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Deaths in Custody: Excited Delirium or Excessive Force?

Deaths in Custody: Excited Delirium or Excessive Force?
By Tom Zeller Jr.


Nathaniel Jones, who the police said was behaving wildly, died shortly after being subdued by a number of officers in Cincinnati. The coroner said it could have been a case of “excited delirium.”

For more than a decade now, a controversial malady known as “excited delirium” has been bandied about in police departments.

Psychologists, medical examiners, and perhaps most pointedly, law enforcement officers insist that it’s a real and discrete condition, but civil rights advocates are dubious about what they say is an increasing reliance on the diagnosis.

It is used to describe people — suspects encountered on the street, often enough — who share a number of characteristic symptoms, including elevated blood pressure and heart rate, paranoia, hallucinations and violent impulses, that are often associated with drug use, mental illness, or the two together.

But those people also share something else: a proclivity for dying in police custody. And that is why critics say something is wrong. National Public Radio is taking the latest crack at the topic; it broadcast the first of a two-part investigation, “Death by Excited Delirium: Diagnosis or Cover-up,” yesterday.

From a portion of the broadcast posted to the network’s Web site:

    Deborah Mash, a professor of neurology at the University of Miami, describes the symptoms of the condition:

    “Someone who’s disproportionately large, extremely agitated, threatening violence, talking incoherently, tearing off clothes, and it takes four or five officers to get the attention of that individual and bring him out of harm’s way — that’s excited delirium.”

    Mash says the phenomenon came to light in the 1980s, when cocaine burst onto the scene. Most victims have cocaine or drugs in their systems. … Mash says victims become irrational, their body temperatures rise so fast their organs fail, and then they suddenly die.

    “It’s definitely real,” Mash says. […]

    But nearly all reported cases of excited delirium involve people who are fighting with police. And that’s extremely problematic, says Eric Balaban of the American Civil Liberties Union.

    “I know of no reputable medical organization — certainly not the A.M.A. [American Medical Association] or the A.P.A. [American Psychological Association] — that recognizes excited delirium as a medical or mental-health condition,” Balaban says.

    He’s right. Excited delirium is not recognized by professional medical associations, and you won’t find it listed in the chief psychiatric reference book.

    Balaban charges that police officials are using the diagnosis “as a means of white-washing what may be excessive use of force and inappropriate use of control techniques by officers during an arrest.”

As readers might already suspect, the term “excited delirium” itself grew out of the crack- and cocaine-fueled stories of the street in which doped-up fiends acquired superhuman strength — or suffered from temporary insanity. The CBS program 60 Minutes II covered the topic in 2003 — as it happens, also using an interview with Dr. Mash:

    These are individuals that are acting wildly, incoherently, completely out of control. Exhibiting super strength. Babbling incoherently. Some individuals jumping on top of police cars. Breaking through plate glass windows. Jumping off of second-story buildings,” says Mash. “Many of them exhibit behavior — behavior and unexpected strength that would be Hulk-like.”

    Dr. Mash has examined dozens of brains from so-called excited delirium victims, and found that nearly all of them were drug abusers, usually of cocaine or methamphetamine. The drug abuse can flood the brain with the natural chemical dopamine, the theory goes. Then the struggle with the police produces high levels of adrenaline. Together, she says, they make a deadly cocktail.

    “What exactly kills the person when they have excited delirium? I think it’s not completely understood,” says Mash. “I think when your temperature’s shooting up to 107, 108, you’re, in essence, cooking your brain.”

We’re not surewhether Dr. Mash’s Hulk simile is overstated, but in both the N.P.R. report and an Associated Press report on the topic last September, several doctors described the condition as essentially an overdose of adrenaline. “You are gunning your motor more and more and more, and it is like you blow out your motor,” Vincent DiMaio, chief medical examiner in Bexar County, Texas, told The A.P.

Dr. DiMaio estimated that the condition kills as many as 800 people nationwide each year. “You are just overexciting your heart from the drugs and from the struggle,” he was quoted as saying.

Some police departments are addressing the issue with special training initiatives that don’t always involve brute force. The Dallas police, for instance, are trained to call for an ambulance any time a suspect fits the description, and to defuse encounters with mentally ill suspects by slowing things down, using suspects’ first names and trying to avoid the use of force.

Patrol officers, 911 operators and dispatchers also receive mental health training, according to The A.P.

The police say those protocols are in place because excited delirium is real.

From the news agency, which spoke with Senior Cpl. Herb Cotner of the Dallas Police:

    Cotner recalled a suspect years ago who appeared in the throes of excited delirium. The man scaled a six-foot wrought-iron fence, tore his leg open, raced on for several blocks and almost bit off a fireman’s finger, Cotner said. He fought police who were trying to restrain him and provide medical care. Then his heart stopped, and he died in the street.

    “Call it anything you want, it doesn’t matter,” Cotner said. “I know these people exist.