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Beyond Words: The Excited Delirium Discussion

Words wield power in law enforcement. The language chosen by officers is not merely a means of communication, but a vital tool that shapes their interactions and outcomes. This aspect of policing is crucial not just in individual encounters but also plays a significant role in influencing community perceptions of law enforcement. The recent debate, particularly following California's legislative shift on the term 'excited delirium,' underlines the importance of language. 


In light of these linguistic shifts, it's important for agencies to reflect on their policies and the language they use, ensuring it resonates with current societal values and norms. However, it's also crucial to recognize that these changes in terminology are just that — changes in language, not necessarily in action. As agencies navigate these linguistic updates, the most important takeaway in this current debate should not be the language used but the policies and procedures being employed. While departments are revising their policy language, they should, more importantly, review and align their response procedures to such incidents with best practices. This ensures that they are positioned to achieve the most favorable outcomes for all involved.


Background on the California Ruling


The state of California, in a landmark legislative act, banned the use of 'excited delirium' in police reports and as a cause of death, a move that has set a precedent and sparked a national reassessment of the term's appropriateness and utility. California's recent legislative ban on 'excited delirium' follows in the wake of significant shifts in stance from leading health organizations. The American Medical Association (AMA), the American Psychiatric Association (APA), and the American College of Emergency Physicians (ACEP) have all expressed concerns or direct opposition to the term. They argue that it lacks clinical validation, is not recognized within the Diagnostic and Statistical Manual of Mental Disorders (DSM), and may carry implicit racial biases.


Terminology's Impact


The term 'excited delirium' has traditionally been part of the vocabulary for many agencies, used to describe individuals displaying signs of acute behavioral distress, including but not limited to symptoms such as hyperactivity, agitation, extreme anxiety, or erratic behavior. However, opponents of the term argue that it lacks clinical validation, drawing parallels to the use of 'multiple personality disorder,' which was redefined as Dissociative Identity Disorder (DID) in the DSM in 1994. But as law enforcement officers, our role was never to diagnose medical or psychological disorders. Our job is simpler: to respond, observe, and effectively communicate our observations to incoming units, and to recognize the need for additional resources, such as EMS or officers trained in crisis intervention.


For example, An officer encountering an individual with symptoms suggestive of schizophrenia would not attempt to diagnose the individual. Instead, they would detail their observations in a report, noting behaviors such as the individual speaking to unseen entities, reacting to auditory hallucinations, or displaying disorganized thought patterns. This approach ensures accurate communication without overstepping into the realm of clinical diagnosis.


Beyond Semantics: The Real Impact on Patrol Response


The debate surrounding terms like 'excited delirium' does not substantially change the fundamental approach of patrol officers. Across the Commonwealth, officers will persist in applying their training and experience, emphasizing the use of clear, direct language that steers clear of medical jargon and remains within the scope of their law enforcement responsibilities. Additionally, they will continue to implement procedures that are designed to enhance the likelihood of achieving the most positive outcomes in their interventions. This consistent approach underlines the commitment of officers to effective, respectful, and situation-appropriate responses, regardless of the evolving terminology in the field.


In both their radio communication and reporting, officers should prioritize descriptive communication that paints a clear picture of the situation without venturing into medical diagnoses. For instance, in radio communication, an officer might relay that the individual is “displaying extreme agitation,” “sweating,” and “not responding to verbal commands”. This type of communication ensures that essential information is effectively relayed to responding units and EMS, facilitating an informed and coordinated approach. Such approaches may include but are not limited to employing de-escalation techniques; having EMS staged nearby to evaluate the individual after they are taken into custody; and/or having officers trained in crisis intervention respond to provide specialized expertise. 


Similarly, in their written reports, officers should employ the same type of descriptive language to document the incident accurately. A report might read, "Subject exhibited extreme physical restlessness, profuse sweating despite cool temperatures, and a lack of responsiveness to communication efforts." This approach ensures that the report is factual and objective, providing a clear and detailed account of the observed behaviors without implying a medical diagnosis. 


Ultimately, the shift away from using terms like 'excited delirium' does not necessarily signify a fundamental change in our response to such incidents. Instead, it represents an alignment of terminology with evolving perspectives in public health and safety. The key takeaway is the consistency of our response protocols, ensuring the safety and well-being of both the community and individuals in crisis.

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