in no way a measure of psychiatric distress. Now, it would have been quite easy for

the authors to review these cases, a total of 37 recorded instances that would require simply a review
of the corresponding self-report rating by the inmate during the time period at issue. I explicitly
pointed this out to the authors prior to their public presentation of the data and prior to their final
submission for publication. Yet the authors declined to perform this crucial check on their data.
And, indeed, even looking cursorily at the data, it is fairly obvious that such a review would have
revealed that the self-report data was worthless.
5. Conclusion.
There are a number of other methodological difficulties with their report, but in the end, much of the
163 page final report consists of long and endless statistical dissections of the self-report data. Yet
these minute dissections reveal nothing, because the data they dissect does not in any meaningful
manner reflect the psychiatric pathology they are supposed to be studying. They endlessly dissect
garbage. And statistics are not alchemy; they cannot transform garbage into anything else but
different arrangements of garbage. Thus the saying among computer people and statisticians: “G.I. G.O. --- garbage in, garbage out.”

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