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In the second season opener of Orange is the New Black, the show's heroine Piper uses her breakfast to paint a bird on the wall. A month alone in a cell the size of a parking spot has clearly messed with her head. Thirty minutes later, a row of naked prisoners opt to bend over and "spread 'em" rather than be sent to solitary. Mentions of "the SHU" — Security Housing Unit or Segregated Housing Unit — continue like this. In almost every episode of the second season of Orange Is the New Black, solitary confinement looms large, representing a villain even more terrifying than Vee, the show's new violent and manipulative matriarch.

And that's how it should be, to the extent that Orange Is the New Black is based on true stories. Every day, around 80,000 prisoners are locked in solitary or other forms of isolated confinement in this country. In real life and on Netflix, solitary confinement truly is every prisoner's worst enemy. Here's why:

Solitary confinement can literally drive people crazy. In the opening scene, an officer wakes up Piper, who has no idea what time of day it is, and mocks her for smearing her "breakfast" all over the wall. Sure enough, the usually rational Piper has created a mural of egg yolk on her filthy cell wall. "This is art," she insists, describing the streaky mess as "a yellow warbler drinking out of a daffodil."

Piper's borderline, incoherent rambling and general confusion is . People held in isolation, with little besides their own thoughts, fears, and emotions to sustain them, can deteriorate rapidly. They lose the ability to focus, have trouble sleeping, and become obsessive and confused.

The conditions of solitary confinement are sparse and often filthy. Piper's about the size of a parking space, with filthy walls and floor. There's a small bed and a steel toilet-sink combination — and not much else. The door is solid steel, compounding the feeling of claustrophobia. Piper has a book and three sheets of paper on which she seems to be keeping track of the days and the guards' different shifts, but otherwise she is allowed little or no personal property. Piper's cell, down to the mystery substances and years of grime smeared and caked onto the walls, is typical of a real solitary confinement cell.

Medical and mental health care in solitary confinement is usually extremely poor. In Episode 2, Tiffany "Pennsatucky" Doggett, Piper's foe from last season, emerges from the SHU acting dazed and loopy, confused about her own mental state. She struggles to follow a normal conversation with Corrections Officer Sam Healy and contradicts herself, asserting, "I got all my marbles back. . . . I can promise you that I've never felt more saner than I do now. You know, when you spend that much time down there, in solitary, it's, like, real purification"—but then, in the same breath, she says, "my head is so fuzzy." She seems to have been improperly medicated.

Prisoners with preexisting mental health problems like Pennsatucky in "the box." This is often exacerbated by inadequate medical and mental health care and monitoring. For example, doctors may prescribe medication without having seen the patient, and "therapy" sessions often take place at the cell door.

Prisoners are often thrown in solitary confinement for weeks or months at a time. Piper and Pennsatucky both were sent to the SHU for thirty days after getting into a fight. Later in the season, Janae Watson cycles in and out of the SHU throughout the season, at the arbitrary mercy of guards who are having a bad day, for nonviolent rule violations like having cigarettes in her bunk. This is a , and as prisoner Yoga Jones says to her fellow hunger-strikers in Episode 10, "It's torture." Also typical, though not represented in the show, is that many prisoners don't come out of the SHU according to schedule. While they may initially get sent to solitary for, say, a month, any rule violation—even a minor one—can result in a longer period in isolation, even lasting years.

Sometimes, correctional officers use solitary confinement as a threat. In Chicago, Piper is subjected to a strip search with a dozen or more other new detainees. The prisoners are forced to line up, totally naked. An officer threatens the group before anyone complains: "If you're feeling shy, I can set you up with a private show-and-tell. . . in solitary!" Later, in Episode 2, Healy threatens Pennsatucky when she suggests she could expose him for failing to intervene when she pulled a knife on Piper: "I oughta throw you back in seg and let you rot."

The does, indeed, instill fear in prisoners. For women prisoners, this means that they sometimes won't report rape or other abuses because they fear being placed in solitary as retaliation. Assignment to solitary, and the duration a prisoner stays there, hinges enormously on the discretion of corrections officers — which means that prisoners can be placed in solitary confinement for virtually any reason.

Back in New York City, Piper's best friend Polly asks Larry, Piper's ex-fiancé, about Piper. Polly's confused — she's heard something about Piper "living in a shoe?" Like most people who have had little experience with incarcerated people, Polly has no idea what's going on at Litchfield, let alone in the SHU. But now, many real-life Pollys may be coming around.

Orange Is the New Black gives a wider audience a glimpse into the darkest corners of American prisons—including their miserable, counterproductive solitary confinement cells.

For more on women in solitary, check out the ÀÏ°ÄÃÅ¿ª½±½á¹û briefing paper, Worse than Second Class: Solitary Confinement of Women in the United States. And check out the campaign to fix the real jail featured on OITNB.

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