A dangerous diagnosis: How ‘excited delirium’ shapes police perception

In November 2022, Abdullah Darwich, a nonverbal autistic 19-year-old left his home in Mississauga, Ont. He made his method to a pile of leaves, which he began playing in, dressed only in his underwear. A fearful neighbour made a phone call to the police. Despite Darwich being registered to the Peel Police Vulnerable Persons RegistryDarwich’s father arrived soon after to search out his son bleeding, terrified and surrounded by police.

When a review was conducted into the incident, the primary responding officer explained that he thought Darwich was experiencing excited delirium. As a results of this assessment, the officer thought it needed to taser Darwich, restrain him and call for backup. The review found no reasonable grounds for misconduct.

How did this occur? At first glance, it could seem unimaginable that Darwich, an unarmed autistic teenager playing in leaves, was perceived as a threat. However, a more in-depth have a look at the diagnosis of excited delirium and the way it shapes police conduct reveals why this incident will not be only unsurprising, but predictable.

Excited delirium

The diagnosis of excited delirium — a condition during which individuals turn into agitated, are impervious to pain and display unnatural strength — has come under increasing fire recently. Those questioning its validity, and the conflicts of interest surrounding its promotion, include the American Psychiatric Associationthe American Medical Associationand Physicians for Human Rights.

In the United Kingdom, police at the moment are barred from using the term to clarify deaths happening within the context of restraint. California and Colorado recently banned using the term in coroner’s reports, and Colorado also removed it from police training. Coroners in 4 Canadian provinces say they now not accept it as a explanation for death.

These are all moves in the fitting direction. However, this troubling term stays in circulation in Canada, the United States and elsewhere, particularly in law enforcement, emergency medicine and on coroner’s reports. And it might have a dangerous influence on what cops see and do.

‘An agitated and delirious state’

Excited delirium has been described as “an agitated and delirious state” that always involves sweating, rapid respiratory, pain tolerance, superhuman strength and “a failure to answer police presence.” Many cops are exposed to this diagnosis in training, and instructed to search for signs of excited delirium when encountering members of the general public who could seem distressed. The appropriate response, they’re taught, is usually “overwhelming force.”

Beyond merely educating cops concerning the key symptoms of excited delirium, this training also impacts what police are more likely to see when on the job. Our perceptions are inevitably shaped by what we consider and expect. Philosophers of science call this theory-ladenness. Whether you see a duck or a rabbit within the image below depends upon what you expect to see:

Theory-ladenness shows up all over the place. What a meteorologist sees when they appear at a weather map is different than what a lay person sees. An ultrasound technician can discover far more on an ultrasound than I’m capable of. A kiss your toddler is giving to their friend seems charming, until you know it’s actually a bite. Similarly, the idea of excited delirium shapes what police perceive.

Rather than seeing a scared teenager who communicates another way than others, an officer saw Darwich as a threat. He explained in an interview that when Darwich didn’t appear to be experiencing pain and stress from being stunned with a Taser, he thought it have to be a case of excited delirium.

Police training

Research shows Black, Indigenous and other racialized persons are more more likely to experience over-policing than those that are white. The description of excited delirium offered in police training is of somebody who’s superhuman, insensitive, feral and have to be stopped in any respect costs. This image aligns with historical depictions of Black, Indigenous and other non-white bodies considered less sensitive to pain and more emotional than white ones. These stereotypes still flow into today, with greater than half of American medical students and residents in a 2016 survey endorsing the statement “black people’s skin is thicker than white people’s skin.”

In training manuals about excited delirium, pictures of people of color said to be experiencing excited delirium are sometimes used, a lot of them nearly naked and in vulnerable positions, reinforcing these biases. A preponderance of information indicates that racialized persons are more likely than white people to be labeled with excited delirium and to experience force and restraint by the hands of police.

Taking this into consideration, the incident with Darwich feels less surprising. If officers are taught to search for excited delirium, and see it in some people greater than others, there’ll inevitably be false positives.

Unfortunately, Darwich’s case was commonplace. The same month, one other nonverbal autistic teenager was tased by police in Québec. The month before, a person experiencing a seizure was tased by police in Hamilton, Ont. None of those individuals were white.

Excited delirium under fire

Fortunately, Darwich recovered from his injuries, but many others haven’t. Eric Parsaa 16-year-old autistic teenager, was killed by police in Louisiana in 2020 after being pinned to the bottom and sat on for greater than nine minutes. In this case, excited delirium was not only used to justify force, but to clarify Parsa’s death.

In Parsa’s case, and plenty of others (Daniel Prude, Clive Mensah, Abdirahman Abdi), excited delirium is used as an evidence of death on a coroner’s report, distracting attention away from restraint and force (chokeholds, hogties, tasers), which is at all times also present. The pseudo-diagnosis is a slippery one, sometimes linked to mental illnessother times drug useand in other instances, bad genesa bad heart or bad blood.

Recently, nevertheless, the coroner’s office agreed to remove the term excited delirium from Parsa’s death report, noting that other aspects were enough to clarify the death. Parsa’s father said the removal of this term has “truly helped in our healing process.”

This, and other strides being made towards recognizing the damage this diagnosis could cause, give us reason to be hopeful. Four provinces in Canada have removed the term from use; others should follow suit. Law enforcement and people working in emergency medicine can work towards eliminating this term from each training and circulation.

However, as excited delirium falls out of favour, we have to be wary of recent language which may slip in and take its place. Other candidates are already emerging, including “acute behavioural disturbance,” “hyperactive delirium with severe agitation” and “autonomic hyperarousal state.” This means we’d like to fundamentally rethink how we reply to those experiencing distress, not merely the language we use to explain them.