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John McCain, probably America’s most famous victim of solitary confinement, described his two years alone in a North Vietnamese cell thus: “It’s an awful thing, solitary. It crushes your spirit and weakens your resistance more effectively than any other form of mistreatment.”

This month, the first-ever considered whether the use of this technique in US prisons constitutes cruel and unusual punishment and is therefore in breach of the Eighth Amendment, as human rights advocates have long maintained.

After testimonies from prison officials, psychologists, lawyers, former prisoners and others, one thing seemed clear: McCain came through his two-year ordeal a lot more successfully than many of America’s “supermax” inmates – those in the highest security units within US prisons – appear to.

, a psychologist at the University of California, Santa Cruz, who specialises in the mental health of inmates was .

“For some prisoners less resilient than he, solitary confinement precipitates a descent into madness,” he said. “Some smear themselves with faeces, sit catatonic in puddles of their own urine, or shriek wildly and bang their fists or heads against the walls that contain them.”

At least half of all prison suicides in the US occur among the 3 to 8 per cent of the prison population who are held in solitary confinement at any one time.

Research on the effects of social isolation stretches back several decades. Recent reviews of the literature highlight a daunting range of harmful psychological consequences in prisoners held in isolation for more than 10 days. They include panic attacks, anxiety, loss of control, excessive anger, paranoia, hallucinations, depression, insomnia, self-mutilation and psychosis ( and ).

Psychologists agree the problem is worse than prison officials recognise. Various studies have found that between 22 and 45 per cent of supermax inmates suffer from serious mental illness, marked psychological symptoms, psychological breakdown or brain damage () – though it is not always clear what proportion were ill before being locked up.

Moreover, there is considerable variation in the degree of suffering and how quickly victims succumb – and how well they recover. , a psychiatrist at the Wright Institute in Berkeley, California, who has served as an expert witness in several class-action lawsuits on prison conditions, says some develop serious psychological problems after a few days or weeks; others cope for months, then suddenly experience massive anxiety or paranoia. Social rehabilitation treatment can help recovery, but “the longer the solitary confinement, the more damaged the prisoner and the worse the prognosis in terms of mental health”.

Why does the prolonged lack of social contact cause such acute ill-health? One theory is that humans need social interaction to maintain a sense of identity and a grasp on reality. Without it, says Kupers, they “have no way to test the reality of their fantasies, and there is a tendency towards paranoia and an inability to control the rage that mounts with each perceived insult”.