Update: Taser’s role in the rise of excited delirium diagnoses is an important part of this story. H/T to @SusieMadrak
Last week, police in Fairfax County, Virginia, said a medical examiner determined that a 37 year old mentally ill black woman named Natasha McKenna died of ‘excited delirium’ in February after being tased and restrained by six armored sheriff’s deputies.
I had never heard of excited delirium before, so I dug into it a little bit. The American Psychiatric Association (APA) maintains a resource known as the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. The DSM contains a diagnostic classification list that details all the diagnoses recognized by the APA. It’s a pretty big book that details many, many mental disorders and diagnoses. Delirium is a classified diagnosis, but excited delirium is not.
That’s because there is significant and decades-old debate in the medical and civil liberties communities over whether excited delirium is real or if it’s a scapegoat for police brutality. Back in 2003, the Los Angeles Times reported that in-custody deaths involving excited delirium diagnoses were thought to be on the rise:
Although no one tracks the number of suspected cases — nor are there any public records on the number of people who die in police custody — researchers suspect that the condition accounts for a half-dozen deaths in most major cities each year. By some estimates, excited delirium is now being ruled as the reason behind the majority off all in-custody deaths.
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According to neurologists and medical examiners who have researched the issue, excited delirium is an often-fatal condition that can occur in a small subset of people who use drugs, mostly stimulants like cocaine or methamphetamines, over a long period of time. Typically, as users continue to take the drugs, the number of drug receptors in the brain rises, which helps pump dopamine and other excess hormones out of the brain.
But in people at risk of excited delirium, there is a genetic fault that impairs the brain’s ability to increase those receptors, they say. After drug use, that can lead to a dangerously high level of hormones in a part of the brain known as the amygdala, which later can bring on delirium, paranoia and aggression. More often than not, that attracts the police.
In such instances, even a minimal struggle can lead to too much pressure on the heart or lungs and the person can die. Another problem: Long-term stimulant use can enlarge and weaken the heart, which can be overtaxed during a big adrenaline rush. “It’s a very dangerous toxic mix of events,” says Karch.
The excited delirium diagnosis originated in the early years of the War on Drugs in cases involving cocaine. It therefor comes directly to us from a law enforcement and forensic psychiatry setting. The diagnosis is not recognized by many mainstream associations like the APA. Most cases involve people in distress who are often suffering from mental illness or, as the LA Times noted, substance abuse and addiction — and the use of force against them by law enforcement, many times involving tasers or restraints.
Amanda Truscott, writing in the Canadian Medical Association Journal in 2008, explored the dynamic between excited delirium cases and the use of force. She defined it as “being characterized by agitation, incoherence, bizarre behaviour, high temperature, superhuman strength, a high tolerance for pain — and sometimes, the compulsion to break or bang on glass.”
She tells the story of Robert Dziekanski, who died in-custody after a confrontation with police at the Vancouver International Airport:
Dziekanski touched down in Vancouver on Oct. 14, 2007, following a 13-hour flight from Poland and for 8 hours roamed the immigration lounge, steadfastly insisting that his mother would soon meet him. She, meanwhile, awaited his arrival in the baggage claims area, while airport officials did nothing to ensure the pair could connect. Lost, confused and unable to speak English, Dziekanski used office chairs to build a makeshift barricade between a pair of glass doors as if to ensure that no one could remove him from his meeting place with his mother. Obviously frustrated, he began to throw computer equipment onto the floor and against a glass wall. The police were summoned and in stunning sequence of events captured on video by an eyewitness’s cell phone, Dziekanski was pinned the floor, shot by a taser and eventually died.
The police said medical examiners determined that Dziekanski died of excited delirium.
In cases where an ‘excited’ person is restrained, tased and pinned to the floor and later dies, the excited delirium diagnosis introduces a level of ambiguity that absolves officers of responsibility for that person’s death. While most rational people would read these stories and conclude that, justified or not, it was the struggle and use of force that killed these individuals, excited delirium diagnoses shift the blame to the victim.
After all, isn’t this the primary tactic in law enforcement and criminal justice that got us to this very point of mass incarceration and extreme racism and brutality on behalf of cops and corrections officers? I do not believe the excited delirium diagnosis is all that different from the “super predator” myth of the 1990’s that helped fill American prisons by dehumanizing young black men as animalistic and aggressive. Instead of being treated as patients or just people in need of a crisis intervention, those who are said to have died of excited delirium are similarly labeled as dangerous monsters that needed to be put down.
In light of all of this, it’s fair to say Natasha McKenna’s purported cause of death could probably use an outside 2nd opinion.
h/t my old friend Kirk Murphy for bringing this to my attention