Excited delirium

The concept of 'excited delirium' is igniting the debate on stun gun use by police forces across Canada.

Defenders of the term call it an unrecognized health and policing crisis while critics fear it could be used to whitewash police brutality.

The term 'excited delirium' was coined in 1985 by an American forensic pathologist to describe a series of behaviours sometimes seen in people under the influence of drugs or suffering from severe psychiatric illness.

It is not officially recognized by any reputable medical organization but it became linked to police activity in the 1980s, paralleling increasing use of cocaine by drug users.

Excited delirium is described as a state of extreme mental and physiological excitement characterized by extreme agitation, hyperthermia, hostility and exceptional strength.

Unexpected deaths during police activity relating to people suffering from excited delirium have been linked to pepper spray, certain police restraint methods, and most recently, stun guns.

Before the introduction of stun guns - commonly known as Tasers - there were between 10 and 20 sudden deaths in Canada each year linked to police restraint methods.

Over 20 deaths have been linked to stun guns in Canada since 2001 but in none of the incidents have the weapon being cited as a direct cause of death.

"My concern is that we had deaths in the 80s, the 90s, the turn of the millennium, and it was 1999 that the first Canadian (police) department picked Tasers up," said Chris Lawrence.

"We had deaths involving the same story before we had access to Tasers. We've blamed neck restraints, we've blamed pepper spray, we've blamed Tasers, but it's the same story. Step back and ask if it's the event or the restraint."

Lawrence is a former police officer and a technical advisor with the Force Science Research Institute at Minnesota State University. He hopes ongoing research into excited delirium will save lives.

Part of the problem, Lawrence admits, is the research data captures only those who die in custody and that creates for researchers a limited view of the problem.

"Until very recently, nobody was tracking these deaths," he said.

"The window that we've got is essentially a window through a police car."

Deborah Mash is a professor of neurology at the University of Miami and has been studying excited delirium for two decades.

"It's a brain disease," she explained.

"An extreme psychiatric disturbance triggered by the use of psycho-stimulants."

Research suggests it's a problem with how the brain regulates the autonomic nervous system,  which in turn regulates the cardiovascular system.

"That's why they die suddenly," said Mash.

"Tasers have nothing to do with it."

Two recent deaths in Quebec have been linked to stun guns and both victims were reportedly in either an intoxicated or agitated state.

Quilem Registre, 39, died in Montreal, and Claudio Castagnetta, 32, died in Quebec City both after being stunned by police in 2007.

They were both hit with multiple shots.

Excited delirium has also come up in two other prominent in-custody deaths of psychiatric patients in the province - that of Brian Bedard in 2001 and that of Justin St-Aubin in 2007.

Ottawa criminologist John Kiedrowski, who authored an independent review of the use of stun guns by the RCMP, fears excited delirium may be used as a "a handy device to explain away deaths in custody."

His research suggests there has been an increase in the use of the term along with an increase of the use of stun guns and seldom with other types of force used by police.

While his report ultimately does not negate the existence of excited delirium, it highlights the crux of the controversy: excited delirium can be used as spin.

Kiedrowski's report notes it can be a "phenomenon of deflecting the attribution of responsibility for death away from police intervention and towards a medical condition" and ultimately recommends the term be removed from RCMP training manuals.

"Let the medical people debate it among medical professionals," he said in an interview.

Taser International sends out information to medical examiners across the United States and - to a limited extent- across Canada.

They admit their weapons cannot be ethically tested on people with psychiatric illness or under the influence.

Lawrence, meanwhile, is pushing to get a medical instead of a repression response in instances where someone causing a disturbance may be suffering from excited delirium.

Still, emergency services can rarely approach the individual unless he - they are male in almost all instances - are either calmed or restrained.

Research into stun guns and excited delirium is ongoing within Canada. One major report on the weapons will be subjected to an independent peer review and  released in 2009 with a longer-term study due in 2010.

Stun guns are used by eight police forces in Quebec. The Montreal force has been using stun guns since 2000 and have about 15 of the weapons in their arsenal. They have a policy of administering immediate medical aid after its use while most other police forces in the province do not.

Lawrence is glad of the increased discussion surrounding excited delirium in the media and in medical circles.

"We have a social concern, that's clear," he said. 

"It occurs with surprising consistency and it continues to occur. Whatever we can do to reduce the incidents, let's do it. If we can't, let's at least understand it."