In late January 2015, Natasha McKenna called 911 to report that she had been assaulted, and was taken by ambulance to a hospital in Fairfax County, Virginia. A diagnosed schizophrenic from the age of 12, with numerous psychiatric hospitalizations in her past, McKenna was cleared for release from the hospital and immediately arrested on an outstanding warrant stemming from her involvement in a scuffle with Alexandria police officers a week and a half earlier. She was transported from the hospital to the Fairfax County Adult Detention Center.
In previous encounters with police and in the course of a recent hospitalization, McKenna had been, according to authorities, agitated and disruptive. She refused food, covered her cell window with wet toilet paper to escape being seen, and showed other signs of unruliness, reportedly kicking, scratching, biting, and spitting at her jailers. And she fought, with what is described by the County Prosecutor as “extraordinary strength and endurance,” against restraint (Report, 15).
On February 3 2015, McKenna was assigned to be transported from the jail in Fairfax county to the Alexandria Adult Detention Center. A Sheriff’s Emergency Response Team (SERT) was dispatched to remove her from the cell. She was surrounded by six officers in all, five of whom appeared before her door in stab-proof vests, gloves, helmets, gas masks, and white Tyvek jump-suits. She was hooded to prevent biting and spitting. McKenna struggled and refused to comply with orders; she fought restraint and resisted attempts to strap her into the chair in which she was to be transported. When she remained uncooperative, one deputy applied a Conducted Energy Device (CED) to her body, discharging the Taser into her leg and upper arm. She was Tased four times in total, in a span of a little over two minutes (25). A few minutes after being Tased the final time, Natasha McKenna stopped breathing. She was revived in the hospital but with major brain injury. McKenna did not regain consciousness from the time she left the jail. She died 5 days later.
The medical examiner’s report of February 9 declared as cause of death “Excited delirium associated with physical restraint including use of conducted energy device” (48). Seven months later State Attorney Raymond F. Morrogh supported that conclusion, determining that the officers involved behaved lawfully and reasonably, and could not be held accountable for her death. All six officers, including the officer who Tased her four times, were cleared of misconduct.
Natasha McKenna’s death has drawn attention to the improper handling of mental illness in America, where the mentally ill are routinely sent through the criminal justice system, and jail time is substituted for psychiatric care. Hers is one of many high-profile instances this year of a person of color dying by the hands of police under suspicious circumstances. McKenna’s death, and the exoneration of the officers involved in it, fits a pattern in which the perception of the person of color as something other than human (subhuman and/or superhuman) is both presented and accepted as justification for the violent use of force. One Deputy described Natasha McKenna’s state as akin to “a demonic possession” (16). In testimony, Darren Wilson described the “intense aggressive face” of Michael Brown as being “like a demon.”
McKenna’s death has also incited renewed scrutiny of a controversial syndrome named as the cause of her death, the condition “excited delirium.” You will not find excited delirium in the DSM; it is not officially recognized by either the AMA or APA. There is no autopsy evidence of excited delirium; no trauma or disease is sufficient to explain it. With no distinct cause of death revealed to postmortem analysis, excited delirium is instead identified by its presenting symptoms in the moments (typically hours or minutes) before death. The syndrome is associated with a host of characteristics including hyperthermia, incoherent speech, aggression, imperviousness to pain, and extraordinary strength of resistance. As the authors of one book on the subject report, “In virtually all such cases, the episode of excited delirium is terminated by a struggle with police or medical personnel, and the use of physical restraint” (Di Maio & DiMaio, quoted Report 44). Excited delirium is rarely cited as a cause of death outside deaths occurring in police custody.
Researchers of excited delirium regularly point to an article of 1849, published in the American Journal of Insanity, as an early account of the syndrome. Written by Luther V. Bell, Superintendent of the McLean Asylum in Somerville Massachusetts, the essay describes many of the symptoms today attributed to the disorder that was in 1985 given its current name. Bell himself is hardly certain whether the malady that would come to be known as Bell’s mania was a disorder separate and distinct from others, warranting “the necessity of its forming a new item in the arrangements of nosology” (Bell, 98). But Bell’s essay gives excited delirium, a diagnosis both of recent date and of uncertain status, the appearance of a stable and long-standing genealogy. The Fairfax country prosecutor describes the presenting symptoms of the disorder as part of a “symptomatology long observed in the medical community” (Report, 45).
Bell’s case studies, several of them concerning adult women in their 20s or 30s who had come under the care of the Asylum, emphasize the “extreme violence of the delirium” (119). Patients are caught up in a “blind fury” urged forward by “desperation” and a “sensation of danger;” afflicted patients have “no disposition to yield to an overpowering force” (100-1). For Bell, as for the police officers, medical examiners, and prosecutors who invoke his essay today, the malady is closely identified with a propensity to physical struggle. Resistance is consistently among the foremost presenting symptoms of the disease; not the autopsy report but the intensity and duration of McKenna’s struggle indicates the presence of excited delirium. The prosecutor’s report twice emphasizes McKenna’s apparently “superhuman” strength in resisting attempts by six officers to restrain her (Report, 46) — noting that “extreme even ‘super human’ strength is a well-documented symptom of excited delirium syndrome” (37). One of the SERT officers testifies that McKenna was “one of the strongest females I have ever encountered in my 11 1/2 years” (14). Where intensity and strength of resistance is encountered, there excited delirium will be found.
In the mid 1980s, when excited delirium was first posited as a cause of death, the proximate cause was understood to be heavy drug use, of cocaine or PCP. Mental illness (bipolar disorder or schizophrenia) is also often named as a contributing factor, as it is in McKenna’s case. In determinations of excited delirium, reports of death in police custody assign no causal value to the applications of force — fists, restraint positions and choke-holds, billy clubs, Tasers — that may be involved in the subject’s death. The title of one Canadian police officer’s report illustrates the occultation of causality in descriptions of this kind: “Excited Delirium and its Correlation to Sudden and Unexpected Death Proximal to Restraint.” Without autopsy evidence to indicate a clear cause of death, correlation and proximity occupy the place of causal explanation. Death is merely proximal to restraint, not a direct or even indirect result of it.
As social justice advocates and others have observed, the diagnosis of excited delirium is not only intended to rationalize deaths in police custody; it achieves this end by making the victim responsible for his or her own death. In excited delirium the principle of excitement is not from without, but from within: the diagnosis stipulates that the victim is literally “excited to death” (Paquette, 93). In clearing all six men of wrongdoing, the prosecutor’s conclusion assigns as cause of death McKenna’s own resistance and faulty brain chemistry: “it was Ms. McKenna’s metabolically unsustainable and protracted resistance to any restraint due to her mental illness and the ensuing excited delirium syndrome that actually caused her death” (50). The prosecutor’s “actually” gives the pronouncement the unintended force of a surprise ending, reintroducing the possibility that the report seeks at length to foreclose.
“[T]he human mind is capable of being excited without the application of gross and violent stimulants.” With this statement William Wordsworth affirms the mind’s independence from the forms of “immediate external excitement” that threaten to overwhelm and extinguish it (599, 607). Wordsworth thought this capacity to be strongest in poets but an endowment available to all, a privilege of human birthright though not equally distributed. It is a statement in defense of human liberty, not a effort to explain away the force of the real.
On exiting her cell and encountering the hooded and masked team that had come to transport her, McKenna said, “You promised me you wouldn’t kill me” (Report, 27). That Natasha McKenna was jailed rather than hospitalized; that McKenna died at the hands of the authorities who wrestled, restrained, and repeatedly Tased her; that her death was unnecessary, and preventable; that she foresaw her own death at the hands of her captors: these are facts that the police, prosecutors and medical examiners of Fairfax county wish a horrified public to ignore. The official narrative, usurping the place of these truths, is that it was the force of her resistance, and not the labors of the six officers assigned to transport her, that killed McKenna — not the gross and violent measures of her handlers but an excited delirium that carried McKenna away.