Excited Delirium

Episode Transcript
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(00:03):
You're listening to Why we do whatwe do. Welcome to Why we do
what we do. I am yoursuffocating host, Abraham, and I am
your delirious host, Shane. Weare a psychology podcast. We talk about

(00:24):
the things that people do and sometimeshow we diagnose what those things are,
and sometimes when we just pretend thatthey do things that they don't actually do,
and sometimes animals and like politics andall kinds of other things. But
that's what we're that's what we're doing. If you found us for the first
time, welcome, Glad to haveyou here. Yeah, stoked you're here.
And today is I think it gonnabe pretty interesting because it's kind of

(00:46):
that thing that comes up where youknow, it's it's almost like everybody is
is so cautious of this thing orworried about this thing, but it never
happens. It's like a cheopicabra almost. Yeah. I mean they say that
it happens like a cheop acabra,but it it doesn't happen. It doesn't
seem to happen that way. Nope. And And by today you mean August
second, which is National ice CreamSandwich Day. Ah, Yes, what

(01:08):
a great day. It's also aNational Coloring Book Day, so if you
would like to revert back to yourchildhood, today is the day to do
it. Yeah. This is takea penny, Leave a penny day and
not more than that. Steve.Yeah, yeah, we know, we
know what you're doing. It's alsoInternational Clown Week, so I guess if
you are not afraid of clowns,that's good. If you like counting clowns

(01:30):
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But if you don't like any ofthat, that seems too complicated. This
week is also Simplify your Life Week. Indeed, for those of you for
whom you'd like to celebrate. Thisis also World Breastfeeding Week. Breastfeeding the
world. Good, good for y'all. I like that. It's also Back
to School Month, so at leastin the United States, that's what we're

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sending everybody back to school this year. My daughter is my daughter senior year,
so that's a thing. Whoa,yeah, and we started that's crazy,
all right, message of time,all right. It is also American
Adventures Month. I don't really knowwhat that means, but that's the month
that weren't I guess, yeah,go see some stuff. I guess maybe
avoid some of the deserts right nowbecause they're very hot, very hot.

(02:14):
It's also boomers making a difference month, so that's a change of pace.
Boomers learning zoom yeah, boomers onzoomers. All right, so today we
have an interesting and politically loaded topic, I think politically charged. Maybe if
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about the ways you can support usat the end of this discussion. But
as we're getting into this, it'simportant to acknowledge I want to let everyone
out there know trigger warning. Thisdiscussion is going to contain topics such as
brutal murders, torture, sexual violenceand justice, racism and sexism. Now,

(02:57):
I think we try to handle thoseas gently as we can. There's
also don't want to sugarcoat or whitewashthings and sort of say it as it
is, So if you have troublelistening to those things, you might want
to set this one out, butwe'll do our best to be sensitive in
our discussion of this. I thinkwe can't really talk about this thing without
those things, and you'll see kindof what we mean as we go.

(03:19):
But yeah, if those things areupsetting for you, it's okay to turn
it off and go to the nextepisode. So let's start with a story
that I think eliminates the topic athand. And this begins on December twenty
third, twenty twenty, in Antioch, California. For those of you who
are not up on United States geography, or maybe not on your California geography,
possibly not on your Northern California geography, because that seems like a fairly

(03:43):
small This is still in the BayArea, so kind of over by San
Francisco on the West coast of theUnited States. So this December twenty third,
twenty twenty, in Antioch, California. Angelo Quinto a thirty year old
Filipino veteran. He was having amental crisis and during this time he reportedly
threatened his family. He appeared aggressive. They were concerned that he might hurt

(04:03):
himself or them or someone else,and he appeared just sort of angry.
And so to try and deal withthis. His mother, Cassandra Quinto Collins,
she sort of put him in abear hug to just sort of keep
him restrained in together and in fear. While this is going on, his
sister Bella called the police to alsocome, and obviously, like there's a

(04:27):
whole discussion here about sort of emergencyprocedures, but she thought, I need
to call the police because we're afraidthat there's danger here, and so she
did that. While they were sortof trying to hold him in a pseudo
restraint iff. He will that's wassort of an upright bear hug, right,
So when the police arrived, theypulled Angelo from his mother's arms,
placed him in handcuffs, and laidhim prone, face down on the ground

(04:49):
and kneeled on his shoulders and backfor five minutes, during which time Angelo
begged not to be killed. Soas they're kneeling on him, eventually he
became unresponsive. The paramedics arrived,and they noted that there was blood on
his face and also blood on theground where his face had been pressed,
and that his face was purplish incolor, so they immediately begin life saving

(05:13):
operations. Angelo is taken to thehospital, and at the hospital he never
regained consciousness and was then pronounced deadthree days later. Yeah, it's awful.
The family understandably felt that the policeused successive force that resulted in the
unnecessary death of their brother and son, and after an investigation into his death,
a forensic pathologist testified that the deathwas due to quote excited delirium,

(05:35):
which they categorize as natural causes.So DA Deanna Beckton used this to justify
the decision against pressing charges against theofficers involved in Quinto's death. In response
to this at a press briefing,there's a quote here It goes, quote
what you did last Friday feels likeAngelo was being killed in front of me.

(05:55):
Again. This is Angelo's mother again. This is Cassandra to Collins Shoes
outside of State Building in Oakland afterhearing that there would be no further investigation
into their son's death. It's awful. So this this begs the question of
what the fuck is excited delirium?I mean, that's really what we're trying
to answer here. This apparent psychologicalcondition that's so severe that it leads to

(06:17):
death. Suddenly we add to know, So we're so that's what this episode
is really all about. We're goingto dive into this concept of excited delirium,
because if it's a natural cause,then we should all be really worried
that it's going to come out ofnowhere. But what we might find is
it's not exactly natural. Yeah,just as you said, this is portrayed
as a psychological condition that is alsosort of vaguely linked to medical condition.

(06:41):
But it seems to be at leastpartially, if not significantly, psychological condition
as far as we can tell.The term appears to have been coined in
the early eighties, specifically nineteen eightyone. In nineteen eighty five and publications
by doctor Charles Wetley and doctor DavidFishbaane, and they were describing the behaviors
of people who were intoxicated with highlevels of cocaine, and specifically, these

(07:04):
are people such as drug mules whoare smuggling cocaine intracorporeally, where the container
of cocaine broke open inside of thatperson like they were they were smuggling in
the right and then because it brokeopen inside of them, they received massive
doses of cocaine which led to whatthey described as delirium and also death.

(07:27):
Doctor Wetley and doctor Fishbaine sound likevillains. Those are kind of villainous names,
aren't they. Like Doctor Fishbaine soundslike one. That person's a villain.
Like that person is definitely working onsuper string sharks. Actually, that
doctor is probably the reason why wehave cocaine sharks in Florida now. And
you know what, I'm gonna goahead and trigger my own vocabulary on myself

(07:47):
for a world that I used inthere, which was intracorporeally. Yes,
this is such a good word becauseI think of corporeal as being ghosts related.
Yeah, and that's specifically incorporeal,which basically means not having a body.
Corporeal refers to a body, andtherefore intracorporeal means inside the body.

(08:09):
So basically, intracorporeally the way thatI used it meant contained inside someone's physical
body. Which maybe people have heardthe joke about pooping a balloon, the
idea being that people will consume orotherwise hide drugs in their system to carry
across borders so that they don't haveto try and hide it in their clothes

(08:31):
or in their luggage or something likethat where it could be easily found by
drug dogs or just basic search andseizure procedures. Yep. So that's what
that means. Said another way,people got drugs in their butt, Yeah,
basically, and if the if thecontainer that held those drugs popped,
then they might die of an overdose, and before they die might exhibit some
symptoms of delirium. So let's continueto sort of talk about Wetly and Fishbane

(08:54):
and their descriptions of excited delirium.These villains, all right, So Wetley
extended his theory to explain the deathof twelve black women in Florida who were
presumably sex workers after they had consumedsmall amounts of cocaine. He hypothesized that
the cocaine made men's psychotic because cocainein combination with certain blood types, which

(09:15):
was more common in black folks,is lethal. That was Wetley's argument.
So clearly a villain. Yeah,and this is speculation at best, and
that's really putting it much more nicelythan it deserves. Eventually, a fourteen
year old girl died in similar circumstanceswithout cocaine in her system. And so
long story short about this whole situationhere This is a two year period from

(09:37):
about nineteen eighty six to nineteen eightyeight, and this last girl was fourteen
year old, died in similar circumstances, did not have cocaine in her system,
and so they relooked at this casein a different way. And that
fourteen year old as well as thoseother twelve girls, even though they had
been sex workers, because he hadsuspected that the cocaine was the cause of
their death, they had not lookedat this as homicide. Then when this

(10:00):
fourteen year old died in similar circumstances, they did look at it a homicide
and they discovered that she had beenmurdered, and the other twelve girls had
also been murdered by strangulation from aserial killer that they then found. But
they, of course we're not lookingfor when they were ruling these as natural
cause deaths. Yes, so it'san unfortunate circumstance that you will find that

(10:20):
many many police departments that experience alot of like missing persons related to sex
workers or anything like that, willwrite that off as oh, well,
they're just transient, and tend towrite a lot of sex workers off just
on drugs, yeah, or they'rejust on drugs, and so they'll write
a lot of folks that are sexworkers off as just kind of like disposable.
Yeah, so you'll end up witha lot of Jane Does and a

(10:41):
lot of kind of cold cases asa result of just the fact that somebody's
labeled a sex worker, which iscompletely unfair and unfortunate. And I think
that we talked about sex workers ina previous episode, just of all about
sex work. We did talk aboutthat. Yeah, so you can go
back and I think that we coveredthis and that, or at least part
of that, the fact that they'reso there's so few protections for those people
because of the legal status. So, yes, a little bit more information

(11:05):
in that episode. Yeah. Eventhen, even after the serial killer situation
was found, Wetly insisted that becausethey had cocaine in their systems, they
became overly stimulated during sex and thatresulted in delirium and death. Presumably they
got so worked up while engaging vigoroussex while they had cocaine in their system
that they sort of spontaneously asphyxiated,I guess. And he continued to promote

(11:26):
this idea, even claiming that quoteseventy percent of people dying of coke induced
delirium are blackmails even though most usersare white. Why it may be genetic
end quote. Oh god, that'sso frustrating. Yeah, so you could
really see the racism and misogyny wasbaked right into this idea at its very
foundation that like the beginning place ofthis is the idea that black people basically

(11:50):
belong to a different species that ismore susceptible to these kind of medical conditions
than other people, and it's somethingto do with their genes, supposes,
even though there is no evidence forthat whatsoever, and black people are literally
just people who happen have more melitanin their skin. Right, It's an
absurd theory. It's so frustrating.I'm sure there for folks listening, this

(12:13):
is not a surprise, and Ithink that's an unfortunate thing too, Like
it's it's unfortunate this is a theorythat's come up and that's kind of like
prevailed for some time. But it'salso not a surprised that's something like this
would come up from somebody in thescientific community who has like a particular agenda,
you know, very much so,and we'll definitely get into that and
I do want to clarify really reallyquick because I say that they're just people.

(12:35):
What I'm trying to say here isthat the idea of race is a
construct, and so trying to overlaythis concept of blackness on top of someone
in that being a being linked tothen different genetic susceptibilities to things like cocaine
overdose or delirium doesn't make any sensebecause racist just this construct that does not
explain that sort of thing, rightexactly, making sure that's clear, right.

(12:58):
So, inspired by this line ofreasoning, a defense expert for a
company that manufactured police weapons wrote abook with his wife entitled Quote Excited Delirium
Syndrome, which they promoted by freelydistributing at medical examiner and police chief conferences.
So they would show up at thesedifferent conferences and promote this book.
Yeah, and presumably this is whenthe idea really took hold. So you
basically have this thing that a scientisthas made up, you promote it to

(13:22):
a bunch of people who are lookingfor a reason, and now we have
excited delirium as like a thing thatis that we're dealing with. Yeah,
and presumably at the time they weredoing this there was like five hundred registered
forensic pathologists or something like that,and whoever was like the people going to
this conference these conferences, these medicalexaminers and whatnot, and they printed like
a thousand or fifteen hundred books sothat they make sure they're plenty on hands

(13:46):
that they could just hand them outfreely to these people, so that they
had this idea than as something toinclude in their sort of toolbox. And
so at this point the description ofexcited delirium was fairly consistently described in a
few ways. There's a lot ofwords that they use. They describe it
as, quote bizarre and or aggressivebehavior, shouting, paranoia, violence toward

(14:07):
others, unexpected physical strength, andhypothermia hyperthermia I mean hot end quote.
And then another description here is quotetolerance to pain, constant or near constant
physical activity, failing to respond topolice presence. Yeah, that's a medical
condition. Superhuman strength, rapid breathing, not tiring despite heavy exertion, naked

(14:28):
slash inappropriate clothed also medical condition,apparently sweating profusely hot to the touch,
and attraction to or destruction of glassspecifically, and this comes from authors Jerastomulos
in the Encyclopedia Forensic Science second Editionfrom thirteen and C. A. Hall
and the Encyclopedia of Forensic and LegalMedicine second Edition in twenty sixteen, respectively.

(14:52):
For those two quotes, I insertedthe sarcastic these are medical condition parts
of those quotes. They didn't saythat they did that, but it's just
to me, it's funny to likeuse as part of your description of a
diagnosis destruction of glass inappropriately clothed,right, Like not listening, failure to
attend to police presence. That's justsuch a weird, not like highly specific

(15:18):
thing, right, call like partof a diagnosis, right, a fever
something that occurs across the entire species. And not responding to police officers,
that's specifically a behavior. Come on, let's let's be real here. Yeah,
So what you'll find is, likemany descriptions include superhuman strength, endurance,
and generally psychotic behavior or abnormal behaviorin that circumstance. To me,
I'm reading these and I'm going,well, these could all be behaviors of

(15:41):
somebody who is under the influence ofsomething. Yeah, sure, but I
would be hard breast to call thatlike a specific medical condition by itself,
I'd look for something else, yeah, or diagnosable psychological condition. Right.
Yeah, So anyway, let's let'sbe fair. I want to give a
try and of a fair shake andget the opinions from the professionals, and
the professionals in this case being advertisers. All Right, we're back, and

(16:12):
we have a way of different professionalsand different experts here. We're want to
use what they say, and we'regonna try and I think charitably include their
descriptions of why they think excited deliriumis a good thing to be used to
describe these deaths that are occurring frompeople in police custody. Yes, so,
in defense of the idea of exciteddelirium, critics attempt to explain how

(16:33):
death results from delirium through other underlyingcauses, in factors such as medical or
psychological conditions or drugs eliciting over excitement. And what they do is they question
the idea that someone could even diefrom being restrained prone with someone kneeling on
their back. So they've kind ofcreated this defense that excited delirium exists,
and they will say, like,these other causes aren't actually the reason this

(16:56):
person died. It's this excited deliriumthing, and that like the fact that
they're dying in police custody when they'rebeing restrained in a prone position while someone
kneels on their back, is unrelatedto the fact that they're just a thing.
That's just a thing that happened.And so they tried to show that
by doing a few studies. Andyou might be asking, how do you
do studies where you lean on someone'sback to the point of them dying in

(17:17):
a controlled way, they didn't.So in a series of group designs,
researchers doctors Theodore Chan and Gary vilkor Wilkey maybe took as many as fifteen
to thirty healthy young adults and placedthem in prone position. Let me say
that again, fifteen to thirty healthyyoung adults who are presumably in pretty good
shape. They placed them in aprone position, restrain them in some experiments,

(17:41):
and with up to fifty pounds ofpressure on their back in the initial
studies up to two hundred and twentyfive pounds and later studies, and also
in later studies, they ask themto while they had that weight on their
back, move around vigorously to sortof create the conditions of maybe a heightened
level of pressure on their chest cavitywhile also exerting themselves against that restraint,

(18:03):
and their hypothesis here being, ofcourse, then that if they don't die
from this, then they can't diefrom this. Oh god, Okay.
So they reported statistically but not clinicallysignificant impairments to lung capacity and functionality.
So they basically found that there wassome impairment, but it wasn't that much

(18:27):
in this space. That's what theyreported, right, Yeah, not enough
to account for death. Not enoughto account for death. Yeah. Essentially
their conclusion was then that people cannotdie of asphyxia from being kneeled upon their
backs, and this is not true. We're gonna talk about this later.
And also there's something called positional asphyxiation. Do you talk about that later?
Yeah? Great, I can't waitto talk about that. Yeah. We

(18:48):
have a whole whole thing to talkabout positional asphyxiation coming up here. So,
not surprisingly, most of the academicsupport comes from researchers and disciplines that
stand to face a pretty high levelof scrutiny and at this point probably several
instances of liability. If excited deliriumproves to not in fact be a potential
cause of death. Sure, andso these people then in these sort of

(19:11):
academic circles, if you will,academic in heavy scare quotes, they instead
downplay the extent to which death canbe in any way attributed to the actions
of police, and even give recommendationsfor how to restrain someone in the exact
positions that they're likely to die of. I mean die of excited delirium,
but you know that they're likely todie of, which is wild to me.

(19:33):
So here's some some specific quotes ofrecommendations for giving restraint. This comes
from a two thousand and five entryin the Encyclopedia of Forensic and Legal Medicine
by JD. Howard. Yes,so this is a direct quote. This
is not a recommendation from us,by the way, yes, thank you.
Just to be really clear, Okay, so this is the quote.
Because of the extreme agitation that's oftenassociated with excited delirium, a person may

(19:57):
have restraint devices applied to both thearms and the legs in order to be
adequately controlled. Hobble restraint is usedin reference to a variety of restraint techniques
intended to limit a person's leg movements. Commonly, this refers specifically to the
simultaneous use of handcuffs and leg restraints, a technique that is also called hog
tying. The quote goes on theperson putting the handcuffs and ankle bindings on

(20:19):
the person being restraint often places aknee and weight on the back of the
individual during the process, resulting inchest compression end quote. So that is
how they explain what to do inthese situations. Yes, Abraham did a
really good job of like finding agreat picture of what this would look like.
Yeah, without the pressure on theback, but a very clear hog

(20:41):
tying. It's basically your hands arebehind your back and they're tied to your
ankles behind your back, and soyou're laying on your stomach with your hands
and ankles tied together. That ishow they sort of describe it. So
that is essentially how they're describing andrecommending and defending the use of these types
of tech niques and why they thinkthat they do not result in excited delirium.

(21:03):
Probably more biased than I wanted tomake it, but it's hard hard
to write about these things without laughingat the ridiculousness of it all sometimes.
But so let's let's look at thecritics, though, I think it's worth
still unpacking what they have to sayabout this and specifically this idea of excited
delirium as a contribution to the deathof people in kind of any circumstances,

(21:26):
but specifically in police custody. Right, So one of the big arguments is
that, and specifically critics that argueagainst these studies. What they do is
they'll say, one that the samplesare too small, Yeah, fifteen to
thirty, Yeah, it's fair,and a group designed. Yeah, that's
very very small. That's very verysmall. And second that in one instance,
there was no evidence that IRB approvalwas obtained, which calls in the

(21:48):
question whether the study itself was conductedwith integrity, with the right safeguards in
place. There's a lot to kindof unpack within the situation where there's not
like an IRB specifically overseeing those thosestudies. Yeah, very much. So.
They also argue that the studies includea nonrepresentative sample of participants because they're
using these sort of healthy, young, fit, sober adults that they've measured

(22:12):
with, and they also had anonrepresentative sample of conditions under which death occurs
because they couldn't really simulate that.I mean, this is understandable here,
the researchers could not create the actualcondition that would result in participant death.
Right for research, they can't dolike life threatening what like known life threatening

(22:33):
activity for the safety of the participants. And to be clear, the critics
are not arguing that they should tryand accomplish the scenario that simulates closely enough
like life threatening conditions, because thenpeople again would die and necessarily we don't
want that to happen. So they'rekind of pointing out that it's nearly impossible
to do good research on that questionspecifically, right. They also found that

(22:57):
other aspects of their methodology were dubiousat best, which dubious is such a
great word. Yeah, I feellike whenever I say I had to say
dubious, and that there are clearconflicts of interest and bias among the researchers
and the research teams. So likethat in itself is enough to be able
to call into question at least evena healthy skepticism about these studies. When

(23:18):
you're going into this and you're lookingat this from a critical research lens,
you have to know these things aboutthe studies that are being published very much.
So, now as we kind ofalluded to this already, as we
were giving the description of what exciteddelirium is, we said things just to
sort of refresh your memory on this, but we said things like bizarre aggressive
behavior, unexpected physical strength, failingto respond to police presence, not tiring

(23:45):
despite heavy exertion, inappropriate clothing.And I think a listeners may have noticed
at this point that these are sortof fuzzy, ambiguous definitions and criteria that
are being used to describe this exciteddelirium. Now, surely there are clear
medical or psychological symptoms and etiology thatcan be a diagnose that clearly show excited
delirium. Yeah, so, ifwe had to ask, no, excited

(24:08):
delirium is not a medical or psychologicalcondition recognized by any professional or a medical
association. The DSM has a definitionfor delirium more broadly but explicitly states that
delirium cannot be a cause of death. So there's already like a I mean,
we've got a lot to say aboutthe DSM anyway, but at the
very least, there is a widelyaccepted book that says no, this is

(24:30):
not a cause of death. Theic D also does not contain excited delirium
as a referenceable cause of death.It is always diagnosed post mortem, but
always in cases of ambiguous or evenvaguely arguably ambiguous types of situations. It
is a catch all meant to givesome cause when you don't have another one
or you don't want another one.And I think that seems really convenient for

(24:56):
a large department that wants to reducetheir liability and they don't want to get
in trouble. It sounds like thismight be a really good way out.
Yeah. Now, there's an importantpart here that I think maybe the proponents
of excited delirium like to point to, which is that there is a higher
rate of mortality among people with mentalhealth issues, and that in a lot
of these situations where police are calledand they have a death that is then

(25:21):
later attributed to excited delirium, theseare often people who are in the throes
of a mental health crisis of somekind, such as we described at the
beginning of this discussion in the caseof Angelo Quinto. Right right, and
to a point, this is truebecause life expectancy is ten to twenty years
shorter among people with a mental healthdiagnosis or psychiatric patients compared to non psychiatric

(25:45):
patients or non diagnosed adults of similardemographics right now. Often there are correlated
medical conditions that increase the likelihood ofmortality among people with mental health disorders.
There are often physical diagnoses that alsothen have an impact on cognition, and
therefore they receive a psychiatric or mentalhealth disability, and those medical complications also

(26:06):
are associated with a higher rate ofmortality, meaning that those people with that
mental health diagnosis also then have ahigher rate of mortality. But what are
the causes of death among the populationof people, more generally speaking, who
simply have a psychiatric diagnosis. Well, a twenty eighteen study by Monasterio I
think is how you say that andcolleagues reported that the causes of death among

(26:27):
people with mental health diagnoses were suicide, motor vehicle accidents in falls, medical
causes mostly cardiac arrest, and homicidein that order, and with suicide making
up over half of all of thosedeaths, so all the rest of them
are fairly small percentages, where bythe time you get to homicide it's like

(26:48):
one percent you'll notice in there Idid not say that these were actually caused
by a psychological condition itself, andthere are actually not a lot of acute
psychological conditions that do result directly indeath. That's an critical thing here,
especially when you have corners or medicalexaminers who are reporting that excited delirium is

(27:11):
a cause of death even in postmortem, that they're kind of diagnosing this
right, because at the end ofthe day, it cannot be. The
consistent factor in deaths attributed to exciteddelirium is the restraint itself. People are
not dying suddenly of excited delirium whenthey are being restrained in a supine which
is on your back facing up,yeah, or an upright position and without
neck or chest compressions. The proposition restraint has been condemned by many organizations,

(27:36):
including the US National Institute of Health, and are frequently cited as unsafe
and more likely to result in death. Yes, this is where we really
start to get into this positional asphyxiaas you are talking about. And so
I think acknowledging that we're actually throughsort of the bulk of the main part
of excited delirium here. So thiswill definitely be a shorter episode. Let's

(28:00):
take one more quick ad break.We might throw it squeeze in one more
at the end, but we're gonnatake another quick ad break and then we'll
come back and talk a little bitmore about this positional asphyxia and some other
things about the implications of excited delirium. I love it. Okay, so

(28:22):
we're back. Let's talk more aboutsome of the implications of excited delirium as
it relates to professional organizations. So, according to the Physicians for Human Rights
organization, excited delirium syndrome quote hascome to be used as a catch off
for deaths occurring in the context oflaw enforcement restraint, often coinciding with substance
use or mental illness, and disproportionatelyused to explain the deaths of young black

(28:47):
men and police encounters end quote.So that's a lot to unpack. Yeah,
super important though, to understand whatour data are suggesting right now,
right, and so this is somethingthat we kind of haven't really alluded to
yet, is the fact that itoccurs at a much higher rate with people
of color specifically. And another thingthat people might be thinking about here is,

(29:08):
well, if these are medical examinersand coroners who are making this diagnosis,
then like they're just get receiving thebody and then saying what they see,
and they have as one of theirthings that they can call this excited
delirium. So presumably they're using somelevel of objective criteria to do that.
Well, not really, As wesaid, first of all, there aren't

(29:30):
any objective criteria. They often haveto if they're going to giuse that as
we described in the definition of exciteddelirium, they kind of have to rely
on some police report because they can'tlook at a body and say were they
failing to acknowledge police presence? Right, you know, that's not going to
be something that's immediately and medically evident. And furthermore, what's important here is

(29:51):
that a lot of these medical examinersand coroners exist as part of police departments.
And there's been a really big callfor trying to move medical examiners and
corners to independent, third party systemsbecause a survey of members of the National
Association of Medical Examiners found that twentytwo percent of the members reported feeling pressured

(30:12):
by political or authority figures to changethe manner of death that they listed on
the cause of death certificate, andso in house there is a baked in
bias and the potential of pressure fromauthority figures to specifically call it excited delirium
even when they have already ruled itas something else. It seems unrealistic to

(30:33):
think that a police department might becorrupt in any way. So this is
breaking news for me. I neverwould have thought that departments that, like
you know, really were really intothe war on drugs could not imagine that
they would want to pressure people intochanging document. How could this happen?
How do those were here just policein my day? I can't even finish

(30:56):
that sentence. Although the National Associationof Medical Examiners or NAME has contained most
are many of the people who havechampioned excited delirium as a cause of death.
The more recent position statements from NAMEsay the excited delirium as a term
is quote not endorsed by NAME orrecognized in renewed classifications of the who ICD

(31:17):
ten. In DSM five. Instead, NAME endorses the underlying cause natural or
unnatural, to include trauma, orfor the delirium state be determined if possible,
and used for death certification end quote. So basically what they're saying is
they're not going to use excited deliriumanymore as an organization. Yeah, they
basically they don't recognize that that wouldbe a cause of death. That they

(31:40):
recommend that they look for other conditionsthat would more readily attribute to cause of
death. And although they didn't saythis in their position statement, that's going
to be asphyxia in almost all ofthem. Yes, Now, if you
think about all of the interactions thatmight happen with police, no matter what
side of the spectrum all you areon here in terms of like really for
the use of police tactics or reallyagainst them anywhere in between, there are

(32:02):
many many reasons a person might diein police custody, Right, So you
would think that any one reason wouldactually make up relatively small proportion because there's
just there's so many options, Likeeven if one of them was more than
another, you'd be like, well, there's like a thousand ways that someone
might die that would be even unrelatedto something that police did, you know,
directly, not to mention the thousandways that they might die by something

(32:25):
that police did do directly, Right, And so if you have that many
reasons, then there's not going tobe any one of them that ever makes
up more than like one percent ofthe reasons. Yet there is this one
cause of death that kind of risesto the top as one of the most
common reasons people die in police custody. In fact, here's some numbers about
that very thing. Yeah, realdata. More than sixteen percent of deaths

(32:47):
that occurred in police custody in Texasfrom two thousand and five two seventeen were
reported as due to excited delirium.Sixteen percent of those deaths. Yes,
there's a very large percentage for again, the thousands of ways that someone might
die, right. Sixty two percentof deaths due to excited delirium that occurred
in Florida were people in police custodyfrom two thousand and ten to twenty twenty

(33:09):
two. This state. You know, it's just like you can't I can't
get away from it. Like everytime I'm just like just you know,
it's it's that thing where like youyou're disappointed in somebody, you don't think
they could go any lower, andthey just keep doing it. Like Florida
is that thing for me. It'slike, God, you're beautiful. But
what's wrong with you? Yeah?Exactly, all right, Yeah, it

(33:31):
is a beautiful state. It isbeautiful. It's beautiful. There's a lot
to see here. But good lord, yeah, can we just get something
right government? There is a mess. It's a mess. Fifty six percent
of deaths due to excited delirium andpolice custody. We're black and Latin X
folks, so fifty six percent.Fifty six percent is so high. I

(33:53):
mean, the percent of the populationthat is represented by black and Latin X
folks is so much less than Like, they are not fifty six percent of
the population. They're not even fiftysix percent of people who are arrested by
police, and yet they represent themajority of death due to excited delirium and
police. That by itself is anextremely alarming statistic. In my mind,

(34:15):
that's a red flag. You shouldsee that and go, oh, that's
a problem. Yeah, there mightbe something wrong there. Yes, So
here's the important thing. So thesimple solution here is to stop restraining people
by placing them in a prone positionwith weight on their back or neck and
really honestly in a prone position atall. In fact, let's let's stop
all three of those things separately.No prone restraints, no weights or pressure

(34:38):
on the neck, no weights orpressure on the back. So let's let's
actually talk for a second about positionalasphyxia. So, if you're not familiar
with this term positional asphyxia, itjust means that your airway is restricted because
of a position that you're in.Y So, for example, if you've
ever laid down a certain way orlaid in a certain position and it was

(34:58):
very difficult to breathe, that's anexample of how positional asphyxiation can lead into
cause of death. As somebody who'sa restraint trainer, one of the things
that we are taught and whenever wedo a prone positioning for somebody who might
be in a like a restraint duringa crisis management circumstance, we are told
explicitly to not put any pressure onthe trunk or the torso of the person.

(35:20):
Yeah, like you're not supposed tobe touching their neck, you're not
supposed to be putting your hands oryour knees or any part of your body
on their back or their chests oranything like that. And to be clear,
this is you didn't put them ina prone position. They happen to
be in a prone position in thiscondition, right, yeah, now,
And further to add to this,there are some medical conditions that in a
prone position increases the risk of death. So like if I am overweight a

(35:40):
significant degree, if I have breathingairway issues. Yeah, a lot of
times what they'll say is like,if you have somebody who has down syndrome,
they should not be put in aprone position because they are an asphyxiation
risk just based on the structures oftheir mouth and tongue in their breathing airways
and so so, positional asphyxiation isjust that I am put in a position
that I cannot breathe and my airwaysare restricted. Now does this sound familiar

(36:04):
when we're talking about somebody being ontheir stomach with somebody pressing on their on
their chest cavity or their back.They're pressing on this part of your body
that is supposed to expand to gatherbreath. Yeah, exactly. And just
as you were saying, we're trainedthat, I mean even in someone as
soup pine. So we've been talkingabout proposition meaning face down, even if
they're souppine, which means they're faceup. We're still trained. You do

(36:27):
not put pressure on their on anyplace on their torso you can block arm
movements, you can block leg movements, but you do not put pressure because
there's just the additional risk of anykind of medical emergency that might come from
squishing people's organs like their lungs,their heart, their stomach, their intestines,
anything like that. Don't do it. And this is many many governments

(36:52):
and medical organizations and medical government governmentlike affiliate affiliations have come out and basically
said, don't use prone restraint.Don't put someone in prone positions. Like
people will arrive in prone positions.They tripped and fell, they threw themselves
down, there might be many reasonsthat they end up prone. But you
do not put someone in a proneposition. If you can get them into

(37:14):
a supine position safely, then youcan do that. If you need to
restrain them, restrain them in anupright or supine position. But no matter
what, don't put compression on theirchest or airways because that can kill them.
And that's just something that we know, so you don't do it.
Right. So police are even generallyaware of this, although it seems that

(37:34):
within this kind of space and withinthe space of excited delirium. Many of
them see excited delirium as a kindof mystical, spurious cause of death to
avoid feeling responsible, I would imagine. So. For example, while Minneapois
police officer Derek Chauvin or Chauvin knelton George Floyd's neck, one of his
fellow officers, Thomas Lane, suggested, quote roll them on his side,

(37:55):
I just worry about the excited deliriumor whatever end quote actually came up in
George Floyd's case. Yeah, hemight accidentally die from a thing that's not
your fault because you're kneeling on hisneck. Yeah, yeah, yeah,
yeah, in that space if youwere to pick that apart, if it

(38:15):
were excited delirium and that were areal thing, it wouldn't matter what position
he was in. He would endup dying from the excited delirium, right
exactly. So rolling him over wouldn'thave changed that. But suggesting to roll
him over suggests that we know it'snot a real thing. We know that
you're probably going to cause a problem. Yeah, Oh, I think suffice
it to say kind of it wouldprobably more to say, but prone restraints

(38:37):
and Chester neck compressions are completely unnecessaryto ever sufficiently restrain someone. There are
other less risky restraints that can alwaysbe used to successively subdue aggressive behavior that
do not depend on putting someone ina prone restraint. Right, I think
we just need to outright say nomore prone restraints. That will solve so

(38:58):
many of these problems, like somany of them. So like, let's
just do that, because we cansuccessfully easily restrain people without putting their lives
at risk by virtue of just havingthem in an appropriate position or applying undue
compression to their breathing in airways.Right, It's also worth taking a moment
to evaluate what circumstances led me toa point where I need to restrain somebody,

(39:22):
Like how did I get to thisplace where I would need to even
do that? If it's something thatyou can avoid in the future, that's
the best way to go, Like, it's best to set up a circumstance
so you don't need to restrain somebody. Yeah, there's so many things that
can lead up to it, AndI'm not going to go out there and
say that, like, no restraintever is the thing, because I've been
in situations where I've used my hostagenegotiation tactics and all the things that come

(39:45):
up that like to kind of preventand de escalate. Sometimes it doesn't work,
But I can count on one handhow many times I've ever had to
use a prone positioning for a restraint, and that was, i mean ten
years ago, so I've been ableto move away from that. So yeah,
I think it's probably worth just stoppingand saying and kind of like maybe
summing all this up right, whatis excited delirium? It's nothing, It's

(40:07):
made up. Yeah, It's somethingthat some police departments pressure corridors to put
on paperwork, is what it is. It's not a real psychological event as
far as the psychological and medical fieldsare concerned. Is a description applied to
situations in which someone died at thehands of someone else and that someone else
wants to escape culpability by saying itwas something that just happened, and specifically

(40:30):
it is used to target people ofcolor in these spaces. Yeah, from
the get go, it was establishedto be a thing that happened to people
of color only, and that ishow it has turned into something that is
used so much today. Yes,so that's kind of it, Like this
whole idea of excited delirium, itadds up to a big old nothing burger

(40:51):
in terms of it what it actuallyis. I think how it's used is
potentially the more interesting thing here andunderstanding it is. On the one hand,
I kind of want to be sensitiveto the fact that I want to
almost celebrate that police feel bad enoughabout killing someone an accident that they want
to take the responsibility off of themselves. It makes me happy to think that

(41:14):
they care that they killed somebody andthat they feel bad about that, right,
I mean just that like they don'thave that as a value that like
murder is not something they actively seekto do. I mean, obviously many
of them do, but in manyof these cases they're like trying to absolve.
And maybe it's just legal culpability.Maybe that's the only thing. But
I would like to choose to believethat, like there's some amount of like

(41:36):
I don't want to be responsible foranother humans death that might enter into at
least some of their consciousness as they'rein the situation that they would like to
invoke this so that they don't havethat wane on them. Now. I
think that as being in my mindextremely generous to the vast majority of people
for whom this has been the case. And I don't want to be accused

(41:58):
of sort of trying to, youknow, take a specific side of the
people who are the perpetrators of thecase, where there are people who are
being victimized by the brutality of theseauthority figures. But what I am trying
to do is take the nuanced positionof is there silver lining here at all?
And the silver lining, if Ican see any, is that there

(42:19):
might be the desire to not killpeople, and that then they feel like
that that's how they try and getthat off of their mind, and that
just makes me feel better that theydon't want to kill people. But I
am speculating wildly at this point.Yeah. Yeah, again, being way
nicer than I need to be.Yeah, yeah, because it's still a
thing that happens, and it's stillterrible. Yeah. So a couple of

(42:40):
the quick interesting things I thought justthat there's a lot of names for this.
So if the whole time you've beenhere and excited to let him and
being like, I don't know whatthat means, but I have heard of
Bell's mania, Well, in thatcase, same thing there's also a psychosis
with exhaustion. This is actually trickybecause I heard this and in a separate
discussion on a podcast, and Icould find no references to any but a

(43:00):
calling it that, even looking overthe timeline of it. So I'm not
sure where that one came from,but I did hear it you, so
I thought i'd at least mention ithere. I also saw as terms that
people might use to describe this agitateddelirium, restraint asphyxia, and as we
noted before, positional asphyxia. Sosome of the fun things they're not fun,
which you know, yeah, andwhich you know, agitated delirium and

(43:22):
restraint asphyxia are two very different things, right like when you really understand when
you look at the ideology of orlike the etymology of that, right like
when you look at kind of yeah, what like these come from. Agitated
delirium is suggestive of a psychological disorder, where restraint asphyxia is very clearly a
circumstantial thing. Okay, well,I think we actually didn't make it to

(43:42):
another ad break. So we aregoing to say yeah, thank you,
as we're going to acknowledge our team. We're going to give you if you're
joining us for the first time,you may not know this, but we
actually like to end with one Ithink as one of one of the more
fun segments of every piece that wedo, which is we get some We
give some recommendations for things that wehave enjoyed recently, so if you want
to, you can go check themout, and you don't have to.
Of course, we'll let the advertisersdo their thing and then come back with

(44:05):
our sort of wrap up here.Okay, as I always like to end
on, they'll try and keep thisrelatively brief because I spend a lot of
time on this every episode, andI know that people who have been with
us for a long time have heardthis just many, many, many times.
You can support us by picking upmerch on our website, and you
can join us on Patreon, whereyou get access to extra perks and benefits.

(44:29):
The people who have already done thatway we appreciate so much includes Mike
m Megan, Laila, Mike t, Justin, Kim, Joshua, Brad,
Stephanie, Olivia and Brian. Thankyou all for your awesome support.
You are the best. If youjoin us, you get a shout out
just like they did. Yeah,you can also support us by leaving us
a rating and review, subscribe,tell of friends, do all that sort
of stuff. Thank you so muchto my team for their help. Shane

(44:52):
and myself do a lot of writingand fact checking, and all of our
editing and production and sound comes fromJustin Greenhouse and a social media coordinator is
Emma Wilson. This is a groupof people I could not do without.
Now, without further ado, dowe have anything before we get to our
recommendations? I don't think so.I think we can just jump right in.
Let's recommend some things, all right, recommendations. So at the time

(45:21):
it's recording, it's been a coupleof Fridays since this one. There was
just one very special Friday where allthis really new music, like really good
new music, came out and itwas like album after album after album,
and I've been like kind of spendinga lot of time with those albums from
that day. And the one albumthat I gotta say I've been a big
fan of is Chambers A Love toKill for. Okay, if you have

(45:43):
not heard Chamber, I'm gonna goahead and say, if you are somebody
who is trying to find that DillingerEscape Plan kind of analog. Yeah,
this is a good place to go. My friend described it as this.
He was making lasagna and the lasagnacame out like while he was listening to
this, he was making lason.You listening to this, and the lason
it came out tasting like a fight. Listen to a chamber I love to

(46:06):
kill for. Oh yeah, listento chamber. I love to kill for.
Wow, it's very like chaotic.The drummer is really incredible. I
mean, when you listen to it, you're like, this is wild.
It's very angry. So if youdon't like stuff like this, then you
know, go listen to suicide machineslike we talked about earlier, and have
some fun for our patrons bonuses.But it's definitely a good listen if you
like that type of like kind ofheavy, chaotic kind of like if you're

(46:30):
a fan of Not Loose, ifyou're somebody who knows who Knoed Loose is
listening to this, then you mightlike this because it's a little bit more
interesting. I think, all right, fair enough, well, I love
Dillinger Escape Plan, so I youvery much have piqued my interest. I
think you'll like this band a lot. That's awesome. I did that.
I actually I should have this asmy recommendation because I just recently went through
the Dillinger Escape Plans entire discography againand so good, so much fun,

(46:53):
really good stuff. But I'll maybesave that for another day. Just consider
that as a bonus. Off thecuff. I said a thing that you
might like. Yeah, But myactual recommendation is a movie that came out
somewhat recently on Netflix called The Outlaws. This is a very silly action adventure
comedy sort of thing that I don'twant to spoil too much about, but

(47:15):
suffice it to say it's about twopeople who are getting married and the groom
meets the bride's parents, who arevery eccentric people, and they're a wacky
adventure ensues, and so I thinkit's supposed to be a pun on The
in Laws instead called The Outlaws.It's a fun, fun time if you're
into like a sort of turn yourmind off and just watch a silly,

(47:37):
funny action adventure movie. Not terriblylong. It Scott Pierce brosn and and
it a lot of other notable actors, but just a fun movie. I
love that. I like movies thatare just fun, like you don't have
to like overthink it? You know, yes, this is not an overthink
it type movie, but hasn't goodcomedy beats in it? So good?
All right? If you have somethingto say about Excited Delirium, I'd like

(47:57):
to tell us how great of ajob that we did. You should reach
out to us to so you canreach us on social media. You can
email us directly info at WWDWWD podcastdot com. We look forward to hearing
from each and every one of youand all that you have to say.
And as I said, consider joiningus on Patreon to help support what we're
doing in this show. Is thereanything that I miss or anything you would
like to add before we wrap uptoday? Shane, No, I think
that covers it perfect. This isAbraham and this is Shane. We're out.

(48:20):
See. Yeah, you've been listeningto Why We Do what We do.
You can learn more about this andother episodes by going to WWDWWD podcast
dot com. Thanks for listening andwe hope you have an awesome day

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