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In this issue:
I. IS EXCITED DELIRIUM A FAKE CONDITION INVENTED TO WHITEWASH ABUSIVE FORCE?
A CRITICAL LOOK AT NPR'S RECENT REPORTS
II. WHERE TO FIND OUT MORE--IN PERSON--ABOUT HOW FSRC'S UNIQUE RESEARCH CAN
HELP YOU SURVIVE ON THE STREET & IN COURT
III. KICKIN' ASS! DR. BILL LEWINSKI ACHIEVES A COVETED 5TH DEGREE BLACK BELT
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I. IS EXCITED DELIRIUM A FAKE CONDITION INVENTED TO WHITEWASH ABUSIVE FORCE?
A CRITICAL LOOK AT NPR'S RECENT REPORTS
Two perspectives on law enforcement's role in the violent human meltdown
known as excited delirium faced off on National Public Radio recently, in
broadcasts that have themselves become controversial.
On one side in the 2-program report were 2 police critics, a staff lawyer
with the ACLU and the director of a California "watchdog" group called
PoliceWatch. The lawyer denied that ED is a recognized condition and charged
that police are using the term "as a means of whitewashing" excessive force
and "inappropriate use of control techniques" during arrests. The watchdog
rep claimed that law enforcers want to blame "victims" who are
inappropriately "dying at the hands of officers." She said police have a
responsibility to "make sure" that anyone they take into custody "stays
alive, whatever the condition of the person's brain or body temperature or
their agitated state."
Voices on the other side included a neurology professor from the University
of Miami, the former chief medical examiner for San Antonio, and a senior
corporal from Dallas PD with first-hand experience in trying to control
raging ED subjects. The professor said the condition is "definitely
real...the result of a neurochemical imbalance in the brain." The ME said,
"[T]hese people are dying of an overdose of adrenaline" and insisted that
it's wrong to blame the police. And the cop said, "There's no one thing that
simply describes this. One minute a person is fighting and screaming, the
next minute he's dead."
By the time NPR finished its total of less than 13 minutes of air time on
the subject, emails were flying among followers of the ED issue. One
authority, Chris Lawrence, a Canadian police college instructor, a technical
advisor to the Force Science Research Center at Minnesota State
University-Mankato, and a columnist for PoliceOne.com, perhaps sums up the
sentiment of many.
NPR's failure to spotlight this thorny topic in depth for its 26 million
listeners, he believes, served only to "stir the pot" of controversy without
illuminating its many perplexities. "No one in the media presents an
in-depth, knowledgeable discussion of this subject even for an hour,"
Lawrence told Force Science News. "A series of sound bites can't do it
justice. It's too complicated. People are left with the impression that no
one knows what's going on, and that's not to anyone's benefit."
If you missed the NPR programs, which aired on more than 800 stations on
2/26 and 2/27, you can read transcripts and listen to the broadcasts at
www.npr.org. Just conduct an in-site search for "excited delirium" and
you'll get to the appropriate links.
Meanwhile, FSN asked Lawrence, who was not involved in NPR's programming, to
address and expand on some of the more provocative highlights of what was
broadcast.
ASSERTION: In questioning ED as a legitimate phenomenon, rather than
something the police are just making up, the ACLU attorney, Eric Balaban,
said, "I know of no reputable medical organization-certainly not the
American Medical Association or the American Psychiatric Association-that
recognizes excited delirium as a medical or mental-health condition."
NPR's reporter Laura Sullivan added: "He's right. Excited delirium is not
recognized by professional medical associations, and you won't find it
listed in the chief psychiatric reference book. The International
Association of Chiefs of Police hasn't accepted it either, saying not enough
information is known."
RESPONSE: Descriptions of the symptoms that characterize ED have appeared in
medical literature under various names, including Bell's Mania and fatal
catatonia, for more than a century, Lawrence says. "Excited delirium" is
fairly recent terminology, "but it is not a problem that is new."
The literature search that was made when the Psychiatric Assn. compiled its
latest edition of the 980-page Diagnostic & Statistical Manual of Mental
Disorders (DSM-IV TR, "the chief psychiatric reference book" cited on NPR)
was cut off in 1996, Lawrence says--more than a decade ago.
"If you do an online search today at the website PubMed, provided by the
National Library of Medicine and the National Institutes of Health, you'll
find at least 20 articles on ED from professional medical journals," the
vast majority of which were published after the DSM cut-off.
"For the last 10 years, the National Association of Medical Examiners has
said ED is real and has recognized it as a problem. They've published a
position paper that repeatedly references it in the context of cocaine abuse
and, in some cases, the failure of mental patients to take prescribed
psychotropic drugs. This is not something we're making up. Saying it doesn't
exist doesn't contribute to solutions for dealing with it."
[For more details of ED in medical literature, see archives of Lawrence's
columns at
www.policeone.com. The NAME position paper was authored by 4 MDs
and a PhD and appeared in The American Journal of Forensic Medicine and
Pathology, Mar. 2004.]
ASSERTION: By blaming ED, authorities in effect "want the victim to be
looked at as the cause of his or her own death," PoliceWatch director Dawn
Edwards charged on NPR. "The bottom line is that these people are dying at
the hands of, or in the custody of, police officers." In her view, it's a
police responsibility to assure that anyone taken into custody "stays alive."
RESPONSE: During one of the broadcasts, the former ME, Dr. Vincent Di Maio,
who has written a textbook on ED, challenged Edwards' position. Civil
liberties groups are wrong in blaming officers for ED deaths, he said. "They
buy into this mode that if somebody dies, somebody's got to be responsible.
And of course it can't be the person who's high on coke and meth," even
though drug abuse appears to be closely associated with many ED episodes.
Lawrence points out that deaths ascribed to ED have occurred even in
hospitals with the most sophisticated medical intervention immediately at
hand. To expect guaranteed life preservation from officers attempting to
deal with an out-of-control offender on the street is wholly unrealistic.
Professionals knowledgeable about ED agree that it needs to be viewed
ultimately as a medical problem, he says. "But this condition is a very
complicated event. It involves multiple body mechanisms. The breakdown of
any one of these by itself could result in death. Even the efforts of a
highly trained physician may not prevent the subject from dying.
"By the time police are called, the ED subject may be deep into mental and
physical distress, possibly at an irreversible intensity. We're dispatching
a first responder who generally has a first aid certificate. He may never
have seen ED before or even recognize what it is. And we're supposed to say,
'Now you handle this very complicated event, with your first-aid skills, and
by the way, we're going to hold you solely responsible if he dies'? How
realistic is that?"
By pointing out certain factors, such as drug usage and mental illness, that
seem commonly associated with ED episodes, Lawrence says, "we're not trying
to blame the 'victim.' We are trying to better understand the person
experiencing excited delirium and to identify things about him that may
assist everyone in helping him to survive."
ASSERTION: NPR's Sullivan stated during the second program that the debate
about ED "becomes more complicated" because TASERs are often involved when
officers try to control physically violent subjects who end up dying. "Civil
liberties groups fear that the diagnosis is being used" not only to "cover
up police abuse" but also to "protect companies like Taser International
from lawsuits," she said. "Taser may have financial reasons to support-and
even encourage-the use of the excited delirium diagnosis."
RESPONSE: In the view of Lawrence, a DT instructor, the deployment of TASERs
is not so diabolical. "Electronic control devices provide a modern, prompt,
humane method of restraint" in many ED situations, he says. "Physical force
and technology that depend on pain compliance tend not to work because these
subjects don't seem to feel pain. Mechanical leverage techniques that lock
up the joints can be difficult to apply because ED people are very, very
strong and they won't let you do it.
"With an ECD, you can cause them to lose control of the muscles that
maintain balance, and they fall down. This can provide a very brief window
of opportunity to quickly get them handcuffed and to secure their legs with
a strap device to minimize kicking and effectively establish some control.
You end up with fewer injuries both to the suspect and to the officers
involved."
The TASER is just the latest scapegoat blamed for causing ED deaths,
Lawrence says. He cites the recent testimony of Dr. Christine Hall, a
Canadian ER physician and ED researcher, at a coroner's inquest into the
death of a psychiatric patient who was TASERed while in a highly agitated
state.
Hall testified that when people in this state died while being restrained by
the police in the 1970s, the blame was often placed on baton use. In the
1980s, it was multiple-officer restraint and "positional asphyxia." In the
1990s, it was pepper spray. Now it's the TASER.
"The blame shifts as tactics and technology change and police critics
continue to look for something other than the condition itself as the cause
of death," Lawrence says.
Whatever the mode, the goal of police intervention, he stresses, is to
control dangerous behavior, to get ED subjects "assessed by someone with
more medical training than a police officer has, and to get him transported
to a place of sophisticated medical treatment. You are not going to get any
medical assistance until control has been established. There's no way around
this point.
"Even if you could drive a doctor to the scene and say, 'You manage this,'
nothing could be done until the subject is stabilized, and stabilization
requires restraint. At some point someone has to take control of the
individual, unless he somehow gets back to reality on his own and says, 'I'm
going to let you help me,' and that's not a very likely development with
people who are dying in excited delirium."
ASSERTION: The ACLU's Balaban expressed concern that the messages police
receive about ED may actually exacerbate confrontations. If officers are
being told in training that ED subjects "have superhuman strength," he
speculated, officers may treat them "as if they are somehow not human,"
leading "officers to escalate situations."
RESPONSE: The fact is, Lawrence says, that the display of extremely abnormal
strength is one of the characteristics that makes a subject who's
experiencing ED so difficult to control.
Indeed, Sr. Cpl. Herb Cotner of Dallas PD, interviewed by NPR, told of ED
manifesting itself by "someone doing pushups with two 150-pound officers on
their back." He described one ED experience in which the subject smashed
through a plate-glass window, fell from a fence, broke his leg several
times--and still walked 2 blocks to fight with police. Another confrontation
involved a handicapped individual who "dragged us across a parking lot."
Lawrence observes: "That may not be the way the ACLU would like it to be,
but the truth is the truth. Officers must be trained for reality."
Next month [4/07] during a 2-day Force Science seminar in London, England,
Lawrence will present a briefing on ED for European police officials and
attorney Bill Everett, also an FSRC Board Member, will speak on managing the
media during high-profile, controversial incidents, such as a death by ED.
The interest abroad in this topic, "indicates that this is a problem that is
international in scope," says Dr. Bill Lewinski, executive director of FSRC.
For more information on this program and instructions on how to register for
it, go to:
http://www.forcescience.org/training/seminars/[NOTE: Force Science News has transmitted 9 articles dealing with excited
delirium since this newsletter was founded in 2004. To review them for a
broader understanding of the subject, go to:
http://www.forcesciencenews.com/home/search.html and enter "excited
delirium" in our archival search engine.]
Our thanks to Wayne Schmidt, executive director of Americans for Effective
Law Enforcement, for tipping us about the NPR series.