Strange Fruit; Excited Delirium and racialized police violence.

Updated: Apr 18



Content warning; the following article contains graphic descriptions of police brutality, racial persecution and death.


Increasingly concerned about gang violence in the Denver suburb in which she lived, Sheneen McClain chose to move to Aurora, Colorado to allow her children to grow up without the constant fear of arbitrary violence. Aurora would soon become a place that she and her family would call home; a place where her son Elijah could safely bike around the neighbourhood. However, this sense of emotional and physical security would be shattered when twenty three year old Elijah would be murdered following an altercation with the police (Tompkins, 2022).


The circumstances surrounding the death of Elijah McClain followed a similar pattern to that of many other Black men who have died in police custody. Whilst stopping by a gas station to buy a drink, an observer would make a call to 911 about a Black man wearing a ski mask. In the transcript, the caller would dryly note “He might be a good person or a bad person”. This expression of ambiguity concerning Elijah’s character would fall on deaf ears. Prepared for conflict before they had even arrived, two police officers would soon confront Elijah. What should have been nothing more than a quick exchange between the two parties escalated into a physical altercation at a dizzying speed.


Despite his unimposing stature and sweet demeanour, he would be placed in a carotid hold, hindering his ability to breath. Soon, an ambulance would arrive; following a brief consultation with the officers, the attending paramedics would administer a baffling half gram of pure racemic ketamine. Whilst en route to the hospital, Elijah’s heart stopped; the paramedics attempted to resuscitate him, but their efforts were in vain. Upon arrival, he would be pronounced braindead, a consequence of cerebral hypoxia resulting from cardiorespiratory arrest. After consultation with his family, he would be taken off life support three days later.


During the investigation concerning the circumstances surrounding Elijah’s death, the coroner would go on to state that Elijah was administered a “therapeutic level” of ketamine. For inducing anaesthesia, intravenous ketamine is administered at a rate of between 1-2 mg per kilo of body weight. For Elijah, this would have been somewhere in the range of 60 to 120mg. The attending paramedics would instead administer a massive dose of 500mg. The administration of such a large dose of ketamine can nevertheless be legally justified if a snap diagnosis of Excited Delirium is made. Excited Delirium (ED) is a controversial medical diagnosis that has entered popular discourse due to its association with many deaths in police custody. In a clinical setting, the symptomatic manifestation of ED is characterised by “aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, ‘‘superhuman’’ strength, diaphoresis, and lack of willingness to yield to overwhelming force” (Vilke et al,. 2012. p.897).


Accordingly, ED is associated with a considerable risk of sudden death. The most frequent cause of death in ED cases is cardiopulmonary arrest, which was determined to be Elijah McClain’s cause of death (Mash, 2016). In order to manage the severe physical agitation and belligerency supposedly associated with ED, doctors may therefore choose to employ the use of a chemical restraint such as Ketamine or Haloperidol (Sekhon et al,. 2020).


Mortality rates for those suffering from ED range between 8.3% and 16.5% (Gonin et al,. 2018). However, what remains uncertain is to what degree these deaths can be attributed to the existence of an organic medical syndrome as opposed to the complications of measures used to subdue afflicted individuals. Indeed, a study found no evidence to suggest the presence of an underlying “occult pathophysiologic process” in ED related deaths (Rimmer, 2021, p.1). Unsurprisingly, all the subjects who died due to cardiorespiratory arrest had previously been restrained in the prone position by police officers. In order to reflect the inorganic and multifactorial nature of such deaths, the UK Independent Advisory Panel on Deaths in Custody (IAP) has suggested the use of the term “sudden death in restraint syndrome” instead of Excited Delirium (Aiken et al,. 2011).


—----------------------------------------


In 2020, Minneapolis police officer Derek Chauvin spent almost ten minutes kneeling on the neck of George floyd, a 46 year old Black man. Floyd’s last moments would in many ways mirror those of Elijah McClain. Both men would die from cardiorespiratory arrest after the use of positional asphyxia by the attending police officer. In the moments preceding their death, both men would utter the same cry of desperation; “I can’t breathe!”. And in both cases a questionable diagnosis of Excited Delirium would be used in an attempt to justify the use of excessive force by a police officer.


Between 2017 and 2019, paramedics in Colorado would administer ketamine 902 times to suspects exhibiting signs of Excited Delirium. In 17% of these cases, the subject experienced serious medical complications as a result. Despite the fact that ED is frequently cited as a contributing factor to a large number of deaths in police custody, there remains little consensus in the medical community regarding the exact clinical presentation of Excited Delirium. Indeed, a number of medical experts and institutions have questioned whether Excited Delirium even exists as a formal medical construct.


For instance, the diagnosis of Excited Delirium is not recognised by the American psychiatric association or the American Medical Association. Furthermore, it is not included in the International Classification of Diseases (ICD), which is perhaps the most widely used medical diagnostic resource in the world. In 2021, the AMA released a policy which opposed the use of the “Excited Delirium” diagnosis. AMA President Gerald E. Harmon specifically condemned its use as “a manifestation of systemic racism that has unnecessarily dangerous and deadly consequences for our Black and Brown patients,”. The American Psychiatric Association have equally affirmed that The concept of "Excited Delirium" (also referred to as "Excited Delirium syndrome" (ExDs)) has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term Excited Delirium is disproportionately applied to Black men in police custody.”. These statements reflect widely held concerns in the medical community that the diagnosis of Excited Delirium has been appropriated by law enforcement agents in order to justify persecution and violence against racial minorities.


Applying a diagnosis of Excited Delirium conveniently absolves the participating police officers of responsibility for the victims demise, as their death is attributed to an organic medical syndrome rather than to police brutality. When an informal diagnosis of ED is made, the suspect is now perceived as nothing more than a rabid animal - a violent beast, possessing ‘superhuman strength’, that poses an immediate risk to the lives of the attending officers. Under these conditions, any measure may be justified, including extreme violence or the administration of dangerous chemical restraints.


—----------------------------------------


On the one hand, the weaponisation of Excited Delirium by law enforcement authorities constitutes a conscious attempt to justify violence enacted on the bodies of racial minorities. Simultaneously, the unstable constellation of attributes associated with Excited Delirium is itself impregnated with the imprint of racial prejudice and hatred. Using data from a single county in Florida between 1979 to 1990, one study identified that cocaine related deaths in police custody were far more likely to involve a diagnosis of Excited Delirium if the victims were Black. In contrast, deaths involving white people would generally receive the less incriminating diagnosis of “accidental cocaine toxicity” (Ruttenber et al,. 1997, p.25).


Indeed, many of the purported behavioural symptoms of Excited Delirium reflect racial stereotypes about Black people. Black men in particular are frequently stereotyped as being aggressive, belligerent and ‘brutish’ (Harrison and Esqueda, 2001). In one study, Black suspects were perceived to be taller and more physically imposing than white counterparts of identical stature by police officers, a perception which reflects the “Black brute” archetype, which portrays Black men as apelike savages who use their imposing physical frame to threaten others” (Hester & Grey, 2018, p.2711).


Naturally, these perceptions are conducive to the propagation of dubious claims by police officers that suspects suffering from Excited Delirium frequently exhibit ‘superhuman strength’. When Black men are subjected to brutal violence in police custody, an informal diagnosis of ED effectively inoculates law enforcement agents against claims of racial discrimination. Institutional narratives surrounding Excited Delirium thereby engage in a form of discursive deracialization, “in which racial categories are attenuated, eliminated, or substituted and racial explanations are omitted or de-emphasised” (Augoustinos & Every 2007, P.133). For instance, The brutally violent subjugation of a scared and confused Black man who is experiencing drug induced psychosis may attract scathing condemnation. However, the same is unlikely to be true if that man is framed as a rabid, intoxicated beast who presents an immediate danger to themselves and to the community.


Racial panic over the perceived threat posed specifically by non-compliant Black bodies is thereby granted medicolegal validation under the auspices of that most sacrosanct entity ; the clinical diagnosis. Throughout the last two centuries, medicalized and ‘psychiatrized’ racial discourses have played, and continue to play, a critical role in the industrial disappropriation, murder and incarceration of POC. Black or other racial minority individuals suffering from psychotic disorders are significantly more likely to be offered psychiatric medication in lieu of psychotherapy (Das-Munshi, Bhugra & Crawford, 2018). Furthermore, Black people are more likely to be subjected to involuntary hospitalisation, an association which remains even after controlling for sociodemographic differences (Davies et al,. 1996).


One particularly illuminating study observed that white doctors assumed that Black patients needed lower doses of painkillers. The presumption that Black people have a higher pain tolerance is unequivocally informed by racial stereotypes which characterise POC as brutish, insensuous and animalistic. It also arguably testifies to the fact that Black suffering is perceived to be of lesser worth than white suffering. Naturally, such perceptions lend credibility to the use of physical and psychological violence during police encounters where Excited Delirium is cited as an extenuating factor in the officer’s conduct.


On the one hand, doctors and paramedics will choose to administer higher doses of chemical restraints such as ketamine because the racialized victim is expected to be more resistant to sedative or analgesic drugs. This results in a greater risk of drug-condition interactions, a process that sometimes results in fatal outcomes (As was the case for Elijah McClain). Simultaneously, police officers will choose to initially apply disproportionate force to overwhelm the victim, who is perceived to be unnaturally strong and immune to pain. The victim's body thereby becomes a canvas for the mordant stroke of the officer’s violence. For the same reason, police officers are likely to ignore or actively mock the victim’s cries of distress; surely a ‘superhuman’ body can endure ‘superhuman’ violence?


In a similar vein, the strategic attribution of Excited Delirium to ‘disobedient’ Black bodies represents a recent effort in the historic campaign to pathologize Black resistance to racialized structural violence. For instance, In the antebellum south, a number of attempts were made to portray defiance to slavery as a mental illness. For the southern physician, Samuel Cartwright, all attempts to make the Black man anything other than “the submissive knee-bender” would constitute a disruption in the natural order. Consequently, Cartwright was incredibly perplexed by the fact that some slaves would willingly choose to run away. In order to resolve this seemingly intractable conflict, Cartwright would propose that slaves absconding from service were afflicted by as “much a disease of the mind as any other species of mental alienation.”.


For the exceedingly perceptive Cartwright, resistance to slavery could only be explained by a syndrome of mental derangement to which he ascribed the catchy moniker of Drapetomania; after all, why else would someone choose to oppose the incredibly appealing institution of chattel slavery? Fortunately, Drapetomania never caught on - a surprising outcome considering the intellectual rigour manifest in Cartwright’s proposal (sarcasm intended). Nevertheless, any perceptive reader might observe that Drapetomania’s spirit of medicalized racism remains alive and well, embodied in the modern construct of Excited Delirium.


—----------------------------------------


To my British readers; Excited Delirium is more than just a horrifying symptom of America’s diseased criminal enforcement system. In the UK, the lives of countless individuals will be decided by institutions that are built upon a foundation of structural racial violence. In the 2020 documentary Ultraviolence, documentarian Ken Fero critically investigates the discourse and manifestation of racialized police violence in the United Kingdom. I had the privilege to attend a screening of the film at my university which was accompanied by a Q&A with the director.


The film describes a number of deaths in police custody. The documentary’s presentation is austere and inflammatory, which feels appropriate. Equal parts upsetting and infuriating, Fero demands that we not avert our gaze as he presents us with unadorned images of brutalised Black men in the throes of death. One could imagine that such a candid approach could invite accusations of engaging in cynical voyeurism. Admittedly, there might be an element of truth to such a critique. Nevertheless, the emotional impact was undeniable.


One case in particular would remain branded onto my memory. After receiving a complaint concerning a possible domestic incident, an astonishing fifteen police officers were dispatched to a house in London. The suspect was Paul Coker, a thirty two year old Black man, who had begun a fight with his girlfriend whilst under the influence of cocaine and cannabis. Paul was subsequently subjected to a brutal beating from as many as ten police officers. Fading in and out of consciousness, Paul would be transported to Plumstead police station. After arriving at the police station, the officers would leave the obviously unwell Paul Coker in a sterile white cell.


In Ultraviolence, Ken Fero forces us to bear witness to the final moments of Paul coker's life. Severely disoriented and clearly suffering from an acute brain injury, Paul Coker would silently pass away. Oblivious to his distress, the police officers would be observed exchanging banter at Paul’s expense. Indeed, five minutes after being pronounced dead, one officer would quip “You have to get one death in custody under your belt.”. In the months that would follow, an inquest into the circumstances surrounding Paul’s death would absolve the participating officers of complicity. Unsurprisingly, the cause of death would be largely attributed to Excited Delirium caused by acute cocaine intoxication.


—----------------------------------------


The screening of Ultraviolence was accompanied by a Q&A with Ken Fero and two women belonging to the families of men who had died in police custody. I participated in the Q&A, and I specifically asked about whether Excited Delirium was cited as a causative factor in the deaths of their loved ones. My question was particularly directed at Janet Alder, the sister of Christopher Alder, who died on the floor of a police station in Hull. Alder was assaulted outside of a nightclub in Hull and he sustained a traumatic brain injury (TBI) as a consequence.


Upon arriving at Hull Royal Infirmary, the staff would soon contact the police, claiming that Alder was behaving erratically (which was likely a natural consequence of having sustained a TBI). Two police officers then proceeded to forcibly escort Alder from the hospital to the police station. Alder was then left facedown on the floor of the police station, minimally conscious and writhing periodically. Engaged in jovial banter, the police officers failed to notice that Alder’s cries of distress grew weaker and weaker. Whilst Alder lay dying, some of police officers would even imitate the noise made by a monkey, callous behaviour which was undoubtedly a consequence of Alder’s ethnicity. Within minutes, Alder would pass away from a cerebral haemorrhage.


Janet Alder thanked me for my query, and confirmed my suspicions; Excited Delirium was cited as a causative factor in Christopher’s death. Although it may only be a minor consolation for Christopher’s family, a report by the Independent Police Complaints Commission condemned the Hull police force for being "unwittingly racist", specifying that the officers were guilty of "the most serious neglect of duty" (Campbell, 2020).


Despite this scathing condemnation, none of the officers would ever be convicted of any crime. In the end, it didn’t matter that Alder was a decorated army veteran. It didn’t matter that he had two children, and aspired to become a computer programmer. In the eyes of the Hull police force, he represented nothing more than another disposable Black body. As Christopher Alder lay dying on the floor of the police station, I can only imagine the final thoughts that ran through his mind:


“Of what crime have I been found guilty?”


“And if I am guilty, why have I been condemned to death?”



If you want to support Janet Alder’s campaign for justice, she is raising funds to mount a legal challenge against the South Yorkshire Police. I also recommend you watch Ken Fero’s Ultraviolence if you want further insight into this topic - you can follow him @migrantmedia on Instagram.


Bibliography


Aiken, F., Duxbury, J., Dale, C., and Harbison, I. (2011). Review of the Medical Theories and Research Relating to Restraint Deaths. http://iapdeathsincustody.independent.

gov.uk/wp-content/uploads/2011/11/Caring-SolutionsUK-Ltd-Review-of-Medical-Theories-of-RestraintDaths.pdf (accessed 19 December 2013).


Augoustinos, Martha, and Danielle Every. ‘The Language of “Race” and Prejudice: A Discourse of Denial, Reason, and Liberal-Practical Politics’. Journal of Language and Social Psychology 26, no. 2 (1

June 2007): 123–41. https://doi.org/10.1177/0261927X07300075.


Das-Munshi, Jayati, Dinesh Bhugra, and Mike J. Crawford. ‘Ethnic Minority Inequalities in Access to Treatments for Schizophrenia and Schizoaffective Disorders: Findings from a Nationally Representative

Cross-Sectional Study’. BMC Medicine 16 (18 April 2018): 55.

https://doi.org/10.1186/s12916-018-1035-5.


Davies, S., G. Thornicroft, M. Leese, A. Higgingbotham, and M. Phelan. ‘Ethnic Differences in Risk of

Compulsory Psychiatric Admission among Representative Cases of Psychosis in London’. BMJ (Clinical

Research Ed.) 312, no. 7030 (2 March 1996): 533–37. https://doi.org/10.1136/bmj.312.7030.533.


‘Elijah McClain Was Injected with Ketamine While Handcuffed. Some Medical Experts Worry about Its Use during Police Calls.’ NBC. July 3 2020.https://www.nbcnews.com/news/us-news/elijah-mcclain-was-injected-ketamine-while-handcuffed-some-medical-experts-n1232697.

Gonin, Philippe, Nicolas Beysard, Bertrand Yersin, and Pierre-Nicolas Carron. ‘Excited Delirium: A Systematic Review’. Academic Emergency Medicine 25, no. 5 (2018): 552–65. https://doi.org/10.1111/acem.13330.

Hester, Neil, and Kurt Gray. ‘For Black Men, Being Tall Increases Threat Stereotyping and Police Stops’. Proceedings of the National Academy of Sciences 115, no. 11 (13 March 2018): 2711–15. https://doi.org/10.1073/pnas.1714454115.

Hill, Evan, Ainara Tiefenthäler, Christiaan Triebert, Drew Jordan, Haley Willis, and Robin Stein. ‘How George Floyd Was Killed in Police Custody’. The New York Times, 1 June 2020, sec. U.S. https://www.nytimes.com/2020/05/31/us/george-floyd-investigation.html.

Hoffman, Kelly M., Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver. ‘Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites’. Proceedings of the National Academy of Sciences of the United States of America 113, no. 16 (19 April 2016): 4296–4301. https://doi.org/10.1073/pnas.1516047113.

Mash, Deborah C. ‘Excited Delirium and Sudden Death: A Syndromal Disorder at the Extreme End of the Neuropsychiatric Continuum’. Frontiers in Physiology 7 (13 October 2016): 435. https://doi.org/10.3389/fphys.2016.00435.

‘Medics in Colorado Dosed 902 People with Ketamine for “Excited Delirium” in 2.5 Years, Including Elijah McClain’. Accessed 30 January 2022. https://coloradosun.com/2020/07/23/ketamine-use-paramedics-elijah-mclain/.

Rimmer, Abi. ‘Excited Delirium: What’s the Evidence for Its Use in Medicine?’ BMJ 373 (5 May 2021): n1156. https://doi.org/10.1136/bmj.n1156.

Ruttenber, A., Lawler-Heavner, J., Yin, M., Wetli, C., Hearn, W. and Mash, D., 1997. Fatal Excited Delirium Following Cocaine Use: Epidemiologic Findings Provide New Evidence for Mechanisms of Cocaine Toxicity. Journal of Forensic Sciences, 42(1), p.14064J.

Sekhon, Sandeep, Michelle A. Fischer, and Raman Marwaha. ‘Excited Delirium’. In StatPearls. Treasure Island (FL): StatPearls Publishing, 2022. http://www.ncbi.nlm.nih.gov/books/NBK546674/.

Tompkins, Lucy. ‘Here’s What You Need to Know About Elijah McClain’s Death’. The New York Times, 18 January 2022, sec. U.S. https://www.nytimes.com/article/who-was-elijah-mcclain.html.

Vilke, Gary M., Mark L. DeBard, Theodore C. Chan, Jeffrey D. Ho, Donald M. Dawes, Christine Hall, Michael D. Curtis, et al. ‘Excited Delirium Syndrome (ExDS): Defining Based on a Review of the Literature’. The Journal of Emergency Medicine 43, no. 5 (November 2012): 897–905. https://doi.org/10.1016/j.jemermed.2011.02.017.




0 comments