Apologia Pro Vita Excited Delirium Syndrome

As soon as dinner ended last night, my wife and I trundled up to our bedroom for an evening's pleasure. This night was even more exciting than most. A new book had arrived, and I was eager to begin it. There is no thrill quite so satisfying as learning something new.

Excited Delirium Syndrome: Cause of Death and Prevention, is not exactly hot of the press. It was published in 2006 by the Taylor & Francis Group as part of its CRC series. I've read other volumes in the series. The works aspire to shed light on common problems by means of applied science.

I am contemplating a law suit against Taser International and a local police department arising from the death of a young man. Police responded to a noise complaint. When they arrived, they found the man behaving in a confrontational and irrational manner. He issued threats. Police burst into his apartment. He resisted. He was tasered. And now he is dead. This is not an uncommon fact pattern to those who read regularly about police use of force.

I've read through the manuals provided by the manufacturer to the police about the Taser. I've reviewed the past five years worth of reports on the use of Tasers in arrests in the local police department. And now I have read a comprehensive account prepared by law enforcement about the man's death. The medical examiner notes that cause of death as excited delirium syndrome. There were no physical findings about death in the autopsy. It's just one of those things that are prone to happen to folks with a history of mental illness or drug abuse when confronted by police.

Excited Delirium Syndrome was written by a husband and wife team. Vincent J.M. Di Maio is a forensic pathologist in Texas. His wife, Theresa G. Di Maio, is a psychiatric nurse who recently obtained what she calls in the book's preface a "Graduate Certificate in Forensic Nursing." She is the primary author but lavishly thanks her husband for making this, her first book, possible.

I dwell on the personalities behind the book because of its rhetorical content. The authors' evince an unscientific sort of hostility, a social psychologist would simply call it a bias, that undermines confidence in the otherwise even tone of the book. Those quick to blame police for deaths are reminded: "That death can be due to normal physiological reactions of the body to stress gone awry, and to the use of stimulants, does not conform to the present mind-set of many Americans, that anytime tragedy occurs someone must be at fault and they should be punished, or even better sued." Science and tort reform are tucked neatly abed together.

Several pages later, a series in The Hartford Courant about deaths while in restraints, is dismissed as inflammatory and reliant upon "incorrect description of treatment by medical staff in response to violent patients." Did the authors conduct an independent review of the files on which the Courant relied? Or did they shoot first, neglecting even to ask questions?

And then again: "The fact is that many of the investigators promulgating the theories of restraint asphyxia have never had contact with or attempted to restrain a violent individual." This explains nothing, but is rather an apologia for those who use force on patients and arrestees who then die. It's not a very elegant apologia and can be boiled down to three simple words: "Blame the victim."

The authors note that excited delirium syndrome was for many years an explanation for chronic conditions unfolding over weeks and months and leading to death. They note that in recent years, the syndrome has taken a new, acute, form. People die now in a matter of minutes and hours. What accounts for this change?

One answer might simply be the manner, means and new technologies associated with the restraint of the mentally ill. Devices such a tasers or methods such as hog tying may well result in enormous stress to those who are vulnerable as a result of mental disease or defect. An argument can be made that law enforcement is on notice that there is an increased risk of death associated with the use of some technologies and means. In that case, it is reckless for law enforcement officers to use a Taser on an apparently mentally ill man. The use of the technoloigy carries a substantial risk of death that may well be unjustified.

I've not finished the Di Maio's book. I will tonight. It is short and clearly written. In the meantime, I have questions about them and Taylor & Francis. Does anyone know whethere the publisher is an outfit funded and sponsored by law enforcement? And what of the Di Maio's? Has their testimony and allegiance already been bought and paid for? Does anyone out there know?


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