The Great Cannibalism Crisis of 2012's Alternative Hypothesis: Excited Delirium Syndrome

Last week was a weird one huh? I'm sure you know what I'm talking about by now, but if you somehow missed it, a bunch of people were caught eating and dismembering other people. Most notably, there was a guy in Miami who ate a homeless guy's leathery homeless face, then was shot to death by policemen after he growled at them with a mouth full of mouth. Most people seem to be blaming bath salts, a popular legal drug that's proven difficult to regulate and that the squares say is a combination of the worst parts of cocaine, LSD, and PCP.

High schoolers and derelicts, on the other hand, think it's a legal and party-infused powder that you can get super high on without having to deal with drug dealers. Either way, the fact that the media (and cannibals) are increasingly linking bath salts to the outbreak in zombie-esque attacks.

That's horrifying, and reminds me of when some people tried to convince me to do Ketamine with them by describing a K-hole as a limbo between life and death. Yeah, no thanks, I'll just finish The Lord of Rings and fall asleep in a bed of Cheetos, if that's cool with you guys. Good luck with purgatory.

But I digress. While it may very well be the case that the Miami Face-eater, the Baltimore Cannibal, the New Jersey intestine-thrower, and the Montreal amateur porn star-turned-murderer may all be able to attribute their George Romero-style behaviors to bath salts, there's another potential source for this wild week in crime coverage. It's a drug-induced medical condition called Excited Delirium Syndrome (ExDS), and is equally as, if not more horrifying than any sort of Bath and Bodyworks-inspired brain powder.

What is ExDS, and where can I get some?

The condition, known generally as excited delirium, is characterized primarily by a sudden onset of bizarre and uncharacteristically intense aggressive behavior, panic and paranoia, insensitivity to pain, and superhuman physical strength. Further adding to the weirdness, victims of ExDS tend to be naked as well, not unlike Rudy Eugene, the Miami face-eater, at the time of the incident. Although not exclusively, Excited delirium usually manifests itself when paired with regular cocaine usage, PCP, meth, or any of the other usual suspects in the life-shattering stimulant drug category. The diagnosis gets bumped up to "excited delirium syndrome" usually when the afflicted person dies, either via drug use or through repeating use of tasers by police with no other recourse for dealing with a naked, super-strong psychopath.

Far before people started listening to disco and throwing powder into their nostrils, people were being diagnosed with a syndrome called Bell's Mania, which was a three or so week long degenerative mental breakdown that almost always resulted in a fatality. While the roots of Bell's Mania are hard to pin down, its symptoms are similar to ExDS, whose prevalence has grown exponentially since the major cocaine boom.

It's also worth saying early that most literature and research on ExDS tends to focus primarily on cocaine as a catalyst for the drug-induced syndrome, so I will keep referencing cocaine primarily. However, meth and PCP can have the same effect, though I'm sure regular meth and PCP users probably have a whole host of other issues that they're contribute to their eventual downfall.

In an effort to better understand the biological reasoning for ExDS as well as the prospect of an increase these news stories, I reached out to Dr. Mark Debard from the Ohio State University College of Medicine. He's the right guy to talk to, considering he chaired a task force dedicated to furthering law enforcement and medical understanding of ExDS, which, while having similar symptoms to supposed bath salt freakouts, isn't totally related.

He explained that the primary reason why the effects of bath salt abuse and ExDS are not necessarily interchangeable is because ExDS affects dopamine transporters, while bath salts affect the norepinephrine and serotonin transporters. There's a different in onset, too: while crazed bath salts reactions could potentially come from an overdose, Dr. Debard points out that ExDS is much more likely to manifest in prolonged, regular abusers, not people experiencing a single overdose.

When you consistently use cocaine, the drug blocks your dopamine transporters in the presynaptic membrane, leading to a dopamine elevation in the tiny space between neurons called the synaptic cleft. At this point, the postsynaptic cells, which receive the receptors, start taking in more dopamine than they can handle. Since dopamine is a big part of regulating heart and brain operations, excess and chaotic dopamine distribution then contributes to such things as paranoia and general psychosis. When paired with a genetic predisposition to mental illness (another important variable in the diagnoses of ExDS) brain function begins to break down.

In this case, we'd be dealing with a person already prone to instability being pumped full of a brain chemical that's essentially saying "You're awesome and deserve a treat" on overdrive, and that will drive someone to do virtually everything to find that reward. (You also probably have a cold, since you've been doing too much blow to get sleep, and you're terrible at taking care of your body, but that's likely a minor concern.)

Imagine it's you. The drug-induced feedback loop of increasingly abnormal chemical production leads to paranoia and psychosis, which then affects your sympathetic nervous system, which is responsible for your fight or flight instincts. You become vastly over-stimulated and starts going berserk. Your heart is beating super fast, and your body temperature is super high, which is why you're now probably naked. Your brain is racing faster than a brain should, so any vague sense of rationale is gone and you're like, "Fuck this, I'm leaving." You might see a wooden picket fence, but that's only a mortal's obstacle, so you plow through it with no pain or fear and probably fracture your shins without even noticing. A police officer shoots you in the leg and you laugh at his toy bullet, or maybe you scream something about a government conspiracy that you saw on the movie Zeitgeist.

__

It's as if you are a human version of a cartoon robot that gets water spilled on it; sparks are going everywhere and you start muttering nonsense that's simply a reflection of your body's internal algorithms backfiring. Eventually seven different police officers, each of who played division two football, tie you down with much difficulty. You're probably convinced that you're on a Polly Pocket "Medical Professional Edition" gurney, so you flex and push and scream and do everything you can to get out of the bindings, all while telling the doctors about the devil's children and how Ashton Kutcher is a seraphim.

If you're lucky, the paramedics sedate you and you wake up in a hospital, having no recollection of what happened. If you're not sedated, and you keep swinging around like the psychopath that you've unfortunately become, then you probably die from either hyperthermia or the immense amount of self-harm you've put yourself through in the middle of your delusions. Or, of course there's the off chance that you might eat someone and get shot down on the side of the highway.

ExDS sounds riveting. Why don't I know more about this?

I mentioned earlier how my interviewee, Dr. Mark Debard was the task force chair on a board dedicated to ExDS. When I first contacted Dr. Debard, it was through white paper report (PDF) the task force gave to the council and board of directors of the American College of Emergency Physicians. In its introduction, the paper spells out its goal of first determining whether or not the "entity commonly referred to as 'excited delirium' exists, and if so, whether it could be better defined, identified and treated." The paper led the ACEP to recognize ExDS as a legitimate issue — and concern for emergency personnel.

Given its bizarre Stan Lee-esque behavioral traits and the world's seemingly unquenchable obsession with mental disorders, it's amazing that ExDS has largely been unrecognized in the medical world. However, Debard reminded me that it is a syndrome after all, and by the very nature of the word it is only really categorized by the collaboration of several very specific behavioral traits. They combine to make an immediately life-threatening cocktail of death, but one that still tends to share traits with similar and more understood diseases.

__

Additionally, while the symptoms are largely medical and require medical attention, it is drug-related after all, so the first people to get the call regarding someone suffering from ExDS are likely the police, who may go straight to using force, even though tasers can kill an ExDS sufferer. The white paper points out that there's a somewhat widespread conspiracy surrounding the very attempt at naming the syndrome, saying

There are those who believe it to be a convenient term used to excuse and exonerate authorities when someone dies while in their custody. It is articulated by some that ExDS is a term or concept that has been "manufactured" as a law enforcement conspiracy or cover-up for brutality.

This whole argument is perpetuated by the unfortunate fact that many medical associations don't even recognize that it exists. Equally as unfortunate, because of the nature of the symptoms, and how ExDS's recognition is dependent on immediate behavioral suspicions, there is a whole hodge-podge of symptoms that are used to diagnose ExDS, which ends up with diagnoses that are either incorrect or too broad. That would be like blaming someone's incessant vomiting on food poisoning from the truck stop sandwich they ate earlier, when in fact they just have the flu.

Now, the question remains: could ExDS be behind the current spate of zombies terrorizing America? Well, unless we have solid toxicology reports, it's impossible to know. But with bath salts being given blanket blame for the face-eating attacks in much of the media, it's important — especially for first responders — to note that other psychosis-inducing conditions exist. And at the end of the day, people must be made keenly aware that ingesting bath salts, PCP, cocaine, meth, or whatever ridiculous drug fad comes next is a pretty awful life decision. As Dr. Debard put it so eloquently in our closing notes, "This is recreational drug use and we'll always have recreational drug use. Whether legal or illegal, we'll always have it with us."