# Has anyone not in police custody ever died of "excited delirium"?
**URL:** https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314
**Category:** Factual Questions
**Created:** [September 23, 2011, 9:55am UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314 "2011-09-23T09:55:39Z")
**Posts on this page:** 10
**Page:** 1
### Author:  [@Grumman](https://boards.straightdope.com/u/Grumman)
#### Post date: [September 23, 2011, 9:55am UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/1 "2011-09-23T09:55:39Z")
[A recent article](http://news.ninemsn.com.au/national/8351254/prisoner-died-of-excited-delirium-autopsy) revealed that this diagnosis has started showing up in Australia as well as the US, which prompted this question:
Has there ever been a case diagnosed as “excited delirium” that was demonstrably _not_ caused by the use of less-lethal weapons or being forcefully restrained?
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### Author:  [@Borzo](https://boards.straightdope.com/u/Borzo)
#### Post date: [September 23, 2011, 11:49am UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/2 "2011-09-23T11:49:28Z")
> [@Grumman](#):
>
> [A recent article](http://news.ninemsn.com.au/national/8351254/prisoner-died-of-excited-delirium-autopsy) revealed that this diagnosis has started showing up in Australia as well as the US, which prompted this question:
>
> Has there ever been a case diagnosed as “excited delirium” that was demonstrably _not_ caused by the use of less-lethal weapons or being forcefully restrained?
I can see how being forcefully restrained would cause some people to have extreme panic-attacks and cause a severe stress response.
In modern civilized society people are generally not forcefully restrained, and when a situation gets difficult, you know, you could always just leave.
I know people who have assorted phobias - including claustrophobia - and without an escape route, I could see some of them pretty much losing their minds.
Combine that panic with physical exhaustion from fighting your restrainers, and have the subject be morbidly obese, out out of shape, or having a heart condition, and I can see a small percentage of people dying.
In short: Restraint is probably a large factor in such deaths.
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### Author:  [@eightysix](https://boards.straightdope.com/u/eightysix)
#### Post date: [September 23, 2011, 1:21pm UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/3 "2011-09-23T13:21:22Z")
A major problem in trying to address this question is selection bias in the cases considered. A defining feature of ED is extreme agitation, often with overt aggression or at least threatening aggression. Knowing that to be present in a given case depends on witness accounts. However, witnessing someone in that state often leads to restraint. Then the person dies, so this becomes a case to be considered. Most of the time, the person is also variably intoxicated, usually with cocaine. If the same ED state happens but is not witnessed, the person is just found dead. Tox shows cocaine, so the cause of death is attributed to cocaine OD. IE without the witness accounts of the antecedent behavior, you cannot “diagnose” ED, but the witness accounts usually leads to restraint being a feature of the circumstances.
I have on occasion dealt with cases where, for example, neighbors have heard huge commotion from the next door apt, banging and yelling ect, but there was no intervention. Then the person is found dead the next day and the place is a shambles. There’s cocaine in their system so, again, COD is cocaine intoxication. But in those cases I have wondered whether ED played a part.
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### Author:  [@Annie-Xmas](https://boards.straightdope.com/u/Annie-Xmas)
#### Post date: [September 23, 2011, 1:34pm UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/4 "2011-09-23T13:34:03Z")
[Death](http://www.cchr.org/cchr-reports/deadly-restraints/introduction.html) in the cuckoo’s nest!
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### Author:  [@md2000](https://boards.straightdope.com/u/md2000)
#### Post date: [September 23, 2011, 3:46pm UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/5 "2011-09-23T15:46:11Z")
The issue came up because of several recent deaths by taser in Canada - generally, yes, people die of things like choking on vomit, heart attacks, etc. while in police custody. However, people dying of being elecric shocked with 50,000 volts by a taser - statistically much much higher death rate than just average Joe, or average Joe arrested the normal way. And yes, IIRC nobody has every claimed death without taser due to “excited delerium”.
Incidentally, part of the problem was that the non-police involved in the Vancouver airport tasering death testified that the police, after shocking a guy already on the floor 5 times, basically stood around and did nothing while the guy died on the floor waiting for the ambulance; (IIRC after a lot of back and forth and a public inquiry, the police have been charged with perjury for lying about their behaviour and directly contradicting video evidence. In fact they confiscated the video originally and it’s a miracle it survived the investigation process).
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### Author:  [@RickJay](https://boards.straightdope.com/u/RickJay)
#### Post date: [September 23, 2011, 4:42pm UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/6 "2011-09-23T16:42:23Z")
> [@md2000](#):
>
> And yes, IIRC nobody has every claimed death without taser due to “excited delerium”.
This is simply untrue; “Excited delerium” as a concept predates common use of Tasers.
Google “Cases of excited delerium” and you’ll have plenty of non-Taser cases. All, so far as I can tell, involve the person being physically restrained, but not necessarily with the use of Tasers.
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### Author:  [@Robb](https://boards.straightdope.com/u/Robb)
#### Post date: [September 27, 2011, 6:17pm UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/7 "2011-09-27T18:17:19Z")
The American College of Emergency Physicians wrote a [white paper](http://ccpicd.com/Documents/Excited%20Delirium%20Task%20Force.pdf) on excited delirium. The paper recounts the history of the syndrome and provides information about how it is diagnosed. Excited Delirium is described by the characteristics a person shows. One group of those characteristics is how the person responds to contact. Since the contact is usually by law enforcement, a diagnosis of excited delirium often contains an element of restraint by law enforcement.
As was pointed out earlier, excited delirium as a modern cause of death started appearing when cocaine became a popular drug.
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### Author:  [@Elendil\_s\_Heir](https://boards.straightdope.com/u/Elendil_s_Heir)
#### Post date: [September 27, 2011, 8:23pm UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/8 "2011-09-27T20:23:12Z")
I work with police very often, and know of no such cases myself, but I’m sure it’s happened. People can respond dramatically differently to being in custody due a number of variables, incl. their own attitudes to law enforcement, if they’re under the influence of any controlled substances, their perceptions of the situation, and the words and actions of police or corrections officers.
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### Author:  [@Measure\_for\_Measure](https://boards.straightdope.com/u/Measure_for_Measure)
#### Post date: [September 28, 2011, 12:52am UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/9 "2011-09-28T00:52:21Z")
The article in the OP made no mention of a Taser. It did however note that the suspect had been pepper sprayed.
From Wikipedia:
> [@](#):
>
> The European Parliament Scientific and Technological Options Assessment (STOA) published in 1998 “An Appraisal of Technologies of Political Control”[5] with extensive information on pepper spray and tear gas. They write:
>
> ```
> The effects of pepper spray are far more severe, including temporary blindness which lasts from 15–30 minutes, a burning sensation of the skin which lasts from 45 to 60 minutes, upper body spasms which force a person to bend forward and uncontrollable coughing making it difficult to breathe or speak for between 3 to 15 minutes.
>
> ```
>
> For those with asthma, taking other drugs, or subject to restraining techniques which restrict the breathing passages, there is a risk of death. The Los Angeles Times has reported at least 61 deaths associated with police use of pepper spray since 1990 in the USA.[6] The American Civil Liberties Union (ACLU) documented 27 people in police custody who died after exposure to pepper spray in California since 1993.[2][7][8] However, the ACLU report counts any death occurring within hours of exposure to pepper spray. In all 27 cases, the coroners’ report listed other factors as the primary cause of death, though in some cases the use of pepper spray may have been a contributing factor.[2]
I rather suspect that being sprayed with the stuff would make most people both excited and delirious.
The white paper Robb posted noted that some succumbed to excited delirium in mental institutions of the 1800s before sedatives were widely used. By the mid 1950s these deaths had declined. But they called it Bell’s Mania: the term “Excited Delirium” only gained prominence in the mid 1980s. It was associated with substance abuse and struggles with the cops. The article mentions that the term is controversial and that some believe it is used to cover up abusive cops (though I doubt whether the authors agree with that assessment).
Re: the OP:
> [@the article](#):
>
> Persons with psychiatric illnesses comprise the second largest but a distinctly smaller cohort of ExDS cases and deaths. The literature on ExDS fre-quently cites abrupt cessation of psychotherapeutic medications as a cause. This raises the question of whether the behavioral changes seen in this context represent withdrawal syndromes characteristic of
> the medications involved, central nervous system adaptations to medications, or recrudescence of underlying disease. Since medication noncom-pliance is common in psychiatric patients, health care providers should be aware of this potential cause of delirium-like behavior. Less commonly, persons with new-onset psychiatric disease (mania or psychosis) will present with ExDS. In most cases, the underlying disease will be untreated at the time of presentation, but in some cases the disease may be partially treated or mistreated.
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### Author:  [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)
#### Post date: [September 28, 2011, 1:29am UTC](https://boards.straightdope.com/t/has-anyone-not-in-police-custody-ever-died-of-excited-delirium/597314/10 "2011-09-28T01:29:15Z")
Back when I worked in a hospital we had a patient who decided to celebrate the night before surgery by having a few drinks with his buddies. He did not react well to general anesthetic. I don’t know the precise term for his state of behavior when he came out of anesthetic, but “excited delerium” was a pretty good description.