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Excited Delirium · Why We Do What We Do

0:03
You're listening to Why we do what we do. Welcome to Why we do
0:16
what we do. I am your suffocating host, Abraham, and I am
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your delirious host, Shane. We are a psychology podcast. We talk about
0:24
the things that people do and sometimes how we diagnose what those things are,
0:27
and sometimes when we just pretend that they do things that they don't actually do,
0:32
and sometimes animals and like politics and all kinds of other things. But
0:37
that's what we're that's what we're doing. If you found us for the first
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time, welcome, Glad to have you here. Yeah, stoked you're here.
0:41
And today is I think it gonna be pretty interesting because it's kind of
0:46
that thing that comes up where you know, it's it's almost like everybody is
0:50
is so cautious of this thing or worried about this thing, but it never
0:53
happens. It's like a cheopicabra almost. Yeah. I mean they say that
0:57
it happens like a cheop acabra, but it it doesn't happen. It doesn't
1:02
seem to happen that way. Nope. And And by today you mean August
1:04
second, which is National ice Cream Sandwich Day. Ah, Yes, what
1:08
a great day. It's also a National Coloring Book Day, so if you
1:11
would like to revert back to your childhood, today is the day to do
1:15
it. Yeah. This is take a penny, Leave a penny day and
1:17
not more than that. Steve. Yeah, yeah, we know, we
1:22
know what you're doing. It's also International Clown Week, so I guess if
1:26
you are not afraid of clowns, that's good. If you like counting clowns
1:30
coming out of cars though, It's International Mathematicians Week, so that's true.
1:36
But if you don't like any of that, that seems too complicated. This
1:38
week is also Simplify your Life Week. Indeed, for those of you for
1:42
whom you'd like to celebrate. This is also World Breastfeeding Week. Breastfeeding the
1:47
world. Good, good for y'all. I like that. It's also Back
1:49
to School Month, so at least in the United States, that's what we're
1:53
sending everybody back to school this year. My daughter is my daughter senior year,
1:57
so that's a thing. Whoa, yeah, and we started that's crazy,
2:01
all right, message of time, all right. It is also American
2:05
Adventures Month. I don't really know what that means, but that's the month
2:07
that weren't I guess, yeah, go see some stuff. I guess maybe
2:09
avoid some of the deserts right now because they're very hot, very hot.
2:14
It's also boomers making a difference month, so that's a change of pace.
2:17
Boomers learning zoom yeah, boomers on zoomers. All right, so today we
2:23
have an interesting and politically loaded topic, I think politically charged. Maybe if
2:30
you like what you hear today and you'd like to support the show, you
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can leave us a rating and review. You can subscribe so you get all
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the episodes. You can join us on Patreon, you can plant a tree
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and name that tree why we do what we do, And they'll talk more
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about the ways you can support us at the end of this discussion. But
2:44
as we're getting into this, it's important to acknowledge I want to let everyone
2:46
out there know trigger warning. This discussion is going to contain topics such as
2:51
brutal murders, torture, sexual violence and justice, racism and sexism. Now,
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I think we try to handle those as gently as we can. There's
3:00
also don't want to sugarcoat or whitewash things and sort of say it as it
3:05
is, So if you have trouble listening to those things, you might want
3:07
to set this one out, but we'll do our best to be sensitive in
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our discussion of this. I think we can't really talk about this thing without
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those things, and you'll see kind of what we mean as we go.
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But yeah, if those things are upsetting for you, it's okay to turn
3:22
it off and go to the next episode. So let's start with a story
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that I think eliminates the topic at hand. And this begins on December twenty
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third, twenty twenty, in Antioch, California. For those of you who
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are not up on United States geography, or maybe not on your California geography,
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possibly not on your Northern California geography, because that seems like a fairly
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small This is still in the Bay Area, so kind of over by San
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Francisco on the West coast of the United States. So this December twenty third,
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twenty twenty, in Antioch, California. Angelo Quinto a thirty year old
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Filipino veteran. He was having a mental crisis and during this time he reportedly
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threatened his family. He appeared aggressive. They were concerned that he might hurt
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himself or them or someone else, and he appeared just sort of angry.
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And so to try and deal with this. His mother, Cassandra Quinto Collins,
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she sort of put him in a bear hug to just sort of keep
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him restrained in together and in fear. While this is going on, his
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sister Bella called the police to also come, and obviously, like there's a
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whole discussion here about sort of emergency procedures, but she thought, I need
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to call the police because we're afraid that there's danger here, and so she
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did that. While they were sort of trying to hold him in a pseudo
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restraint iff. He will that's was sort of an upright bear hug, right,
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So when the police arrived, they pulled Angelo from his mother's arms,
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placed him in handcuffs, and laid him prone, face down on the ground
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and kneeled on his shoulders and back for five minutes, during which time Angelo
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begged not to be killed. So as they're kneeling on him, eventually he
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became unresponsive. The paramedics arrived, and they noted that there was blood on
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his face and also blood on the ground where his face had been pressed,
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and that his face was purplish in color, so they immediately begin life saving
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operations. Angelo is taken to the hospital, and at the hospital he never
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regained consciousness and was then pronounced dead three days later. Yeah, it's awful.
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The family understandably felt that the police used successive force that resulted in the
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unnecessary death of their brother and son, and after an investigation into his death,
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a forensic pathologist testified that the death was due to quote excited delirium,
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which they categorize as natural causes. So DA Deanna Beckton used this to justify
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the decision against pressing charges against the officers involved in Quinto's death. In response
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to this at a press briefing, there's a quote here It goes, quote
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what you did last Friday feels like Angelo was being killed in front of me.
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Again. This is Angelo's mother again. This is Cassandra to Collins Shoes
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outside of State Building in Oakland after hearing that there would be no further investigation
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into their son's death. It's awful. So this this begs the question of
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what the fuck is excited delirium? I mean, that's really what we're trying
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to answer here. This apparent psychological condition that's so severe that it leads to
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death. Suddenly we add to know, So we're so that's what this episode
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is really all about. We're going to dive into this concept of excited delirium,
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because if it's a natural cause, then we should all be really worried
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that it's going to come out of nowhere. But what we might find is
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it's not exactly natural. Yeah, just as you said, this is portrayed
6:35
as a psychological condition that is also sort of vaguely linked to medical condition.
6:41
But it seems to be at least partially, if not significantly, psychological condition
6:46
as far as we can tell. The term appears to have been coined in
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the early eighties, specifically nineteen eighty one. In nineteen eighty five and publications
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by doctor Charles Wetley and doctor David Fishbaane, and they were describing the behaviors
7:00
of people who were intoxicated with high levels of cocaine, and specifically, these
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are people such as drug mules who are smuggling cocaine intracorporeally, where the container
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of cocaine broke open inside of that person like they were they were smuggling in
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the right and then because it broke open inside of them, they received massive
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doses of cocaine which led to what they described as delirium and also death.
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Doctor Wetley and doctor Fishbaine sound like villains. Those are kind of villainous names,
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aren't they. Like Doctor Fishbaine sounds like one. That person's a villain.
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Like that person is definitely working on super string sharks. Actually, that
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doctor is probably the reason why we have cocaine sharks in Florida now. And
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you know what, I'm gonna go ahead and trigger my own vocabulary on myself
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for a world that I used in there, which was intracorporeally. Yes,
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this is such a good word because I think of corporeal as being ghosts related.
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Yeah, and that's specifically incorporeal, which basically means not having a body.
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Corporeal refers to a body, and therefore intracorporeal means inside the body.
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So basically, intracorporeally the way that I used it meant contained inside someone's physical
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body. Which maybe people have heard the joke about pooping a balloon, the
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idea being that people will consume or otherwise hide drugs in their system to carry
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across borders so that they don't have to try and hide it in their clothes
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or in their luggage or something like that where it could be easily found by
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drug dogs or just basic search and seizure procedures. Yep. So that's what
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that means. Said another way, people got drugs in their butt, Yeah,
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basically, and if the if the container that held those drugs popped,
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then they might die of an overdose, and before they die might exhibit some
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symptoms of delirium. So let's continue to sort of talk about Wetly and Fishbane
8:54
and their descriptions of excited delirium. These villains, all right, So Wetley
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extended his theory to explain the death of twelve black women in Florida who were
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presumably sex workers after they had consumed small amounts of cocaine. He hypothesized that
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the cocaine made men's psychotic because cocaine in combination with certain blood types, which
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was more common in black folks, is lethal. That was Wetley's argument.
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So clearly a villain. Yeah, and this is speculation at best, and
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that's really putting it much more nicely than it deserves. Eventually, a fourteen
9:28
year old girl died in similar circumstances without cocaine in her system. And so
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long story short about this whole situation here This is a two year period from
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about nineteen eighty six to nineteen eighty eight, and this last girl was fourteen
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year old, died in similar circumstances, did not have cocaine in her system,
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and so they relooked at this case in a different way. And that
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fourteen year old as well as those other twelve girls, even though they had
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been sex workers, because he had suspected that the cocaine was the cause of
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their death, they had not looked at this as homicide. Then when this
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fourteen year old died in similar circumstances, they did look at it a homicide
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and they discovered that she had been murdered, and the other twelve girls had
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also been murdered by strangulation from a serial killer that they then found. But
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they, of course we're not looking for when they were ruling these as natural
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cause deaths. Yes, so it's an unfortunate circumstance that you will find that
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many many police departments that experience a lot of like missing persons related to sex
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workers or anything like that, will write that off as oh, well,
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they're just transient, and tend to write a lot of sex workers off just
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on drugs, yeah, or they're just on drugs, and so they'll write
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a lot of folks that are sex workers off as just kind of like disposable.
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Yeah, so you'll end up with a lot of Jane Does and a
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lot of kind of cold cases as a result of just the fact that somebody's
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labeled a sex worker, which is completely unfair and unfortunate. And I think
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that we talked about sex workers in a previous episode, just of all about
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sex work. We did talk about that. Yeah, so you can go
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back and I think that we covered this and that, or at least part
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of that, the fact that they're so there's so few protections for those people
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because of the legal status. So, yes, a little bit more information
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in that episode. Yeah. Even then, even after the serial killer situation
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was found, Wetly insisted that because they had cocaine in their systems, they
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became overly stimulated during sex and that resulted in delirium and death. Presumably they
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got so worked up while engaging vigorous sex while they had cocaine in their system
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that they sort of spontaneously asphyxiated, I guess. And he continued to promote
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this idea, even claiming that quote seventy percent of people dying of coke induced
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delirium are blackmails even though most users are white. Why it may be genetic
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end quote. Oh god, that's so frustrating. Yeah, so you could
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really see the racism and misogyny was baked right into this idea at its very
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foundation that like the beginning place of this is the idea that black people basically
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belong to a different species that is more susceptible to these kind of medical conditions
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than other people, and it's something to do with their genes, supposes,
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even though there is no evidence for that whatsoever, and black people are literally
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just people who happen have more melitan in their skin. Right, It's an
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absurd theory. It's so frustrating. I'm sure there for folks listening, this
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is not a surprise, and I think that's an unfortunate thing too, Like
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it's it's unfortunate this is a theory that's come up and that's kind of like
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prevailed for some time. But it's also not a surprised that's something like this
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would come up from somebody in the scientific community who has like a particular agenda,
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you know, very much so, and we'll definitely get into that and
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I do want to clarify really really quick because I say that they're just people.
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What I'm trying to say here is that the idea of race is a
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construct, and so trying to overlay this concept of blackness on top of someone
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in that being a being linked to then different genetic susceptibilities to things like cocaine
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overdose or delirium doesn't make any sense because racist just this construct that does not
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explain that sort of thing, right exactly, making sure that's clear, right.
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So, inspired by this line of reasoning, a defense expert for a
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company that manufactured police weapons wrote a book with his wife entitled Quote Excited Delirium
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Syndrome, which they promoted by freely distributing at medical examiner and police chief conferences.
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So they would show up at these different conferences and promote this book.
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Yeah, and presumably this is when the idea really took hold. So you
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basically have this thing that a scientist has made up, you promote it to
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a bunch of people who are looking for a reason, and now we have
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excited delirium as like a thing that is that we're dealing with. Yeah,
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and presumably at the time they were doing this there was like five hundred registered
13:33
forensic pathologists or something like that, and whoever was like the people going to
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this conference these conferences, these medical examiners and whatnot, and they printed like
13:41
a thousand or fifteen hundred books so that they make sure they're plenty on hands
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that they could just hand them out freely to these people, so that they
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had this idea than as something to include in their sort of toolbox. And
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so at this point the description of excited delirium was fairly consistently described in a
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few ways. There's a lot of words that they use. They describe it
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as, quote bizarre and or aggressive behavior, shouting, paranoia, violence toward
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others, unexpected physical strength, and hypothermia hyperthermia I mean hot end quote.
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And then another description here is quote tolerance to pain, constant or near constant
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physical activity, failing to respond to police presence. Yeah, that's a medical
14:22
condition. Superhuman strength, rapid breathing, not tiring despite heavy exertion, naked
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slash inappropriate clothed also medical condition, apparently sweating profusely hot to the touch,
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and attraction to or destruction of glass specifically, and this comes from authors Jerastomulos
14:41
in the Encyclopedia Forensic Science second Edition from thirteen and C. A. Hall
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and the Encyclopedia of Forensic and Legal Medicine second Edition in twenty sixteen, respectively.
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For those two quotes, I inserted the sarcastic these are medical condition parts
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of those quotes. They didn't say that they did that, but it's just
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to me, it's funny to like use as part of your description of a
15:05
diagnosis destruction of glass inappropriately clothed, right, Like not listening, failure to
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attend to police presence. That's just such a weird, not like highly specific
15:18
thing, right, call like part of a diagnosis, right, a fever
15:22
something that occurs across the entire species. And not responding to police officers,
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that's specifically a behavior. Come on, let's let's be real here. Yeah,
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So what you'll find is, like many descriptions include superhuman strength, endurance,
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and generally psychotic behavior or abnormal behavior in that circumstance. To me,
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I'm reading these and I'm going, well, these could all be behaviors of
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somebody who is under the influence of something. Yeah, sure, but I
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would be hard breast to call that like a specific medical condition by itself,
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I'd look for something else, yeah, or diagnosable psychological condition. Right.
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Yeah, So anyway, let's let's be fair. I want to give a
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try and of a fair shake and get the opinions from the professionals, and
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the professionals in this case being advertisers. All Right, we're back, and
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we have a way of different professionals and different experts here. We're want to
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use what they say, and we're gonna try and I think charitably include their
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descriptions of why they think excited delirium is a good thing to be used to
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describe these deaths that are occurring from people in police custody. Yes, so,
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in defense of the idea of excited delirium, critics attempt to explain how
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death results from delirium through other underlying causes, in factors such as medical or
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psychological conditions or drugs eliciting over excitement. And what they do is they question
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the idea that someone could even die from being restrained prone with someone kneeling on
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their back. So they've kind of created this defense that excited delirium exists,
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and they will say, like, these other causes aren't actually the reason this
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person died. It's this excited delirium thing, and that like the fact that
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they're dying in police custody when they're being restrained in a prone position while someone
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kneels on their back, is unrelated to the fact that they're just a thing.
17:07
That's just a thing that happened. And so they tried to show that
17:11
by doing a few studies. And you might be asking, how do you
17:12
do studies where you lean on someone's back to the point of them dying in
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a controlled way, they didn't. So in a series of group designs,
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researchers doctors Theodore Chan and Gary vilk or Wilkey maybe took as many as fifteen
17:26
to thirty healthy young adults and placed them in prone position. Let me say
17:30
that again, fifteen to thirty healthy young adults who are presumably in pretty good
17:37
shape. They placed them in a prone position, restrain them in some experiments,
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and with up to fifty pounds of pressure on their back in the initial
17:45
studies up to two hundred and twenty five pounds and later studies, and also
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in later studies, they ask them to while they had that weight on their
17:52
back, move around vigorously to sort of create the conditions of maybe a heightened
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level of pressure on their chest cavity while also exerting themselves against that restraint,
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and their hypothesis here being, of course, then that if they don't die
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from this, then they can't die from this. Oh god, Okay.
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So they reported statistically but not clinically significant impairments to lung capacity and functionality.
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So they basically found that there was some impairment, but it wasn't that much
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in this space. That's what they reported, right, Yeah, not enough
18:30
to account for death. Not enough to account for death. Yeah. Essentially
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their conclusion was then that people cannot die of asphyxia from being kneeled upon their
18:37
backs, and this is not true. We're gonna talk about this later.
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And also there's something called positional asphyxiation. Do you talk about that later?
18:45
Yeah? Great, I can't wait to talk about that. Yeah. We
18:48
have a whole whole thing to talk about positional asphyxiation coming up here. So,
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not surprisingly, most of the academic support comes from researchers and disciplines that
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stand to face a pretty high level of scrutiny and at this point probably several
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instances of liability. If excited delirium proves to not in fact be a potential
19:07
cause of death. Sure, and so these people then in these sort of
19:11
academic circles, if you will, academic in heavy scare quotes, they instead
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downplay the extent to which death can be in any way attributed to the actions
19:19
of police, and even give recommendations for how to restrain someone in the exact
19:25
positions that they're likely to die of. I mean die of excited delirium,
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but you know that they're likely to die of, which is wild to me.
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So here's some some specific quotes of recommendations for giving restraint. This comes
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from a two thousand and five entry in the Encyclopedia of Forensic and Legal Medicine
19:45
by JD. Howard. Yes, so this is a direct quote. This
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is not a recommendation from us, by the way, yes, thank you.
19:49
Just to be really clear, Okay, so this is the quote.
19:52
Because of the extreme agitation that's often associated with excited delirium, a person may
19:57
have restraint devices applied to both the arms and the legs in order to be
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adequately controlled. Hobble restraint is used in reference to a variety of restraint techniques
20:06
intended to limit a person's leg movements. Commonly, this refers specifically to the
20:11
simultaneous use of handcuffs and leg restraints, a technique that is also called hog
20:15
tying. The quote goes on the person putting the handcuffs and ankle bindings on
20:19
the person being restraint often places a knee and weight on the back of the
20:23
individual during the process, resulting in chest compression end quote. So that is
20:30
how they explain what to do in these situations. Yes, Abraham did a
20:33
really good job of like finding a great picture of what this would look like.
20:38
Yeah, without the pressure on the back, but a very clear hog
20:41
tying. It's basically your hands are behind your back and they're tied to your
20:45
ankles behind your back, and so you're laying on your stomach with your hands
20:48
and ankles tied together. That is how they sort of describe it. So
20:52
that is essentially how they're describing and recommending and defending the use of these types
20:59
of tech niques and why they think that they do not result in excited delirium.
21:03
Probably more biased than I wanted to make it, but it's hard hard
21:07
to write about these things without laughing at the ridiculousness of it all sometimes.
21:12
But so let's let's look at the critics, though, I think it's worth
21:15
still unpacking what they have to say about this and specifically this idea of excited
21:22
delirium as a contribution to the death of people in kind of any circumstances,
21:26
but specifically in police custody. Right, So one of the big arguments is
21:30
that, and specifically critics that argue against these studies. What they do is
21:34
they'll say, one that the samples are too small, Yeah, fifteen to
21:38
thirty, Yeah, it's fair, and a group designed. Yeah, that's
21:41
very very small. That's very very small. And second that in one instance,
21:45
there was no evidence that IRB approval was obtained, which calls in the
21:48
question whether the study itself was conducted with integrity, with the right safeguards in
21:52
place. There's a lot to kind of unpack within the situation where there's not
21:56
like an IRB specifically overseeing those those studies. Yeah, very much. So.
22:02
They also argue that the studies include a nonrepresentative sample of participants because they're
22:07
using these sort of healthy, young, fit, sober adults that they've measured
22:12
with, and they also had a nonrepresentative sample of conditions under which death occurs
22:18
because they couldn't really simulate that. I mean, this is understandable here,
22:22
the researchers could not create the actual condition that would result in participant death.
22:29
Right for research, they can't do like life threatening what like known life threatening
22:33
activity for the safety of the participants. And to be clear, the critics
22:37
are not arguing that they should try and accomplish the scenario that simulates closely enough
22:44
like life threatening conditions, because then people again would die and necessarily we don't
22:49
want that to happen. So they're kind of pointing out that it's nearly impossible
22:52
to do good research on that question specifically, right. They also found that
22:57
other aspects of their methodology were dubious at best, which dubious is such a
23:02
great word. Yeah, I feel like whenever I say I had to say
23:04
dubious, and that there are clear conflicts of interest and bias among the researchers
23:08
and the research teams. So like that in itself is enough to be able
23:14
to call into question at least even a healthy skepticism about these studies. When
23:18
you're going into this and you're looking at this from a critical research lens,
23:22
you have to know these things about the studies that are being published very much.
23:25
So, now as we kind of alluded to this already, as we
23:29
were giving the description of what excited delirium is, we said things just to
23:33
sort of refresh your memory on this, but we said things like bizarre aggressive
23:37
behavior, unexpected physical strength, failing to respond to police presence, not tiring
23:45
despite heavy exertion, inappropriate clothing. And I think a listeners may have noticed
23:49
at this point that these are sort of fuzzy, ambiguous definitions and criteria that
23:55
are being used to describe this excited delirium. Now, surely there are clear
23:59
medical or psychological symptoms and etiology that can be a diagnose that clearly show excited
24:04
delirium. Yeah, so, if we had to ask, no, excited
24:08
delirium is not a medical or psychological condition recognized by any professional or a medical
24:14
association. The DSM has a definition for delirium more broadly but explicitly states that
24:19
delirium cannot be a cause of death. So there's already like a I mean,
24:23
we've got a lot to say about the DSM anyway, but at the
24:26
very least, there is a widely accepted book that says no, this is
24:30
not a cause of death. The ic D also does not contain excited delirium
24:34
as a referenceable cause of death. It is always diagnosed post mortem, but
24:40
always in cases of ambiguous or even vaguely arguably ambiguous types of situations. It
24:45
is a catch all meant to give some cause when you don't have another one
24:49
or you don't want another one. And I think that seems really convenient for
24:56
a large department that wants to reduce their liability and they don't want to get
25:00
in trouble. It sounds like this might be a really good way out.
25:03
Yeah. Now, there's an important part here that I think maybe the proponents
25:07
of excited delirium like to point to, which is that there is a higher
25:11
rate of mortality among people with mental health issues, and that in a lot
25:15
of these situations where police are called and they have a death that is then
25:21
later attributed to excited delirium, these are often people who are in the throes
25:26
of a mental health crisis of some kind, such as we described at the
25:30
beginning of this discussion in the case of Angelo Quinto. Right right, and
25:33
to a point, this is true because life expectancy is ten to twenty years
25:38
shorter among people with a mental health diagnosis or psychiatric patients compared to non psychiatric
25:45
patients or non diagnosed adults of similar demographics right now. Often there are correlated
25:51
medical conditions that increase the likelihood of mortality among people with mental health disorders.
25:56
There are often physical diagnoses that also then have an impact on cognition, and
26:00
therefore they receive a psychiatric or mental health disability, and those medical complications also
26:06
are associated with a higher rate of mortality, meaning that those people with that
26:10
mental health diagnosis also then have a higher rate of mortality. But what are
26:14
the causes of death among the population of people, more generally speaking, who
26:18
simply have a psychiatric diagnosis. Well, a twenty eighteen study by Monasterio I
26:23
think is how you say that and colleagues reported that the causes of death among
26:27
people with mental health diagnoses were suicide, motor vehicle accidents in falls, medical
26:33
causes mostly cardiac arrest, and homicide in that order, and with suicide making
26:41
up over half of all of those deaths, so all the rest of them
26:44
are fairly small percentages, where by the time you get to homicide it's like
26:48
one percent you'll notice in there I did not say that these were actually caused
26:52
by a psychological condition itself, and there are actually not a lot of acute
26:59
psychological conditions that do result directly in death. That's an critical thing here,
27:03
especially when you have corners or medical examiners who are reporting that excited delirium is
27:11
a cause of death even in post mortem, that they're kind of diagnosing this
27:14
right, because at the end of the day, it cannot be. The
27:17
consistent factor in deaths attributed to excited delirium is the restraint itself. People are
27:22
not dying suddenly of excited delirium when they are being restrained in a supine which
27:26
is on your back facing up, yeah, or an upright position and without
27:30
neck or chest compressions. The pro position restraint has been condemned by many organizations,
27:36
including the US National Institute of Health, and are frequently cited as unsafe
27:41
and more likely to result in death. Yes, this is where we really
27:45
start to get into this positional asphyxia as you are talking about. And so
27:51
I think acknowledging that we're actually through sort of the bulk of the main part
27:56
of excited delirium here. So this will definitely be a shorter episode. Let's
28:00
take one more quick ad break. We might throw it squeeze in one more
28:03
at the end, but we're gonna take another quick ad break and then we'll
28:06
come back and talk a little bit more about this positional asphyxia and some other
28:11
things about the implications of excited delirium. I love it. Okay, so
28:22
we're back. Let's talk more about some of the implications of excited delirium as
28:27
it relates to professional organizations. So, according to the Physicians for Human Rights
28:33
organization, excited delirium syndrome quote has come to be used as a catch off
28:37
for deaths occurring in the context of law enforcement restraint, often coinciding with substance
28:41
use or mental illness, and disproportionately used to explain the deaths of young black
28:47
men and police encounters end quote. So that's a lot to unpack. Yeah,
28:52
super important though, to understand what our data are suggesting right now,
28:57
right, and so this is something that we kind of haven't really alluded to
29:00
yet, is the fact that it occurs at a much higher rate with people
29:03
of color specifically. And another thing that people might be thinking about here is,
29:08
well, if these are medical examiners and coroners who are making this diagnosis,
29:12
then like they're just get receiving the body and then saying what they see,
29:18
and they have as one of their things that they can call this excited
29:22
delirium. So presumably they're using some level of objective criteria to do that.
29:27
Well, not really, As we said, first of all, there aren't
29:30
any objective criteria. They often have to if they're going to giuse that as
29:34
we described in the definition of excited delirium, they kind of have to rely
29:38
on some police report because they can't look at a body and say were they
29:44
failing to acknowledge police presence? Right, you know, that's not going to
29:47
be something that's immediately and medically evident. And furthermore, what's important here is
29:51
that a lot of these medical examiners and coroners exist as part of police departments.
29:56
And there's been a really big call for trying to move medical examiners and
30:00
corners to independent, third party systems because a survey of members of the National
30:07
Association of Medical Examiners found that twenty two percent of the members reported feeling pressured
30:12
by political or authority figures to change the manner of death that they listed on
30:17
the cause of death certificate, and so in house there is a baked in
30:22
bias and the potential of pressure from authority figures to specifically call it excited delirium
30:29
even when they have already ruled it as something else. It seems unrealistic to
30:33
think that a police department might be corrupt in any way. So this is
30:37
breaking news for me. I never would have thought that departments that, like
30:41
you know, really were really into the war on drugs could not imagine that
30:45
they would want to pressure people into changing document. How could this happen?
30:49
How do those were here just police in my day? I can't even finish
30:56
that sentence. Although the National Association of Medical Examiners or NAME has contained most
31:02
are many of the people who have championed excited delirium as a cause of death.
31:06
The more recent position statements from NAME say the excited delirium as a term
31:11
is quote not endorsed by NAME or recognized in renewed classifications of the who ICD
31:17
ten. In DSM five. Instead, NAME endorses the underlying cause natural or
31:22
unnatural, to include trauma, or for the delirium state be determined if possible,
31:27
and used for death certification end quote. So basically what they're saying is
31:33
they're not going to use excited delirium anymore as an organization. Yeah, they
31:37
basically they don't recognize that that would be a cause of death. That they
31:40
recommend that they look for other conditions that would more readily attribute to cause of
31:44
death. And although they didn't say this in their position statement, that's going
31:47
to be asphyxia in almost all of them. Yes, Now, if you
31:51
think about all of the interactions that might happen with police, no matter what
31:55
side of the spectrum all you are on here in terms of like really for
31:59
the use of police tactics or really against them anywhere in between, there are
32:02
many many reasons a person might die in police custody, Right, So you
32:07
would think that any one reason would actually make up relatively small proportion because there's
32:12
just there's so many options, Like even if one of them was more than
32:15
another, you'd be like, well, there's like a thousand ways that someone
32:19
might die that would be even unrelated to something that police did, you know,
32:22
directly, not to mention the thousand ways that they might die by something
32:25
that police did do directly, Right, And so if you have that many
32:30
reasons, then there's not going to be any one of them that ever makes
32:32
up more than like one percent of the reasons. Yet there is this one
32:37
cause of death that kind of rises to the top as one of the most
32:39
common reasons people die in police custody. In fact, here's some numbers about
32:45
that very thing. Yeah, real data. More than sixteen percent of deaths
32:47
that occurred in police custody in Texas from two thousand and five two seventeen were
32:52
reported as due to excited delirium. Sixteen percent of those deaths. Yes,
32:58
there's a very large percentage for again, the thousands of ways that someone might
33:01
die, right. Sixty two percent of deaths due to excited delirium that occurred
33:05
in Florida were people in police custody from two thousand and ten to twenty twenty
33:09
two. This state. You know, it's just like you can't I can't
33:15
get away from it. Like every time I'm just like just you know,
33:17
it's it's that thing where like you you're disappointed in somebody, you don't think
33:22
they could go any lower, and they just keep doing it. Like Florida
33:24
is that thing for me. It's like, God, you're beautiful. But
33:28
what's wrong with you? Yeah? Exactly, all right, Yeah, it
33:31
is a beautiful state. It is beautiful. It's beautiful. There's a lot
33:35
to see here. But good lord, yeah, can we just get something
33:39
right government? There is a mess. It's a mess. Fifty six percent
33:45
of deaths due to excited delirium and police custody. We're black and Latin X
33:49
folks, so fifty six percent. Fifty six percent is so high. I
33:53
mean, the percent of the population that is represented by black and Latin X
33:58
folks is so much less than Like, they are not fifty six percent of
34:02
the population. They're not even fifty six percent of people who are arrested by
34:07
police, and yet they represent the majority of death due to excited delirium and
34:12
police. That by itself is an extremely alarming statistic. In my mind,
34:15
that's a red flag. You should see that and go, oh, that's
34:19
a problem. Yeah, there might be something wrong there. Yes, So
34:22
here's the important thing. So the simple solution here is to stop restraining people
34:28
by placing them in a prone position with weight on their back or neck and
34:30
really honestly in a prone position at all. In fact, let's let's stop
34:34
all three of those things separately. No prone restraints, no weights or pressure
34:38
on the neck, no weights or pressure on the back. So let's let's
34:42
actually talk for a second about positional asphyxia. So, if you're not familiar
34:46
with this term positional asphyxia, it just means that your airway is restricted because
34:52
of a position that you're in. Y So, for example, if you've
34:54
ever laid down a certain way or laid in a certain position and it was
34:58
very difficult to breathe, that's an example of how positional asphyxiation can lead into
35:02
cause of death. As somebody who's a restraint trainer, one of the things
35:06
that we are taught and whenever we do a prone positioning for somebody who might
35:10
be in a like a restraint during a crisis management circumstance, we are told
35:15
explicitly to not put any pressure on the trunk or the torso of the person.
35:20
Yeah, like you're not supposed to be touching their neck, you're not
35:22
supposed to be putting your hands or your knees or any part of your body
35:23
on their back or their chests or anything like that. And to be clear,
35:27
this is you didn't put them in a prone position. They happen to
35:30
be in a prone position in this condition, right, yeah, now,
35:32
And further to add to this, there are some medical conditions that in a
35:36
prone position increases the risk of death. So like if I am overweight a
35:40
significant degree, if I have breathing airway issues. Yeah, a lot of
35:45
times what they'll say is like, if you have somebody who has down syndrome,
35:47
they should not be put in a prone position because they are an asphyxiation
35:51
risk just based on the structures of their mouth and tongue in their breathing airways
35:55
and so so, positional asphyxiation is just that I am put in a position
35:59
that I cannot breathe and my airways are restricted. Now does this sound familiar
36:04
when we're talking about somebody being on their stomach with somebody pressing on their on
36:08
their chest cavity or their back. They're pressing on this part of your body
36:13
that is supposed to expand to gather breath. Yeah, exactly. And just
36:16
as you were saying, we're trained that, I mean even in someone as
36:21
soup pine. So we've been talking about proposition meaning face down, even if
36:23
they're souppine, which means they're face up. We're still trained. You do
36:27
not put pressure on their on any place on their torso you can block arm
36:31
movements, you can block leg movements, but you do not put pressure because
36:36
there's just the additional risk of any kind of medical emergency that might come from
36:43
squishing people's organs like their lungs, their heart, their stomach, their intestines,
36:46
anything like that. Don't do it. And this is many many governments
36:52
and medical organizations and medical government government like affiliate affiliations have come out and basically
36:59
said, don't use prone restraint. Don't put someone in prone positions. Like
37:02
people will arrive in prone positions. They tripped and fell, they threw themselves
37:07
down, there might be many reasons that they end up prone. But you
37:10
do not put someone in a prone position. If you can get them into
37:14
a supine position safely, then you can do that. If you need to
37:16
restrain them, restrain them in an upright or supine position. But no matter
37:21
what, don't put compression on their chest or airways because that can kill them.
37:25
And that's just something that we know, so you don't do it.
37:29
Right. So police are even generally aware of this, although it seems that
37:34
within this kind of space and within the space of excited delirium. Many of
37:38
them see excited delirium as a kind of mystical, spurious cause of death to
37:43
avoid feeling responsible, I would imagine. So. For example, while Minneapois
37:46
police officer Derek Chauvin or Chauvin knelt on George Floyd's neck, one of his
37:52
fellow officers, Thomas Lane, suggested, quote roll them on his side,
37:55
I just worry about the excited delirium or whatever end quote actually came up in
38:00
George Floyd's case. Yeah, he might accidentally die from a thing that's not
38:06
your fault because you're kneeling on his neck. Yeah, yeah, yeah,
38:12
yeah, in that space if you were to pick that apart, if it
38:15
were excited delirium and that were a real thing, it wouldn't matter what position
38:17
he was in. He would end up dying from the excited delirium, right
38:21
exactly. So rolling him over wouldn't have changed that. But suggesting to roll
38:24
him over suggests that we know it's not a real thing. We know that
38:29
you're probably going to cause a problem. Yeah, Oh, I think suffice
38:32
it to say kind of it would probably more to say, but prone restraints
38:37
and Chester neck compressions are completely unnecessary to ever sufficiently restrain someone. There are
38:43
other less risky restraints that can always be used to successively subdue aggressive behavior that
38:50
do not depend on putting someone in a prone restraint. Right, I think
38:53
we just need to outright say no more prone restraints. That will solve so
38:58
many of these problems, like so many of them. So like, let's
39:02
just do that, because we can successfully easily restrain people without putting their lives
39:08
at risk by virtue of just having them in an appropriate position or applying undue
39:14
compression to their breathing in airways. Right, It's also worth taking a moment
39:17
to evaluate what circumstances led me to a point where I need to restrain somebody,
39:22
Like how did I get to this place where I would need to even
39:24
do that? If it's something that you can avoid in the future, that's
39:28
the best way to go, Like, it's best to set up a circumstance
39:30
so you don't need to restrain somebody. Yeah, there's so many things that
39:34
can lead up to it, And I'm not going to go out there and
39:36
say that, like, no restraint ever is the thing, because I've been
39:39
in situations where I've used my hostage negotiation tactics and all the things that come
39:45
up that like to kind of prevent and de escalate. Sometimes it doesn't work,
39:49
But I can count on one hand how many times I've ever had to
39:51
use a prone positioning for a restraint, and that was, i mean ten
39:54
years ago, so I've been able to move away from that. So yeah,
39:59
I think it's probably worth just stopping and saying and kind of like maybe
40:02
summing all this up right, what is excited delirium? It's nothing, It's
40:07
made up. Yeah, It's something that some police departments pressure corridors to put
40:12
on paperwork, is what it is. It's not a real psychological event as
40:15
far as the psychological and medical fields are concerned. Is a description applied to
40:20
situations in which someone died at the hands of someone else and that someone else
40:23
wants to escape culpability by saying it was something that just happened, and specifically
40:30
it is used to target people of color in these spaces. Yeah, from
40:34
the get go, it was established to be a thing that happened to people
40:37
of color only, and that is how it has turned into something that is
40:42
used so much today. Yes, so that's kind of it, Like this
40:45
whole idea of excited delirium, it adds up to a big old nothing burger
40:51
in terms of it what it actually is. I think how it's used is
40:54
potentially the more interesting thing here and understanding it is. On the one hand,
40:59
I kind of want to be sensitive to the fact that I want to
41:04
almost celebrate that police feel bad enough about killing someone an accident that they want
41:09
to take the responsibility off of themselves. It makes me happy to think that
41:14
they care that they killed somebody and that they feel bad about that, right,
41:19
I mean just that like they don't have that as a value that like
41:22
murder is not something they actively seek to do. I mean, obviously many
41:25
of them do, but in many of these cases they're like trying to absolve.
41:29
And maybe it's just legal culpability. Maybe that's the only thing. But
41:32
I would like to choose to believe that, like there's some amount of like
41:36
I don't want to be responsible for another humans death that might enter into at
41:39
least some of their consciousness as they're in the situation that they would like to
41:45
invoke this so that they don't have that wane on them. Now. I
41:49
think that as being in my mind extremely generous to the vast majority of people
41:53
for whom this has been the case. And I don't want to be accused
41:58
of sort of trying to, you know, take a specific side of the
42:01
people who are the perpetrators of the case, where there are people who are
42:06
being victimized by the brutality of these authority figures. But what I am trying
42:10
to do is take the nuanced position of is there silver lining here at all?
42:15
And the silver lining, if I can see any, is that there
42:19
might be the desire to not kill people, and that then they feel like
42:23
that that's how they try and get that off of their mind, and that
42:28
just makes me feel better that they don't want to kill people. But I
42:30
am speculating wildly at this point. Yeah. Yeah, again, being way
42:34
nicer than I need to be. Yeah, yeah, because it's still a
42:36
thing that happens, and it's still terrible. Yeah. So a couple of
42:40
the quick interesting things I thought just that there's a lot of names for this.
42:44
So if the whole time you've been here and excited to let him and
42:45
being like, I don't know what that means, but I have heard of
42:47
Bell's mania, Well, in that case, same thing there's also a psychosis
42:52
with exhaustion. This is actually tricky because I heard this and in a separate
42:57
discussion on a podcast, and I could find no references to any but a
43:00
calling it that, even looking over the timeline of it. So I'm not
43:02
sure where that one came from, but I did hear it you, so
43:05
I thought i'd at least mention it here. I also saw as terms that
43:08
people might use to describe this agitated delirium, restraint asphyxia, and as we
43:14
noted before, positional asphyxia. So some of the fun things they're not fun,
43:17
which you know, yeah, and which you know, agitated delirium and
43:22
restraint asphyxia are two very different things, right like when you really understand when
43:25
you look at the ideology of or like the etymology of that, right like
43:30
when you look at kind of yeah, what like these come from. Agitated
43:32
delirium is suggestive of a psychological disorder, where restraint asphyxia is very clearly a
43:38
circumstantial thing. Okay, well, I think we actually didn't make it to
43:42
another ad break. So we are going to say yeah, thank you,
43:45
as we're going to acknowledge our team. We're going to give you if you're
43:47
joining us for the first time, you may not know this, but we
43:50
actually like to end with one I think as one of one of the more
43:52
fun segments of every piece that we do, which is we get some We
43:55
give some recommendations for things that we have enjoyed recently, so if you want
44:00
to, you can go check them out, and you don't have to.
44:01
Of course, we'll let the advertisers do their thing and then come back with
44:05
our sort of wrap up here. Okay, as I always like to end
44:15
on, they'll try and keep this relatively brief because I spend a lot of
44:19
time on this every episode, and I know that people who have been with
44:21
us for a long time have heard this just many, many, many times.
44:23
You can support us by picking up merch on our website, and you
44:25
can join us on Patreon, where you get access to extra perks and benefits.
44:29
The people who have already done that way we appreciate so much includes Mike
44:31
m Megan, Laila, Mike t, Justin, Kim, Joshua, Brad,
44:36
Stephanie, Olivia and Brian. Thank you all for your awesome support.
44:39
You are the best. If you join us, you get a shout out
44:42
just like they did. Yeah, you can also support us by leaving us
44:45
a rating and review, subscribe, tell of friends, do all that sort
44:49
of stuff. Thank you so much to my team for their help. Shane
44:52
and myself do a lot of writing and fact checking, and all of our
44:54
editing and production and sound comes from Justin Greenhouse and a social media coordinator is
45:00
Emma Wilson. This is a group of people I could not do without.
45:02
Now, without further ado, do we have anything before we get to our
45:06
recommendations? I don't think so. I think we can just jump right in.
45:08
Let's recommend some things, all right, recommendations. So at the time
45:21
it's recording, it's been a couple of Fridays since this one. There was
45:23
just one very special Friday where all this really new music, like really good
45:28
new music, came out and it was like album after album after album,
45:31
and I've been like kind of spending a lot of time with those albums from
45:35
that day. And the one album that I gotta say I've been a big
45:37
fan of is Chambers A Love to Kill for. Okay, if you have
45:43
not heard Chamber, I'm gonna go ahead and say, if you are somebody
45:45
who is trying to find that Dillinger Escape Plan kind of analog. Yeah,
45:52
this is a good place to go. My friend described it as this.
45:54
He was making lasagna and the lasagna came out like while he was listening to
45:59
this, he was making lason. You listening to this, and the lason
46:00
it came out tasting like a fight. Listen to a chamber I love to
46:06
kill for. Oh yeah, listen to chamber. I love to kill for.
46:07
Wow, it's very like chaotic. The drummer is really incredible. I
46:12
mean, when you listen to it, you're like, this is wild.
46:14
It's very angry. So if you don't like stuff like this, then you
46:17
know, go listen to suicide machines like we talked about earlier, and have
46:21
some fun for our patrons bonuses. But it's definitely a good listen if you
46:24
like that type of like kind of heavy, chaotic kind of like if you're
46:30
a fan of Not Loose, if you're somebody who knows who Knoed Loose is
46:32
listening to this, then you might like this because it's a little bit more
46:35
interesting. I think, all right, fair enough, well, I love
46:37
Dillinger Escape Plan, so I you very much have piqued my interest. I
46:42
think you'll like this band a lot. That's awesome. I did that.
46:45
I actually I should have this as my recommendation because I just recently went through
46:49
the Dillinger Escape Plans entire discography again and so good, so much fun,
46:53
really good stuff. But I'll maybe save that for another day. Just consider
46:57
that as a bonus. Off the cuff. I said a thing that you
47:00
might like. Yeah, But my actual recommendation is a movie that came out
47:04
somewhat recently on Netflix called The Outlaws. This is a very silly action adventure
47:10
comedy sort of thing that I don't want to spoil too much about, but
47:15
suffice it to say it's about two people who are getting married and the groom
47:20
meets the bride's parents, who are very eccentric people, and they're a wacky
47:25
adventure ensues, and so I think it's supposed to be a pun on The
47:30
in Laws instead called The Outlaws. It's a fun, fun time if you're
47:34
into like a sort of turn your mind off and just watch a silly,
47:37
funny action adventure movie. Not terribly long. It Scott Pierce brosn and and
47:40
it a lot of other notable actors, but just a fun movie. I
47:45
love that. I like movies that are just fun, like you don't have
47:47
to like overthink it? You know, yes, this is not an overthink
47:51
it type movie, but hasn't good comedy beats in it? So good?
47:53
All right? If you have something to say about Excited Delirium, I'd like
47:57
to tell us how great of a job that we did. You should reach
47:59
out to us to so you can reach us on social media. You can
48:00
email us directly info at WWDWWD podcast dot com. We look forward to hearing
48:06
from each and every one of you and all that you have to say.
48:07
And as I said, consider joining us on Patreon to help support what we're
48:12
doing in this show. Is there anything that I miss or anything you would
48:14
like to add before we wrap up today? Shane, No, I think
48:16
that covers it perfect. This is Abraham and this is Shane. We're out.
48:20
See. Yeah, you've been listening to Why We Do what We do.
48:23
You can learn more about this and other episodes by going to WWDWWD podcast
48:30
dot com. Thanks for listening and we hope you have an awesome day