A controversial unproven syndrome with roots in the US is being used in British coroners’ courts to explain why people die after police restraint.
‘Excited delirium’ or ‘sudden-in-custody-death-syndrome’ is a niche diagnosis not yet recognised by the World Health Organisation or any international authority. A number of leading pathologists have expressed concern about the use of the term in inquests.
Individuals in the throes of ‘excited delirium’ are described as aggressive, agitated, displaying bizarre behaviour, insensitive to pain and with superhuman strength until they collapse and die
But research by the Bureau has found that the ‘condition’ has been used by coroners to explain 10 restraint-related deaths that occurred in police custody in England and Wales since the late 1990s.
It has also been postulated by forensic pathologists and police defence lawyers in seven other cases.
Critics argue that the term is being used as ‘an excuse’, as a means of suggesting a victim would have died even if they had not been restrained by officers.
Dr Nat Cary, a leading forensic pathologist, has conducted numerous autopsies on people who died in police custody. He said: ‘Excited delirium is a way of offering an excuse on behalf of the state for a death in custody. It is a psychiatric diagnosis – pathologists have no position making such a finding. It is a meaningless catch-all term that appears repeatedly in restraint cases when the individual is seen acting aggressively, and is on drugs or mentally ill.’
Pathologist Dr Nat Cary speaks about excited delirium, here.
‘If the restraining were done by a civilian, the death would probably be listed as a homicide – most probably caused by some form of traumatic asphyxia.’
Dr Michael Baden, New York State Police Medicolegal Investigation Unit
Adopted from the US
The term ‘excited delirium’ was first coined in the US, where Professor Deborah Mash, a neurologist at the University of Miami, is at the vanguard of the research. She has analysed the brain tissue of 120 suspected victims of excited delirium.
She believes that in rare cases, chronic cocaine users have a genetic predisposition that makes them susceptible to excited delirium, leading to multiple organ failure and cardiac arrest.
Individuals in the throes of excited delirium are described as aggressive, agitated, displaying bizarre behaviour, insensitive to pain and with superhuman strength until they collapse and die.
‘The issue here again is proximity, [it] is not causality,’ Mash told the Bureau. ‘Just because you die in police custody, doesn’t mean that what the police were doing at the time that you died led to your death. This is a brain base disorder. That’s why the police are called to the scene to begin with.’ Mash admits her research is at an early stage.
Excited delirium was first used in a British case in 1996, following the death in police custody of Gambian asylum seeker Ibrahim Sey. Since then it has been cited in 16 other cases and put down by coroners as a cause of death in 10 of these.
There is evidence to suggest that people suffering from cocaine intoxication or mental health problems can behave erratically and aggressively and need restraining. But Cary believes that such individuals should be sedated and calmed down.
‘They can definitely be very difficult to deal with for the police, but it is naive to suggest these people are dying simply because of a psychiatric condition – which is what someone in an excited state is suffering from.
‘In every excited delirium case that I have come across the individual is restrained in a prone position, for a prolonged period of time, by a number of officers.’
‘Excited delirium is a way of offering an excuse on behalf of the state for a death in custody. It is a psychiatric diagnosis – pathologists have no position making such a finding.’
Dr Nat Cary, leading forensic pathologist
Excited delirium ‘a theory’
Prof Derrick Pounder, a forensic pathology expert at the University of Dundee and forensic science adviser to the United Nations, says questions over the term mean it should not be used as a cause of death. He said: ‘Excited delirium is a theory – enthusiasm for the hypothesis should not be evidence in itself. It belongs in the scientific literature, not the wider medical community. It has come from the United States, where the science is very politicised, without a robust enough analysis.
Related article: Nadeem Khan: A case of excited delirium?
‘If you write off a death as excited delirium then you close the door to guilt being attributed and, more importantly, lessons being learned from the types of restraint used.’
The Independent Advisory Panel on Deaths in Custody, a governmental advisory body, recently reviewed the scientific evidence on excited delirium.
‘Just because you die in police custody doesn’t mean that what the police were doing at the time that you died led to your death.’
Professor Deborah Mash, neurologist, Miami University
Dr Richard Shepherd, a leading pathologist sitting on the panel, told the Bureau: ‘We know there are a group of people who exhibit this very bizarre behaviour. Whether they strictly fall into this group called ‘excited delirium’ or not, I think will become clearer as more research is done. We need this one to be more clearly defined before we can simply say, ‘Oh, they were suffering from excited delirium’.’
He continued: ‘I think it’s a term that should be used with great care, it shouldn’t be taken as a done deal, because I don’t think it is yet established that closely and it should never explain a death simply by the use of those two words. In terms of using it in court, it needs to be used with great care and not as a dustbin.’
The Bureau’s investigation into Deaths in Custody is reported in Radio 4′s File on 4.
February 4th, 2012 at 12:14 pm (#)
We wish to extend our thanks and congratulations to Charlie Mole and the TBIJ team for the investigation and subsequent event and BBC broadcast.
This has now prompted an IPCC review of the way custody deaths are dealt with and recorded – another step in the right direction.
Our recent launch of the No10 Petition calling for a full inquiry into custody deaths was also launched on 20th January. Whilst it was regrettable that TBIJ did not feel they could align the investigation results with this launch, we nevertheless feel that recent press coverage will assist in growing petition signatories.
I understand that senior personnel at TBIJ wanted the report to remain ‘impartial’ but with respect it is clear it was indeed biased to seeking reform and / or redress of the way custody deaths are dealt with, which is ultimately what our petition, and the co-operation of many families during your investigation, also sought to achieve.
We are always grateful for any coverage that assists the hundreds of families seeking justice for their loved ones. Throughout the year that the petition is to run we are going to need as much support from campaigns, organisations and sympathetic press to achieve the 100,000 signatures required to force a parliamentary debate for an inquiry.
On behalf of the United Families & Friends Campaign and its supporters, I express thanks for the exposure that your investigation has bought about.
Thanks again
February 14th, 2012 at 5:51 pm (#)
The term “excited delirium” has also been used widely by police forces in Canada to explain deaths that result from the use of tasers. In fact, the largest taser manufacturer in the United States, Taser International, has promoted the use of “excited delirium” as a legitimate medical condition–and thus, as an acceptable cause of death. The company’s website contains numerous references and links to research about “excited delirium,” and apparently includes a discussion of the disorder when training police forces in the use of tasers.