I was not surprised to learn of the death, apparently by suicide, of Jeffrey Epstein. He was facing a grim future: sexual abusers of children are the prisoners upon whom all others look down, and they must be protected from the violent self-righteousness of these others. They live in justified fear of attack, and Epstein must have known that this was how he might have to live for the rest of his life, all the more so because of his inescapable notoriety. No more Palm Beach, no more Virgin Islands, no more ranch in New Mexico; for him, abandoned by all those who once would have accepted his invitations, only the grim and unrelenting existence of prison.

Given the salacious details and ramifications in his case, it is natural that conspiracy theories should abound, but let us for the sake of argument accept the most likely explanation of his death—namely, suicide. Attorney General William Barr has already blamed the federal detention center in which Epstein was held for his death, and it seems from reports that the staff were indeed lax and undisciplined in their supervision. That is not quite the same, however, as saying that they were to blame for his death, for prisoners commit suicide even when under the best supervision possible.

Based on my professional experience as a prison psychiatrist, I will assume the best possible case for the jail in which he was held, without claiming that the case is actually correct. I mean only to warn against too hasty a rush to judgment.

Let us suppose that Epstein had been carefully and repeatedly assessed by a psychiatrist, who was able to discern no psychiatric condition susceptible to treatment. Epstein would certainly have been intelligent and gifted enough to be able to conceal his true intentions from him, and no psychiatrist would claim never to have been deceived by a patient in this manner.

Continuous watch is very unpleasant for all concerned. Even the limited privacy of normal prison life is forbidden the prisoner. In the absence of any discernible psychiatric condition, it is perfectly normal to lift such a watch after a few days, and indeed it could be considered cruel to continue it in the absence of psychiatric disturbance or an imminent threat of suicide. Continuous watch is lifted even where there is a long-term risk of suicide, as there obviously was in Epstein’s case. It would have been only slightly less after several months awaiting trial. I remember a notorious serial killer in the prison in which I worked who killed himself after a long period on remand. In the morning of his death, he had been playing pool happily with the officers.

Lifting a continuous suicide watch is a matter of judgment that is inevitably fallible. Suicide proves it wrong; survival proves it right. Epstein was supposed to be observed every 30 minutes, which, from the point of view of preventing suicide in a man who has privately decided to kill himself, is probably useless, even if carried out (as in this case it was not). Most suicides in British psychiatric hospitals, for example, occur among patients who are on 15- or 30-minute observations. Even constant observation is not fool proof: I have known of prisoners and psychiatric patients who killed themselves while being directly observed, without any imputation of negligence on the part of those observing them.

I am not claiming that there was no fault in Epstein’s supervision; at the least, there was a breach of procedure. I have known prison officers to turn the other way when a sex offender was being beaten by other prisoners. But in every case, including that of Epstein, the devil is in the detail. Carrying out procedure as ordered is no guarantee that all will turn out as desired.   

Photo: Stephanie Keith/Getty Images


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