Dying of Excitement: Police often blame suspects’ deaths on “excited delirium.” Is that a diagnosis or a cover-up?

At a Canadian public inquiry set up in 2008 to study the appropriateness of allowing cops to use Tasers, Mike Webster, a police psychologist, went further. He blamed Taser International for “brainwashing” cops and testified that “police and medical examiners are using the term [excited delirium] as a convenient excuse for what could be excessive use of force or inappropriate control techniques during an arrest.” He went on to add that members of the law enforcement community “have created a virtual world replete with avatars that wander about with the potential to manifest a horrific condition characterized by profuse sweating, superhuman strength, and a penchant for smashing glass that appeals to well-meaning but psychologically unsophisticated police personnel.”

The results of that two-year official 2009 inquiry, chaired by a retired British Columbia appeals court justice, Thomas Braidwood, concluded that the term excited delirium had been rejected by medical professionals and was being used to cover up actual causes of deaths in custody, especially those involving excessive restraint and Tasers. Braidwood wrote that it was “not helpful to characterize people displaying these behaviors as suffering from excited delirium. Doing so implies that excited delirium is a medical condition or diagnosis, when mental health professionals uniformly reject that suggestion.” Taser International sued to have the Braidwood findings quashed, but the company lost.

Part of the ambiguity is that, much like in cases of sudden infant death syndrome, a medical examiner who diagnoses excited delirium can’t point to a clear cause of death in the autopsy. As Vincent Di Maio, a retired forensic pathologist, explains in his book on the subject, excited delirium is only determined after an autopsy “fails to reveal evidence of sufficient trauma or natural disease to explain the death.” You work backward to the diagnosis.

Researchers are still trying to find biological signals of excited delirium. Wiredreported in 2009 that a study by Deborah Mash and colleagues at the University of Miami and published in Forensic Science International looked at samples of brain tissue for 90 people who had apparently died of excited delirium. The researchers found the signatures of two distinctive “biomarker” proteins that were common to all 90 cases. But subsequent research found that these proteins are evidence of drug use and not specific to excited delirium.

The ACLU is having none of it. Balaban told the Washington Post that the syndrome is simply an easy way to “whitewash” excessive use of force by cops on suspects with serious mental health problems. The notion that mentally ill or drugged suspects who are behaving wildly need to be restrained and beaten is finally getting deserved attention. A horrifying new study from Human Rights Watch shows the extent of abuse of mentally ill prisoners in the American prison and jail systems.

A note in the 2012 Saint Louis University Law Journal by Michael L. Storey blames journalists for perpetuating the idea that excited delirium is a myth. He wrote that they “favor controversy and blame rather than balance and exploration.” But any medical diagnosis that shifts blame from the living to the dead, and from cops onto victims, based on a condition that is diagnosed only in the absence of other clear causes is really not to be blamed on reporters. Apparently while we’re busy hog-tying the prisoner, we should pause to shoot the messenger as well.

Perhaps the final paradox of the excited delirium craze is that it may be leading tobetter police procedures in the long term. Whether excited delirium rests on junk science pushed by Taser International or is a legitimate diagnosis of a genuine disease, some police departments have begun to enact more effective law enforcement training. As Storey notes, cops in Dallas are being trained to call an ambulance when they come across a person displaying symptoms of excited delirium, and they are asked to defuse the situation with suspected mentally ill persons “by slowing things down, and using the suspect’s first name and trying to avoid the use of force.” By training cops to see excited delirium as a medical emergency instead of a fight to the death with a hulking superpredator, the police may be learning to better handle these crises using nonlethal force.

After Randy Escobedo died in police custody, the San Diego Police Department retrained its officers to ensure that suspects were never detained face down, and suspects were monitored after their arrests.  In British Columbia, as a result of the Braidwood hearings, a cop is prohibited from deploying a Taser unless “the subject is causing bodily harm or the officer is satisfied, on reasonable grounds, that the subject’s behavior will imminently cause bodily harm.” In Toronto, a hospital has partnered with two downtown police divisions to create a “mobile crisis intervention team”—a police officer and a mental health nurse—to deal with emergencies involving emotionally disturbed people. If a diagnosis of excited delirium, whatever it is, works in the long term toward treating mental health crises as mental health crises rather than crimes, perhaps it’s a step toward more humane and safe policing.