By David M. Greenwald
Antioch, CA – In December of 2020, Bella Quinto-Collins called 911 seeking help for her 30-year-old brother having a mental health crisis. When police arrived however, they pulled Angelo Quinto from his mother’s arm and eventually for five minutes knelt on his back until he stopped breathing. It was a scene reminiscent of George Floyd from earlier that year.
Last summer, the family learned the official determination of cause of death—“excited delirium syndrome.”
As a report released last week from Physicians for Human Rights (PHR) notes, “An Austin-American Statesman investigation into each non-shooting death of a person in police custody in Texas from 2005 to 2017 found that more than one in six of these deaths (of 289 total) were attributed to ‘excited delirium.’”
PHR notes, “A Berkeley professor of law and bioethics conducted a search of these two news databases and three others from 2010 to 2020 and found that of 166 reported deaths in police custody from possible ‘excited delirium,’ Black people made up 43.3 percent and Black and Latinx people together made up at least 56 percent.[“
When did the term “excited delirium” evolve to describe a distinct type of “delirium?” the report asks. “Physicians for Human Rights (PHR) reconstructed the history of the term ‘excited delirium’ through a review of the medical literature, news archives, and deposition transcripts of expert witnesses in wrongful death cases.”
They conclude, “the term ‘excited delirium’ cannot be disentangled from its racist and unscientific origins.”
PHR’s review “leads to the conclusion that ‘excited delirium’ is not a valid, independent medical or psychiatric diagnosis.”
They write, “There is no clear or consistent definition, established etiology, or known underlying pathophysiology. There are no diagnostic standards, and it is not included as a diagnosis in any version of the International Classification of Diseases, the international standard for reporting diseases and health conditions, currently in its tenth revision (ICD-10), or in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for psychiatric illness. Neither the American Medical Association nor the American Psychiatric Association currently recognize the validity of the diagnosis.”
In general, they conclude, “there is a lack of scientific data, and the body of literature supporting the diagnosis is small and of poor quality, with homogenous citations rife with conflicts of interest.”
During a press conference, Angelo Quinto’s mother described the incident.
“The officers responded saying they weren’t going to kill him,” she said. “Then one officer took possession of his legs, soon crossing them and pushing them against his back. The other officer handcuffed him and knelt on the back of his neck, their prone restraint continues to acknowledge he was experiencing a mental health emergency and he was not violent, had no weapons and was not under the influence of any common substances of abuse as the hospital toxicology would review.”
She described it as they continued kneeling on the back of his neck.
“Angelo was completely unresponsive for at least four and a half minutes of this restraint as the officer continuously failed to check on him,” she said.
Dr. Joy Carter is a forensic pathologist said that she is “quite familiar with the term of excited delirium, but I have never used it.”
“I was taught that you call it what it is. A forensic pathologist is supposed to be a neutral fact finder. When someone has died, you need to know the circumstances of death,” she explained. “Excited delirium is just wrong.”
She explained, “Excited delirium is not a term that I believe in.
“We have a lot of teaching that we need to do,” she said. “We need to not only teach medical students positions in law enforcement, we also need to train judges and attorneys and the media on the correct use of terms. The use of excited delirium takes away from the ability of doing neutral fact-finding death investigation.”
She continued, “The unfortunate use of this term has led people to believe that any death in custody is a result of excited delirium without knowing that person’s health history, mental health, not understanding you can have an altered mental status, even with diabetes, um, emphysema, low blood. It’s so important that you keep an open mind before you just use that term—and it should not be anything that covers a physical altercation that has occurred before someone has died.”
She noted that the term was first used in Miami in 1985 and it spread through the country when Taser first produced its weapon in the 1990s.
“This is a very unfortunate term. It’s a misnomer and I do not believe it should be used anymore. I’m glad that the AMA came out with their stance against the use of this term just last year,” Dr. Carter said, noting that the term has been used “disproportionately against Black and Brown people.”
Dr. Altaf Saadi discussed the symptoms that are said to make up a diagnosis. She also described how neck and prone restraints “come up as playing a role.
“So we’ve heard agitation, confusion, hallucination, elevated temperature, rapid heart rate, rapid breathing, sweating profusely superhuman strength, immunity to pain,” she said. She noted that many of these symptoms “justify the use of super aggressive tactics, because superhuman strength is a feature of this diagnosis and then use it to hide behind medical terminology that shifts the blame from the person that’s exerting the force to the person that’s dying.”
She added, “It also moves the first responders away from treating the underlying medical diagnosis that have medical treatments.”
There are three features that make up the diagnosis that she found particularly disturbing, because the term is disproportionately used as a cause of death for Black men and men of color.
“Two of these in particular rely on racist trope. So that is of having super human strength and becoming impervious to pain,” Dr. Saadi explained. “There’s a large body of literature that even physicians, in a context that we’re not as good at treating the pain of Black individuals or people of color because of perceptions about them not having the same sensitivity to pain as other people and that’s been debunked.”
The third feature is “resistance to law enforcement is listed as a feature.”
She said, “In reality resisting restraint or resisting law enforcement is not pathological. That’s not unexpected. It’s not a surprising reaction if you imagine someone who’s scared or ill.”
Dr. Saadi noted that delirium is an actual condition with underlying causes.
“We’re not arguing that people don’t get delirious or that they don’t become agitated when they become delirious. They do (and) that can happen.”
But she said, “the approach is to find the underlying cause, avoid restraints because we know that can exacerbate and agitate someone who’s delirious even more.”
A key issue here is restraint. “Excited delirium was associated with restraints in over 90 percent of all death,” she said. “So it begs the question, is it excited delirium that’s causing the death? Or is it the restraint that’s causing the death?”
She said “we know medically that restraining someone face down or pressing on their neck can cause irregular heart activity, can cause blood by vessels in the neck to tear and form clots. It can cause death.”
She said that “that’s why one of our recommendations is really looking and interrogating this context of police custody, where these deaths are happening and promoting transparency about death and custody.”