Grits' contributing writer Amanda Woog asked me recently about "excited delirium," having seen the term come up in death in custody reports she's curating as part of her Texas database project. (Look for a big announcement soon as she releases new datasets beyond just recent police shootings.) I first heard the term when I directed the ACLU of Texas' Police Accountability Project around the turn of the century and it represents one of the most curious and bizarre distortions of medical terminology in service to a political agenda I've ever personally run across. Really, excited delirium is not a diagnosis at all so much as an acknowledgement of the lack of other diagnoses. It's what authorities say when someone dies after being restrained or Tazed by police, they don't want to blame the officer(s), but there are no other explanations for the outcome. One often sees the term suggested in the press by unions before medical examiners ever release their findings.
Excited delirium is a medical condition which seemingly only manifests itself when the patient is being beaten, Tazed, or otherwise physically restrained by law enforcement, which makes it an atypical diagnosis, to say the least. Cynics contend it's a fake diagnosis created to cover up police misconduct. Among professional associations, those fields more closely associated with law enforcement - medical examiners and emergency physicians - accept the term, while the AMA, APA, the DSM, and the World Health Organization do not. The chairman of Texas' Forensic Science Commission, Vincent Di Maio, wrote the principal, professional text making the case for the diagnosis (though clearly it wasn't enough to convince the AMA, etc.).
Anyway, debates over the diagnosis reignited in the last year - with major pieces in the Washington Post, Slate, and Vice/The Influence - in light of renewed interest in death-in-custody cases inspired by the rise of the Black Lives Matter movement. If someone as well-read as Amanda was unfamiliar with the term, then perhaps others aren't, either. So I thought it'd be good to compile some key links on the topic.
One of the earliest significant MSM pieces I remember on it was from 60 Minutes in December 2003; that sort of put the debate on the map, for me, anyway. Mother Jones in 2009 attributed the rise of the term to the company Taser International, which reportedly employed Di Maio as an expert witness and handed out free copies of his book at law enforcement trainings.
The website PoliceOne has covered the issue quite a bit over the years. Here are a few key items:
- Excited Delirium and its medical status (good summation)
- Is excited delirium a fake condition invented to whitewash abusive force? (response to critics)
- New study: Fast effective option for excited delirium cases (sedation)
The since-fired Austin officer who shot and killed David Joseph, a black teenager who was buck naked sprinting down the street, said he thought the young man may have suffered from "excited delirium."
Grits is very much a skeptic here. If we had people dying of excited delirium under other circumstances besides being taken into custody by law enforcement, I'd consider the idea to have more merit. But it's awfully convenient to blame some vague "syndrome" that can't be verified while ignoring violent actions immediately preceding a death as the most likely cause. No civilian would ever get such consideration.
OTOH, it almost doesn't matter. The truth is that police wouldn't be held accountable for those deaths even if no one had ever heard of "excited delirium." (Taser is probably the chief beneficiary of such blame shifting; they don't enjoy qualified immunity.) Meanwhile, pretending the syndrome exists may result in training recommendations for de-escalation techniques which are beneficial regardless of the terminology used.
For example, recently the missus ran across a case from 2015 in which Robert Brandon Edwards was restrained by police and died in transit to the hospital. See Statesman coverage from when the officers were no-billed, the APD incident report and autopsy report, which concluded that Edwards "died as a result of the combined effects of methamphetamine and phencyclidine toxicity and physiologic stress associated with restraint procedures." Though the medical examiner didn't cite "excited delirium" as a cause of death, the detective taking a statement from one of officers used the term to describe Mr. Edwards' condition.
If the department were to alter procedures aimed at preventing deaths like Mr. Edwards, the benefits would not be reduced because they adopted a trendy catch phrase.
These situations are arising and people are dying, whatever we call it. If it takes acquiescing to use of a pseudoscientific buzzword to convince police to embrace de-escalation and/or restraint techniques that minimize loss of life, I suppose we shouldn't mind. In the meantime, though, "excited delirium" still strikes me as less a diagnosis than a strained defense.