Is excited delirium killing coked-up, stun-gunned Miamians?

July 13, 2010
By Gus Garcia-Roberts, Miami New Times News

"And then all of a sudden he broke out in a great flame of anger, stamping with his foot, brandishing the cane, and carrying on like a madman." — The Strange Case of Dr. Jekyll and Mr. Hyde

It was as if he were two people. Most of the time, Xavia Jones was a mellow, caring father to his daughter, Catherine. He was an ex-con determined to self-improve, a CNN junkie who studied after work at the Miami Beach Convention Center to earn union certification.

But more and more often, something terrible was taking hold of the lanky Opa-locka native whose skin was inked with "Immortal," "Outlaw," and "Thug Life." Xavia's live-in girlfriend, Carrie, would find him hiding behind the couch, a sweating, convulsing fugitive from invisible corrections officers or other unknown enemies. And he'd burst into evil spells, slapping Carrie and pulling her hair, threatening to kill her for cheating on him, his face a dark slate. "He could be a very good friend," Carrie says, "or the next moment he could be scared and paranoid, thinking everybody in the world was after him."

And then one Friday night after work in January 2008, Xavia permanently entered his own private horror show. Sitting on a couch among friends in a Coral Gables condo, sweating, twitching, and blasted on lines of coke and a half-dozen beers, he hugged himself and pleaded, "Oh, please, Jesus, give me the strength not to do this."

Then he began growling, screaming, and running in and out of the apartment like a man on fire.

At 2 a.m., Coral Gables cops found him lying in the middle of traffic-clogged U.S. 1, screaming, "God is coming to take me!" As an officer edged toward him with gun drawn, Xavia's eyes gleamed as he dared him: "Kill me, kill me, shoot me, shoot me."

One of the four cops present would later say Xavia's threatening posture made it "unsafe to approach." So Sgt. Jesus Garcia unloaded his Taser four times into the writhing man. It "seemed to have no effect." So another officer, Scott Selent, hit him with five more electrical bolts. This time, Xavia "kind of locked up, almost like he was a board," the police would later recall.

As the electricity coursed through Xavia's muscles, the cops slapped cuffs on his wrists, dragged him to the sidewalk, and set him facedown on the pavement. "What the heck is going on?" one officer asked.

"Fuck you, motherfucker," was the answer. As soon as Xavia said it, his body went limp and a white liquid trickled from his mouth.

Xavia Jones was the fifth person to die after being hit with a police stun gun in Miami-Dade, according to a December 2008 study by Amnesty International, ranking it seventh of all counties in the United States. Fifty-two people died in Florida after being hit by the 50,000-volt department-issued Tasers, second only to California's 55.

But the electricity didn't kill Xavia, according to Miami-Dade County associate medical examiner Erik Mont. The official cause: "excited delirium syndrome, associated with cocaine use."

The symptoms were all there, wrote Mont: "agitation, excitability, paranoia, aggression, great strength, numbness to pain, and sudden death."

In fact, in all five county cases of death following tasing, the medical examiner's office named excited delirium as the cause of death. According to the 2008 Amnesty International study, 111 of the nation's 334 post-Taser deaths were blamed on excited delirium.

The bizarre syndrome, first diagnosed in Miami, transforms its typically sane victim into a slobbering, raging, supernaturally strong menace hell-bent on self-destruction. It could be ripped straight from the pages of The Strange Case of Dr. Jekyll and Mr. Hyde, Scottish scribe Robert Louis Stevenson's 1886 archetypal tale of split personality. In the novella, the gentle Dr. Jekyll drinks a potion to become the murderous, hideous Mr. Hyde. In this real-life affliction, the spark is cocaine.

Excited delirium appears to be inflicting Miamians at an especially alarming rate. Since 1989, the Miami-Dade medical examiner's office has declared 38 people dead of the syndrome. In the past decade alone, that number is 28, compared to five during that time in Broward County.

The Miami victims were predominantly male. Twenty were white or Hispanic; 18 were black. They included a hairdresser, a truck driver, and an attorney. Thirty-six of them had cocaine in their system. The other two were diagnosed schizophrenics.

Among the cases: the crack-addicted former lawyer who ran around Liberty City, screaming that somebody was trying to kill him. He broke into an abandoned house and began beating the walls, and himself, with a stick when he was tased. He died in handcuffs soon after.

Then there was the 35-year-old Northwest Miami-Dade father who for a full day had been "acting paranoid" and was unable to recognize his children, his wife later told cops. Police showed up after he ran into noontime traffic, and he stopped breathing one to two minutes after being handcuffed.

Perhaps the strangest rampage was that of the Key Largo vacationer from Homestead who jumped on the hood of a moving vehicle and rode it for a mile, ransacked a toll booth after chasing away the collector, and climbed in and out of an unlocked van before bursting into an occupied houseboat and hiding in the bathroom. When cops showed up, he swam to a small island, where he was finally apprehended and expired in plastic cuffs and leg restraints.

While Miami-Dade seems to be far outpacing more populated counties throughout the nation in the number of excited delirium cases, critics from the American Civil Liberties Union and the families of victims believe there's a reason the syndrome resembles overwrought fiction: because it is.

The syndrome is not listed in textbooks or recognized by the American Medical Association or the American Psychiatric Association. It has been met with skepticism as it has spread to the United Kingdom and Canada: A police psychologist in Canada recently made headlines when he testified that excited delirium is a "mythical... dubious disorder" used to justify the use of stun guns, and the Canadian Medical Association Journal has termed it a "pop culture phenomenon."

It is police, not excited delirium, causing at least some of the deaths, critics charge. Of 35 excited delirium death reports the Miami-Dade medical examiner's office made available to New Times, 23 of the subjects died after struggling with police officers. Besides the five tasing incidents, they were hogtied, headlocked, and pepper-sprayed. All were unarmed.

"It's overused by medical examiners across the country to hide brutal murders by law enforcement," says Ronald J. Kurpiers, an attorney who recently challenged the diagnosis in a U.S. Supreme Court lawsuit against West Palm Beach Police officers. "It's bullshit."

As for Xavia Jones's bereaved girlfriend, Carrie, she tells their 5-year-old daughter, Catherine, that Daddy died of a heart attack. "When she gets older," Carrie explains, "I'll tell her the whole story."

Asked if she thinks the police killed Xavia, Carrie scoffs. "I can tell you that he wouldn't have died if they weren't there."

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Four decades before Robert Louis Stevenson is said to have scrawled his nightmare-inspired tale of rampage in a three-day cocaine-fueled writing spell, a horse and carriage pulled on to the manicured grounds of the McLean Asylum for the Insane in Somerville, Massachusetts. The coach had traveled 40 miles, and the 31-year-old woman whom orderlies struggled to extricate had "contended violently" the entire way.

She would be immortalized in scientific literature only as "E.A.P.," and she "attack[ed] wildly and discriminately all who approached her."

Her condition that day in July 1847 was a mystery. She was an Army wife, and her husband was away fighting the Mexican-American war. She didn't drink, so the asylum director, Luther V. Bell, ruled out she was suffering from the withdrawal mania delirium tremens. The normally reasonable woman had simply blown a fuse, it appeared, during tea with friends.

McLean Asylum was an opulent place, later home to the notably unstable such as Sylvia Plath, Rick James, and Ricky Williams. The patients ate lobster, and the psychiatric methods were relatively modern. But director Bell broke his own rule and tied E.A.P. to her hospital bed. For the next 16 days, she remained "highly excited" even as she was leeched and administered opium. She rarely slept and "recognize[d] no one."

Then E.A.P. contracted diarrhea. The next day, she simply died.

Bell observed 40 such befuddling cases of unexplained sudden mania from 1836 to 1849, with 30 of them ending in death. The "exhaustive mania" spurned him to publish an October 1849 study in the American Journal of Insanity.

He described the typical afflicted patient as uncomprehending and "suspicious," with dilated eyes and a "pinched-up... florid and greasy" face. "Oftentimes [the] sensation of danger will exhibit itself in the patient attacking any one who approaches him with a blind fury,'' Bell wrote. "If held, he will struggle with the utmost desperation, irrespective of the number or strength of those who may be endeavoring to restrain him... At the expiration of two or three weeks, your patient will sink in death."

The minority that weren't killed by exhaustive mania, wrote Bell, "emerge[d] in a state of absolute recovery at once."

While he noted that "almost every one" of those with the mysterious affliction was strapped to his bed, the doctor was clearly perplexed as to treatment options. He could only cautiously recommend small doses of opium and wine.

The affliction would become known as Bell's mania. Other early 20th-century scientists performed their own studies on similar lethal spells they called "psychotic furors" and "restraint psychosis." And more than a century after the mystery at the gilded asylum, director Bell's findings were revisited in a place he likely could not have imagined: the cocaine-flooded streets of 1980s-era Dade County.

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As the Victorian upper crust had treasured its cure-all opium, Miamians doted on their chic white powder at the height of the disco era. "Cocaine was thought to be an open secret, a wonder drug that nobody ever died from," says Dr. Charles A. Wetli, who took his post as Dade County's second-in-command coroner in the late 1970s. Meanwhile, his office processed two overdoses a week.

So Wetli, also a University of Miami pathology professor, co-authored a scientific paper about "death caused by recreational cocaine use" — a revolutionary concept at the time. But it was more difficult to explain an influx of strange cases that began showing up on his gurney: subjects who had raged wildly before sudden death. Cocaine was found in their systems, but not enough to cause overdose.

Wetli noted a profile. "It only happened in chronic users of cocaine, and predominantly in males," he says. "It's as if they're impervious to pain — to pepper spray, to batons, to numchucks. You spray them with pepper spray and they just sort of look at you."

Wetli and UM colleague David A. Fishbain found seven such cases — six in Miami-Dade and one in Palm Beach County — that had occurred during a 13-month period in 1983 and 1984. The resulting study pioneered excited delirium.

The death cases read like classics of the syndrome: The female drug trafficker, the only woman in the study, who suddenly jumped out of a moving car. "You're trying to kill me. Please don't kill me. I have children," she begged of her boyfriend, who was driving, as she dove out the passenger-side door. She died after several police officers "subdued" her with handcuffs and ankle restraints.

Or the 26-year-old man who fought with his boyfriend, stripped naked, and "ran about the apartment smashing a variety of objects," lacerating himself, before expiring in restraints at the hospital.

And the cocaine freebaser who "began running down the street yelling and screaming unintelligibly." He stole and fired a police officer's gun after being tackled. Cops struck him twice on the head with a heavy flashlight, but the medical examiner didn't find lethal injuries.

In five of the seven cases, the subjects died in police custody. Wetli and Fishbain didn't know why excited delirium caused death, but they posited it might have had something to do with the increasing purity of street cocaine. Their only recommendation was that cops and paramedics "be aware of the potential for sudden death" in crazed subjects.

But if Wetli was treading on shaky ground, his biggest case would call into question whether he was stretching the evidence to fit his theory.

For a decade, the bodies turned up in flop motels, parking lots, and alleyways throughout inner-city Miami. They were often naked from the waist down and all showed signs of recently having had sex. They were all black women. Most were prostitutes and chronic cocaine users.

Cops and medical examiners were stumped by the 32 corpses found from 1980 to the turn of the next decade. But it wasn't the work of a subtropical Jack the Ripper, declared Dr. Wetli. Autopsies "have conclusively showed that these women were not murdered," he told the now-defunct Miami News in 1988. Instead, he hatched a brazen theory that would come to provide ammunition for modern-day debunkers of excited delirium.

Wetli posited that a female offshoot of the syndrome, involving the combination of sex and years of cocaine use, had caused the serial deaths. "My gut feeling," Wetli told New Times in 1989, "is that this is a terminal event that follows chronic use of crack cocaine affecting the nerve receptors in the brain."

"For some reason," he expounded to the Miami News, "the male of the species becomes psychotic [after chronic cocaine use] and the female of the species dies in relation to sex."

But in 1992, police announced they had found a serial killer responsible for the deaths: 36-year-old Charles Henry Williams. Wetli's boss, chief examiner Joseph Davis, exhumed the bodies for re-examination and found evidence of asphyxia. Williams died of an AIDS-related illness before he could face the mounting evidence against him, which included physical links, accounts from escaped victims, and a pattern that showed that when he was in prison, the deaths ceased.

Wetli's apparent missed call 20 years ago casts doubt on excited delirium today, says Nashville attorney and National Police Accountability Project member Andrew Clark. "He's one of the guys who coined excited delirium, and he misapplied it to the work of a serial killer," Clark says. "How do we know his colleagues aren't making a similar mistake?"

Today, Wetli, who is in private practice in New Jersey, initially downplays his theory. He had to make a diagnosis so that the bodies could be buried, he says. But then it becomes clear he still believes that death-by-sex might have killed those women 20 years ago. "It's certainly a possibility," he says. "The guy never went to trial, so we'll never know. The police had a commendable theory in suspecting him. But believing in something, and proving it, is another story."

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University of Miami's brain bank, located on the fourth floor of a drab building in downtown Miami, is all cramped quarters, depressing lighting, and towering filing cabinets. It has about as much evil-lair feng shui as a small-town library.

But this — if you believe critics — is where neurology professor Deborah Mash, Dr. Wetli's heir as the world's leading expert on excited delirium, bends over brain samples, presumably with a hunchbacked assistant by her side, and concocts the science fiction that is gaining acceptance throughout the world.

"She's just a charlatan," California attorney John Burton, who has turned taking on Taser into his career, says of Mash. "She's not a medical doctor, and she has no business opining on cause of death."

But the 56-year-old, dark-eyed neurologist, who wears pantsuits and a skeptical smile, doesn't act the villain when she meets with New Times. She calls a reporter "silly boy" in a chirpy drawl and commiserates with the anger she attracts. "Everybody's pointing fingers. Nobody's happy," she says of excited delirium deaths. "And the problem for medical examiners is that they have no anatomic cause of death. You're running around manic one minute, and the next minute you're dead."

It's not the first time Mash has been called a junk scientist. She made headlines in the 1990s when she championed the use of an organic African hallucinogen called ibogaine as a "vaccine" for cocaine dependence. Stonewalled from government funds, she opened an ibogaine clinic on the Caribbean island of St. Kitts, and she says she's still continuing her research on the drug through private funding.

Mash has met similar resistance with excited delirium. The ACLU says it's used to "whitewash clear cases of police abuse," as spokesperson Eric Balaban puts it.

Founder of UM's groundbreaking Excited Delirium Education, Research and Information Center, Mash probably hasn't helped matters by providing paid expert testimony to Arizona-based Taser, International. The $2 billion company, which distributes stun guns to 40 countries, has successfully fended off dozens of wrongful death and product liability lawsuits.

Taser, which insists its guns are nonlethal, has become an enthusiastic lobbyist for excited delirium. Its reps distribute books about the subject at conferences for medical examiners and police chiefs, send information to medical examiners processing in-custody deaths, and even recently circulated a ready-made statement for police departments to use when somebody dies after being tased: "We regret the unfortunate loss of life. There are many cases where excited delirium caused by various mental disorders or medical conditions, that may or may not include drug use, can lead to a fatal conclusion."

The company has gone so far as to successfully sue medical examiner's offices, such as the one in Akron, Ohio, for listing Taser as a cause of death.

As stun guns have proven virtually unassailable in court, governments across the nation have adopted them en masse. In 2005, a Miami-Dade County grand jury recommended Taser use even in non-life-threatening situations. The finding cited excited delirium repeatedly, endorsing the use of Tasers "as a nonlethal method to incapacitate individuals" believed to be in the throes of the mania.

You could say the company appreciates Mash's work. "She's doing really cutting-edge research all on her own," says Taser spokesperson Steven Tuttle, "and it's very fascinating stuff."

In a 2009 deposition for a civil case against Taser, Mash admitted to earning $16,000 from Taser for excited delirium testimony the year before. In the court interview, she claimed to have forgotten how much the company paid her in previous years, and she recently refused to tell New Times how much Taser has paid her since. "I haven't done my taxes," says Mash, co-owner of an $868,000 North Bay Village house with ex-husband, former Miami-Dade Democratic Party chair, and mayor of the village, Joe Geller. The neurologist adds that Taser has never funded her research.

Mash insists she has testified only as an expert on excited delirium and has no opinion on the safety of stun guns. "Who cares about the Taser?" she squawks. "I don't care about the Taser, and I'll tell you why. Excited delirium was happening before the Taser. Excited delirium was happening in the 1800s, in Bell's institutionalized psych patients. If it happened with pepper spray, you'd say, 'Oh, it's the pepper spray that's killing them.'"

The same goes for restraints, hog ties, and baton strikes, Mash says. But the bottom line: "We have some cases where there were no police involved, and they still died."

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London native Matthew Kahn came to South Beach, along with his boyfriend and three other friends, seeking to celebrate the turning of the millennium in debaucherous fashion. The 28-year-old got his hands on a bag of crystal meth and snorted it away. And then, his partner Dale later told cops, he simply went "mad."

In the early morning of January 3, 2000, Matthew ripped apart the bathroom in a guest room at the Clay Hotel on Española Way, slicing and bruising himself in the process. Just before 10 a.m., paramedics found him in the throes of continuous seizures. He died in the South Shore Hospital emergency room, with only about a tenth of the amount of cocaine or meth in his system needed to cause overdose.

The English tourist's death is one of about five in Miami-Dade's recent history that Dr. Mash has reason to tout. There were no cops involved, no struggle, and no blunt trauma. Matthew, like those Massachusetts asylum patients of scientific lore, simply expired.

The same is true for a 36-year-old bail bondsman named Nathaniel Blash, married father to two teenagers, who was found dead, wearing only boxer shorts and jewelry, lying face-up under an SUV on NE 53rd Street, with cocaine in his system and no signs of injury.

And 29-year-old Marlon Sankar, a clean-living truck driver who apparently turned to cocaine in his distress over a breakup. Authorities found him lying nude and bleeding in his Miami Springs front yard after he tore apart his bathroom with his bare hands. (One simple theory for all of the destroyed bathrooms: that's the most common place to use drugs.) Marlon claimed he had been robbed and beaten — which was later determined to be untrue — and he died suddenly at Jackson Memorial Hospital.

And 41-year-old Roosevelt Baker, who on a hot July afternoon was sprinting in and out of a South Miami RaceTrac gas station and yelling incoherently when he collapsed dead before police arrived.

In this handful of cases, neither family members nor lawyers contested Dr. Mash's cocaine-induced syndrome. It seems there was nothing else there to cause death.

As a police report put it in the case of 29-year-old Stephen Daugharty, who collapsed after running through his Homestead neighborhood while screaming that someone was trying to kill him: "His father said that he had a good heart, but he loved drugs more than life."

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Even as the controversy has raged, Mash has spent the past decade studying patterns in the dissected brains of cadavers diagnosed with excited delirium. And she claims she is close to solving the mystery of why the disputed syndrome causes death.

Mash now believes certain people are genetically predisposed to excited delirium. Cocaine, methamphetamine, or in some cases, unmedicated mental illness is the spark that causes the "electrical event" transmitted from the brain to the heart.

"It's almost like a jack-in-the-box," Mash says of those prone to excited delirium. "The springs are fully wound. You can walk around your whole life like this and you're not going to pop your cork. But if you start smoking crack, and you've been hitting the crack pipe for a number of years, and then one day — dun-dun-dun — you have full-blown excited delirium."

The brain goes into hyperthermia, sizzling like bacon at temperatures of 105 degrees or higher, causing extremely sudden cardiac arrest, which is why many sufferers tend to rip off their clothes or seek shade under vehicles. "Medical examiners have described cases," Mash says, "where paramedics get to the scene and the room is trashed, there are ice cubes everywhere, and the subject is dead. That tells me that person was trying to cool down."

Mash believes some people might suffer "flicker episodes" — nonfatal spells — of excited delirium. If true, that could explain the flashes of strange behavior Xavia Jones exhibited months before being tased in Coral Gables, and it might even solve the mystery of those briefly afflicted patients at the 19th-century McLean Hospital who snapped out of their madness as quickly as they had been smitten by it.

However, there's still no way to identify those cursed with excited delirium until it's too late, Mash says. She responds it's "not [her] job" to give advice to cops or paramedics who encounter somebody in the throes of excited delirium. And she becomes glib when asked how people can protect themselves from dying of the syndrome: "Yeah, don't do drugs. If you're at risk for excited delirium — of course, we don't know who you are — no methamphetamine or cocaine for you. Start with that. And if you're a psychiatric patient, please keep your medicine compliant."

But Miami-Dade Fire Rescue paramedics have taken an unprecedented step in battling the body count: They are now equipped with excited delirium survival kits, designed to stop brains from hitting the griddle.

The new protocol was dreamed up by Miami-Dade chief medical examiner Dr. Bruce A. Hyma — an unabashed excited delirium bible-thumper and member of the Mash-founded UM research center — and fire-rescue officials. "We discussed how we can maybe abort this cycle and somehow save some lives," Hyma says. "The long and short of it is, if we can minimize the amount of physical exertion when this whole process starts, we can mitigate the amount of overheating that leads to death."

The plan, which has been in effect since 2007: First, a police officer tases the manic subject. Next, rescue workers quickly administer a nasal hit of Versed, a knockout drug commonly used on patients before surgery. Last, the subject is injected with iced saline to keep his or her temperature down. "The key is that when one of these events occurs," Hyma says, "it [should] be recognized as a medical emergency, not as a domestic altercation or a civil disturbance."

Hyma believes Miami-Dade is the only county to have such an approach in action, although "maybe others have copied it now and are using it." Hyma offers the unverified claim that 19 of 20 manic subjects hit with the Versed-and-saline cocktail have survived. One hitch: Because they lived, there's no way to prove those survivors were suffering from excited delirium in the first place.

Hyma hopes counties across the nation soon follow Miami-Dade's lead. Then comes the day, naturally, when paramedics are equipped with Tasers. Which is further gloom and doom for the civil rights set. Amnesty International's Jared Feuer sounds fatigued when told of the innovative approach: "So, wait, they tase them and then drug them?"

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"Right in the midst there lay the body of a man sorely contorted and still twitching." —Dr. Jekyll and Mr. Hyde

It's apparent Linda Lewis misses being a mother. She attempts to gorge a reporter on soda, offers to make him lunch, and sternly advises him against speeding on his way back to Miami. Her Lantana home is a shrine with photos of her son, Donald Lewis, who lost his life at the age of 38 on the side of a road in October 2005. Every so often, she picks one up and shakes it. "Does this look like a drug addict to you?" she demands. "He could have been a model!"

The pictures display a John Mellencamp song come to life: shirtless and handsome, with an American flag tattoo on his bicep and a big, beef-eating smile.

It's clear there were two Donalds. There was the one Mom knew, the hard-working screen installer who made $40,000 a year, doted on his teenage son, and grew husky on her home-cooking.

Then there's the one police officers knew: arrested upward of 60 times on drug-possession and petty charges, one of those crackheads who swear to go clean but never do.

On October 19, 2005, Mugshot Donald won the battle for good. That's the day West Palm Beach cops found him writhing and incoherent along 45th Street, wrestled him to the ground, hogtied him, and then struggled in vain to revive him when he suddenly went limp.

A Cops TV crew captured some of his grunted final words: "The cops are killing me... Mother, I love you. Father, I love you. Jesus, I love you."

The Palm Beach medical examiner's ascribed cause of death: "sudden respiratory arrest following physical struggling restraint due to cocaine-induced excited delirium."

What's really happening in the unaired footage depends upon whom you ask. To Dr. Mash, Donald's paranoia and imperviousness to pain — he withstood chokeholds and hard knees to the back and neck from four large male police officers — would appear to be classic excited delirium. But to Linda Lewis, who forced herself to watch the video only once, those same methods used on an unarmed, handcuffed man mean something altogether different. "Excited delirium didn't kill my son," she says. "The police killed my son."

Lewis filed an excessive force suit against the City of West Palm Beach and the five officers on the scene. Dr. Michael Baden, former New York City chief medical examiner, testified that Donald had in fact died of "asphyxia caused by neck compression."

A federal judge ruled the police were protected from the lawsuit by "qualified immunity," and an Atlanta appeals court upheld the decision. This past February, the U.S. Supreme Court dismissed the suit without explanation.

But if excited delirium has become legal Kevlar for police departments and Taser International in wrongful death suits, a few bullets have recently pierced the vest.

In June 2008, a California jury ordered Taser to pay $6.2 million to the family of Robert Heston, who died after being stunned by Salinas Police, despite the company's defense that he had died of excited delirium. Attorney John Burton argued that the company should have known its guns could cause cardiac arrest, and issued a proper warning to police. Though the penalty was later reduced to $1 million, it was the first time Taser had lost in court.

And this May, the City of Fort Worth, Texas, paid a $2 million settlement to the family of 24-year-old Michael Patrick Jacobs, who died after being tased by cops last year. The settlement came with no admission of guilt, but an unprecedented step by Taser spoke volumes. The company issued a bulletin to police departments advising officers to avoid tasing people in the chest.

Taser spokesperson Tuttle, who maintains that his stun guns have still never been proven to be lethal, downplays that development. "The one thing we've always recommended is that the back would be a great shot because there's more nervous tissues and more muscles back there. We're going to have more problems if people aren't using it where we recommend it for maximum effectiveness."

The courtroom batterings of Taser and excited delirium do nothing for Linda Lewis, who has begged for "just an apology" from the officers involved in her son's death. There is no further recourse in her lawsuit against the City of West Palm Beach. Says her attorney, Ronald Kurpiers: "The police literally got away with murder."

A knee in the neck of excited delirium

March 11, 2008
Amanda Truscott
Canadian Medical Association Journal

Some call it an entirely manufactured psychological condition. The police believe it is not only legitimate, but potentially fatal.

The latter, though, may have a vested interest in perpetuating the notion that "excited delirium" is a valid medical condition, given the heat they've taken following last year's death of Polish citizen Robert Dziekanski at Vancouver International Airport after being shot by a taser, a hand-held weapon that uses compressed air to direct a jolt of electricity up to 10.6 metres away.

Did Dziekanski die from "excited delirium" or multiple taser shocks? And what about the officer's knee pressed into his neck?

Dziekanski touched down in Vancouver on Oct. 14, 2007, following a 13-hour flight from Poland and for 8 hours roamed the immigration lounge, steadfastly insisting that his mother would soon meet him. She, meanwhile, awaited his arrival in the baggage claims area, while airport officials did nothing to ensure the pair could connect. Lost, confused and unable to speak English, Dziekanski used office chairs to build a makeshift barricade between a pair of glass doors as if to ensure that no one could remove him from his meeting place with his mother. Obviously frustrated, he began to throw computer equipment onto the floor and against a glass wall. The police were summoned and in stunning sequence of events captured on video by an eyewitness's cell phone, Dziekanski was pinned the floor, shot by a taser and eventually died.

Public outrage prompted the federal government to call an investigation into officers' use of tasers. The Commission for Public Complaints Against the RCMP [Royal Canadian Mounted Police] released an interim report on Dec. 12, 2007, recommending restrictions on the weapon's use. A coroner's inquest will commence in May.

The RCMP claim excited delirium was the cause of death. Media and civil liberties groups are skeptical about both the cause, and the condition.

A controversial condition, "excited delirium" has been defined as being characterized by agitation, incoherence, bizarre behaviour, high temperature, superhuman strength, a high tolerance for pain — and sometimes, the compulsion to break or bang on glass. Those who study it say it can be brought on by drug use, alcohol withdrawal, low blood sugar, mental illness or extreme fatigue. It does not, however, appear in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

But "delirium" — minus the "excited"— does.

Dr. Ian Dawe, director of Psychiatric Emergency Services at St. Michael's Hospital in Toronto, explains delirium as "a fluctuating level of consciousness," a set of symptoms that stereotypically appear together as a result of intoxication or an underlying medical condition.

The DSM says most sufferers of delirium fully recover but some don't as "delirium may progress to stupor, coma, seizures, or death, particularly if the underlying cause is untreated."

Dawe says there are 2 kinds of delirium: active and hypoactive. People suffering from the former might behave more or less as Dziekanski did: they can be agitated, irrational, and hard to communicate with. The hypoactive form, meanwhile, makes people quiet and withdrawn.

Active delirium can increase risks associated with physical restraints, Dawe says. But when someone suffering from delirium dies, determining the cause is problematic. Was it delirium? The taser? Restraint? A complex interplay of all the above?

Dawe says "excited delirium" is a pop culture phenomenon and doesn't have much currency among psychiatrists, although police, coroners and forensic pathologists use it.

University of Miami Professor of Neurology Dr. Deborah Mash, who has studied the condition for 20 years, says "sudden death in the context of emotional stress is well-known. Just because there isn't something called 'agitated delirium' or 'excited delirium' — that vernacular is not in the DSM-IV — doesn't mean that the symptom set is not in the DSM, because it is. We have evidence to suggest it's a brain disease."

Mash argues the condition is the result of an interaction between genes and environment: the gene remains silent until triggered by something like alcohol, drugs, stress or sleep deprivation — anything that affects dopamine. "It's always the same. The presentation is the same, the behavioural syndrome is the same, the hyperthermia is there, and the phenomenon of sudden death is there. And it doesn't matter whether they were restrained, or hogtied, or pepper sprayed or tasered — it's the same."

"This is a condition where law enforcement doesn't have a lot of options ... now, if you just left someone with excited delirium in the woods, I mean, what would happen to them? We don't know the answer. We've had purported excited delirium deaths where there were no police involved."

Yet, here's the rub. Those who die of "excited delirium" usually do so while in police custody, often after having been tasered.

To be sure, it's not a disease invented by the RCMP. In fact, they are late to the adoption of "excited delirium" as a condition. As early as 1849, Dr. Luther Bell described the inexplicable sudden death of psychotic patients as "acute exhaustive mania," while Dr. Charles Wetli coined the term "excited delirium" in 1985 to explain sudden death in recreational cocaine users.

Yet, so convinced are police that "excited delirium" is a legitimate condition that PoliceOne.com, an international information website for police officers, includes a direct link to an excited delirium training video created by the Las Vegas Police Department. In the video, Sherriff Bill Young even asserts that excited delirium leads people to blame police for deaths they didn't cause.

The video explicitly recommends using tasers to override the central nervous system, incapacitating the suspect just long enough for officers to properly restrain him. In a dramatization, a handcuffed suspect lies on the ground, surrounded by 7 officers. They place no weight on him and eventually turn him on his back and sit him upright. Nothing is done that might constrain the suspect's breathing, a point PoliceOne.com is careful to caution against.

The latter is by no means moot — the link between restraint, excited delirium and oxygen supply has long been the subject of debate and concern.

A 1998 review of 21 cases of unexpected deaths in people in a state of excited delirum — 18 of which were people in police custody — found that all "suddenly lapsed into tranquility shortly after being restrained (CMAJ 1998:158[12]: 1603-07). In all 21 cases, the victims had been restrained either face-down or through pressure applied to their necks. In 12 cases, excited delirium was brought on by a psychiatric disorder. In 8 cases, cocaine was the culprit. In 8 cases, the victims suffered chest compression from the weight of 1–5 people.

The study concluded that "the possibility that positional asphyxia contributes to unexpected death in people in states of excited delirium cannot be ignored." Those suffering from excited delirium were in need of more than the usual amount of oxygen, yet the techniques used to restrain them could restrict their ability to breathe.

Dawe is sympathetic to people faced with the task of controlling situations like Dziekanski's. "I wouldn't want to lay blame on anyone." He'd like to enhance cooperation between police, paramedics and mental-health professionals, so that police could have "a broader range of options" when dealing with such cases. St. Michael's has partnered up with 2 downtown Toronto police divisions to create a "mobile crisis intervention team" — a constable and a mental-health nurse who deal with 911 dispatches involving emotionally disturbed people. The idea is to decriminalize mental health issues and reduce visits to the prison and the hospital.

"If something good can come out of tragedy, it's that perhaps we can develop a different approach to these situations," Dawe adds.

Is 'excited delirium' at the root of many Taser deaths?

January 26, 2008
Armina Ligaya, CBC News

When police arrived at the Right Spot bar in downtown Moncton on May 5, 2005, Kevin Geldart was acting strangely. The 34-year-old had a history of bipolar disorder and had somehow walked away from the psychiatric unit of a nearby hospital earlier that night. Police said Geldart was acting combative and violent, and seemed to possess superhuman strength. However, witnesses testified Geldart was talking to himself in a corner but wasn't aggressive to those around him, according to his sister, Karen.

Officers used pepper spray and a Taser, as many as four times, to try and subdue the six-foot-six, 300-pound man. Then four officers pinned Geldart down, tied his feet and cuffed his hands. It was then that the police noticed Geldart had stopped breathing. He was later pronounced dead at a Moncton Hospital.

Fast forward to Oct. 14, 2007. A similar scene, except this time the setting is at the other side of the country — Vancouver International Airport. Robert Dziekanski had just flown in from Poland and couldn’t speak a word of English. The 40-year-old came to start a new life in Canada with his mother and was waiting in the customs area for her to pick him up. By 1:00 a.m., he had been waiting more than eight hours. For reasons that are still unclear, he never saw her.

It was at that point that Dziekanski started acting confused and agitated and began throwing around computer equipment. RCMP were called to the scene. According to an eyewitness video, four officers approached Dziekanski, who stood calmly while talking to them. Dziekanski then walked away and stood by a wall. Seconds later, a loud crack is heard. Dziekanski is shocked by a Taser, wails and collapses to the ground. The officers kneel on top of him, pinning him down as he struggles. He died minutes later.

In both of these sudden deaths, what's the culprit?

A rare condition

Some psychologists say the cause is a rare condition called "excited delirium" and not the obvious common element — the use of a Taser. According to some psychologists, a person with excited delirium acts agitated, violent, sweats profusely and is unusually strong and insensitive to pain. Then, the victim's heart races and eventually stops beating.

A coroner’s inquest into Geldart’s death concluded he was suffering from excited delirium on the night he died. And while the B.C. coroner’s service has not yet determined what killed Dziekanski — an autopsy failed to reveal a clear cause — RCMP have speculated the 40-year-old was also suffering from excited delirium.

"This is not due to a Taser," says Deborah Mash, a neurology professor at the University of Miami who has been studying excited delirium for 20 years. "This is in the brain and they die because the mechanisms that control the heart and the lungs fail."

In recent years, the condition has been showing up in coroner’s reports around the world as a cause of death. Yet, this condition is the subject of fierce debate in psychiatric circles.

Dr. Ian Dawe, the director of psychiatric emergency services at St. Michael’s Hospital in Toronto, says excited delirium is not a recognized mental disorder. In fact, the term is not listed in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, a handbook for professional psychologists and psychiatrists. "The term 'excited delirium' has been co-opted over the course of popular culture, perhaps over the past 15 to 20 years, to refer to this group of people who experience agitation and violence," Dawe told CBC News.

Delirium on its own, however, is a well known disorder, which is marked by confusion and agitation and can be associated with violence. It's usually triggered by another factor such as drugs or a predisposed medical illness, says Dawe.

He's not sure where the prefix "excited" comes from. And in his experience, he says it is uncommon to see patients with delirium suddenly die. "It is rare. Certainly we don’t see it happen in hospitals per se because of the way that we are approaching things."

First reported in the 1800s

According to Dr. Mash, however, individuals with excited delirium symptoms were first reported in the 1800s by Dr. Luther Bell. Bell and his team described it as "exhaustive mania" or "agitated delirium," Mash says. "People would present with this bizarre behaviour — extremely agitated, incoherent speech — really like a manic phase. Then, all of a sudden they become hot and they would have an autonomic system failure. Their cardio-respiratory system would fail and they would collapse."

But the key study that described the phenomenon was released in 1985 by Dr. Charles Wetli, Mash said. It looked into excited delirium and cocaine abuse in Miami, which was experiencing the first wave of the crack-cocaine epidemic that swept through North America. Mash said Wetli outlined the same set of behaviours — agitation, superhuman strength, high pain tolerance — and determined that the condition could be triggered by drugs, alcohol or other stimulants.

"These can sort of trip the switch in vulnerable individuals," she said. "You can also see this with alcohol withdrawal, you can see it in psychiatric patients. It's always the same pattern."

However, these substances don't need to be present to trigger the condition. Excited delirium can also manifest itself in vulnerable patients who are under unusual stress or are sleep-deprived, she says.

Sudden death

While the underlying mechanism of this disease is still unclear, this brain-based illness can lead to sudden death, Mash notes. "The reason people question it is because law enforcement is involved," she argues. "When Dr. Bell described these conditions in the mid-1800s, law enforcement was not involved. These people died in the institutions where they were being housed."

At the time, because these patients were difficult to reason with, they were restrained. The difference today, she says, is the method. "Over the years, they've used various forms of restraints. Some have been hog-tied, some have been in hobble restraints, some have had baton strikes, some have had pepper spray, and more recently now the Taser," Mash says. "What I've seen is that there's no difference from pre-Taser times to the present when Tasers are used."

For his part, however, Dawe says it's uncommon to have patients with delirium suddenly die at facilities such as St. Michael's Hospital. All medical staff are trained how to handle patients who are acting agitated and they can usually be talked down from their state, he says. Medical staff use a technique that includes speaking in calm tones, no matter the reaction of the patient, and neutral body language such as uncrossed arms. They try to figure out why the person is acting agitated and treat it.

Restraint is a last resort, he says. "We believe that we are very successful in helping someone come down from an agitated place in a safe and controlled manner," Dawe says.

Dr. Peter Bieling, manager of the mood disorders program at St. Joseph's Health Care in Hamilton, Ont., said some of the responsibility rests with the police force or those who are called to deal with people with this condition. "If you do know that somebody is in a vulnerable state, maybe you shouldn't use that level of force. Maybe there's something else that could be done. You have to conclude, and this is true for all mental illness, a person can have the disorder, but usually it doesn't fully manifest, it doesn't hit its full impact without a stressor being in place," he says.

The real challenge

Excited delirium hasn't officially made its way into the medical books yet, but Mash believes it's only a matter of time. "It will be recognized," she says. "But these cases are rare. We're seeing more of them now for various reasons, including because people are recognizing the condition."

However, Bieling is skeptical. "When you look at the other things that can resemble excited delirium, such as panic, hypomania, I would say that probably in most cases, those other things are likely going to be the explanation. If I were a betting person, I would think it's not going to make it into the next diagnostic manual," he says.

Bieling also argues that there hasn't been enough research on excited delirium to warrant classification. "I just don't think we know," he says. "And the usual way that we figure these things out is we do studies. We do careful studies to look at prevalence."

But that's where the problem lies. Because deaths of people with these specific symptoms are rare, research in this area is automatically limited. What's more, "what's going to make this one tough is it's so tied to a specific set of circumstances," Bieling says. "We're not talking about something that's going to affect a huge amount of people in the general population, like depression or anxiety. What we're talking about is a specific set of circumstances when people are in police custody. That's going to make it really, really challenging."

Is 'excited delirium' at the root of many taser deaths?

November 21, 2007
CBC News

When police arrived at the Right Spot bar in downtown Moncton on May 5, 2005, Kevin Geldart was acting strangely. The 34-year-old had a history of bipolar disorder and had somehow walked away from the psychiatric unit of a nearby hospital earlier that night. Police said Geldart was acting combative and violent, and seemed to possess superhuman strength. However, witnesses testified Geldart was talking to himself in a corner but wasn't aggressive to those around him, according to his sister, Karen.

Officers used pepper spray and a Taser, as many as four times, to try and subdue the six-foot-six, 300-pound man. Then four officers pinned Geldart down, tied his feet and cuffed his hands. It was then that the police noticed Geldart had stopped breathing. He was later pronounced dead at a Moncton Hospital.

Fast forward to Oct. 14, 2007.

A similar scene, except this time the setting is at the other side of the country — Vancouver International Airport. Robert Dziekanski had just flown in from Poland and couldn’t speak a word of English. The 40-year-old came to start a new life in Canada with his mother and was waiting in the customs area for her to pick him up. By 1:00 a.m., he had been waiting more than eight hours. For reasons that are still unclear, he never saw her. It was at that point that Dziekanski started acting confused and agitated and began throwing around computer equipment. RCMP were called to the scene. According to an eyewitness video, four officers approached Dziekanski, who stood calmly while talking to them. Dziekanski then walked away and stood by a wall. Seconds later, a loud crack is heard. Dziekanski is shocked by a Taser, wails and collapses to the ground. The officers kneel on top of him, pinning him down as he struggles. He died minutes later.

In both of these sudden deaths, what's the culprit?

A rare condition

Some psychologists say the cause is a rare condition called "excited delirium" and not the obvious common element — the use of a Taser. According to some psychologists, a person with excited delirium acts agitated, violent, sweats profusely and is unusually strong and insensitive to pain. Then, the victim's heart races and eventually stops beating. A coroner’s inquest into Geldart’s death concluded he was suffering from excited delirium on the night he died.

And while the B.C. coroner’s service has not yet determined what killed Dziekanski — an autopsy failed to reveal a clear cause — RCMP have speculated the 40-year-old was also suffering from excited delirium. "This is not due to a Taser," says Deborah Mash, a neurology professor at the University of Miami who has been studying excited delirium for 20 years. "This is in the brain and they die because the mechanisms that control the heart and the lungs fail."

In recent years, the condition has been showing up in coroner’s reports around the world as a cause of death. Yet, this condition is the subject of fierce debate in psychiatric circles.

Dr. Ian Dawe, the director of psychiatric emergency services at St. Michael’s Hospital in Toronto, says excited delirium is not a recognized mental disorder. In fact, the term is not listed in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, a handbook for professional psychologists and psychiatrists. "The term 'excited delirium' has been co-opted over the course of popular culture, perhaps over the past 15 to 20 years, to refer to this group of people who experience agitation and violence," Dawe told CBC News. Delirium on its own, however, is a well known disorder, which is marked by confusion and agitation and can be associated with violence. It's usually triggered by another factor such as drugs or a predisposed medical illness, says Dawe.

He's not sure where the prefix "excited" comes from. And in his experience, he says it is uncommon to see patients with delirium suddenly die. "It is rare. Certainly we don’t see it happen in hospitals per se because of the way that we are approaching things."

First reported in the 1800s

According to Dr. Mash, however, individuals with excited delirium symptoms were first reported in the 1800s by Dr. Luther Bell. Bell and his team described it as "exhaustive mania" or "agitated delirium," Mash says. "People would present with this bizarre behaviour — extremely agitated, incoherent speech — really like a manic phase. Then, all of a sudden they become hot and they would have an autonomic system failure. Their cardio-respiratory system would fail and they would collapse."

But the key study that described the phenomenon was released in 1985 by Dr. Charles Wetli, Mash said. It looked into excited delirium and cocaine abuse in Miami, which was experiencing the first wave of the crack-cocaine epidemic that swept through North America. Mash said Wetli outlined the same set of behaviours — agitation, superhuman strength, high pain tolerance — and determined that the condition could be triggered by drugs, alcohol or other stimulants. "These can sort of trip the switch in vulnerable individuals," she said. "You can also see this with alcohol withdrawal, you can see it in psychiatric patients. It's always the same pattern." However, these substances don't need to be present to trigger the condition. Excited delirium can also manifest itself in vulnerable patients who are under unusual stress or are sleep-deprived, she says.

Sudden death

While the underlying mechanism of this disease is still unclear, this brain-based illness can lead to sudden death, Mash notes. "The reason people question it is because law enforcement is involved," she argues. "When Dr. Bell described these conditions in the mid-1800s, law enforcement was not involved. These people died in the institutions where they were being housed." At the time, because these patients were difficult to reason with, they were restrained. The difference today, she says, is the method. "Over the years, they've used various forms of restraints. Some have been hog-tied, some have been in hobble restraints, some have had baton strikes, some have had pepper spray, and more recently now the Taser," Mash says. "What I've seen is that there's no difference from pre-Taser times to the present when Tasers are used."

For his part, however, Dawe says it's uncommon to have patients with delirium suddenly die at facilities such as St. Michael's Hospital. All medical staff are trained how to handle patients who are acting agitated and they can usually be talked down from their state, he says. Medical staff use a technique that includes speaking in calm tones, no matter the reaction of the patient, and neutral body language such as uncrossed arms. They try to figure out why the person is acting agitated and treat it. Restraint is a last resort, he says. "We believe that we are very successful in helping someone come down from an agitated place in a safe and controlled manner," Dawe says.

Dr. Peter Bieling, manager of the mood disorders program at St. Joseph's Health Care in Hamilton, Ont., said some of the responsibility rests with the police force or those who are called to deal with people with this condition. "If you do know that somebody is in a vulnerable state, maybe you shouldn't use that level of force. Maybe there's something else that could be done. "You have to conclude, and this is true for all mental illness, a person can have the disorder, but usually it doesn't fully manifest, it doesn't hit its full impact without a stressor being in place," he says.

The real challenge

Excited delirium hasn't officially made its way into the medical books yet, but Mash believes it's only a matter of time. "It will be recognized," she says. "But these cases are rare. We're seeing more of them now for various reasons, including because people are recognizing the condition."

However, Bieling is skeptical. "When you look at the other things that can resemble excited delirium, such as panic, hypomania, I would say that probably in most cases, those other things are likely going to be the explanation. "If I were a betting person, I would think it's not going to make it into the next diagnostic manual," he says. Bieling also argues that there hasn't been enough research on excited delirium to warrant classification. "I just don't think we know," he says. "And the usual way that we figure these things out is we do studies. We do careful studies to look at prevalence."

But that's where the problem lies. Because deaths of people with these specific symptoms are rare, research in this area is automatically limited. What's more, "what's going to make this one tough is it's so tied to a specific set of circumstances," Bieling says. "We're not talking about something that's going to affect a huge amount of people in the general population, like depression or anxiety. What we're talking about is a specific set of circumstances when people are in police custody. That's going to make it really, really challenging."

New Brunswick man's death from excited delirium raises questions about police Tasers

March 11, 2007
The Canadian Press

FREDERICTON -- A New Brunswick man's death due to a mysterious malady called excited delirium has raised more questions about police arrest techniques and the growing use of stun guns.

Kevin Geldart, 34, of Moncton, N.B., died after he was repeatedly shocked with Taser weapons by RCMP officers in 2005.

It was another in a long series of deaths in North America following the use of police force and Taser guns to control people who are described as combative, irrational and extraordinarily strong.

In most of these cases, the cause of death is difficult to pinpoint and is often attributed to cardiac arrest, drug intoxication or a combination of the two.

But a New Brunswick coroner's inquest into Geldart's death earlier this month ruled that the large, mentally ill man died of excited delirium -- a condition that cannot be found in medical or psychiatric text books.

"Excited delirium is not a diagnosis used in psychiatry,'' says Dr. Roumen Milev of the Mood Disorders Clinic at the Providence Continuing Care Centre in Kingston, Ont. "It does not exist as such either in the American Psychiatric Association's diagnostic and statistical manual, or in the World Health Organization's international classification of diseases.''

Critics say excited delirium exists purely in the imaginations of those who are anxious to defend the use of Taser weapons and excessive police force.

Eric Balaban, a staff attorney with the American Civil Liberties Union, says that blaming excited delirium for in-custody deaths could be a way of whitewashing inappropriate use of force by police. "It's not recognized as a mental-health diagnosis,'' Balaban says. "It is really used only by medical examiners to attribute the cause of death of an arrestee following a violent scuffle with police officers.''

Whatever excited delirium may be, it is characterized by extreme agitation, incoherence, bizarre behaviour, often superhuman strength and a high body temperature.

It is associated with drug abuse and mental illness, and occurs often in people who, like Geldart, are very large. Geldart was tall and weighed at least 350 pounds.

Family members and friends of people who die during police Taser arrests are almost always unsatisfied with descriptions of the cause of death and the fact that the police are exonerated.

One of Geldart's relatives has called for a moratorium on the use of Tasers until more is known about the effects of the weapon on people, especially on those with mental illness.

So far, 212 people in North America have died following custody struggles with Taser-wielding police officers -- at least 15 of them in Canada, where the weapon has been used since 2001.

In all cases, the stun gun has been cleared of any direct involvement in the deaths, even in cases like Geldart's, where there were eight Taser injuries to his body and head.

"I'm not aware of any case in the world where the conductive energy weapon has been found to be the factor that caused death,'' Sgt. Richard Groulx, an RCMP training and tactical weapons expert, told the New Brunswick inquest.

The Taser delivers a pulsating, 50,000-volt electrical current through the body, and police say it can pierce clothing four centimetres thick. The shock, which lasts up to five seconds, locks muscles instantly and overrides the central nervous system.

Dr. Deborah Mash, professor of neurology at the University of Miami and a leading expert in North America on excited delirium, says the ultimate goal of her research is to establish a protocol so police know how to handle people exhibiting signs of the condition.

Mash says excited delirium is a real brain disorder. "There are clearly neuro-chemical changes in the brain,'' she says. "There is a defect. The issue of police brutality is simply wrong. That's not to say it can't occur, but when the police are confronted by someone exhibiting superhuman strength like a Hulk Hogan ... what can they do?''

Mash says the phenomenon came to light in the 1980s, when crack cocaine first burst onto the Florida drug scene. She says many victims have cocaine or drugs in their systems, although mentally ill people like Geldart, who was bipolar, are also susceptible. "It doesn't have to be drug-related,'' she says. "There are a number of triggers that will pop the switch.''

Mash says no one knows the best intervention techniques for police when confronted by an individual in the throes of excited delirium. She says she hopes a standard of practice can be developed. She also says research may ultimately unlock a clear diagnosis of the disorder, so victims can be identified before they run into trouble.

"Thanks to advances in molecular biology, we have an opportunity to look for the first time for real diagnostic markers, and that's what we need,'' Mash says.