By Penny Clute

A man called me a few weeks ago after reading a column I wrote in January 2019 about strangulation. He said an acquaintance had put him in a “chokehold,” actually lifting his feet off the floor. While it was happening, he couldn’t breathe and thought he was about to die.

The reason he contacted me is because the incident was three months earlier and he was still experiencing change in his voice, soreness in his neck, and noticeable fatigue. He felt these were related to the attack, and that what was done to him was more serious than the police and the doctor who was treating him thought.

He googled “choking vs strangulation” and my article appeared. In reading it, his feelings were confirmed about how serious the matter is, and that his continuing symptoms were indeed likely related to the pressure applied to his neck.

Because it is so dangerous, I’ve written about strangulation before in the context of domestic or interpersonal violence. Though often referred to as “choking,” even by its victims, it is different. “Choking,” is an internal issue, which happens when food is caught in your throat, blocking your breathing.

Strangulation is an action that someone else does to you, placing physical pressure from outside your neck. It is usually done with the assailant’s hands, though it could be done by pressing an arm or other body part on the throat or neck, or pulling a cloth or rope tightly around the neck. This prevents you from breathing if the pressure is on your windpipe, or it blocks the flow of blood to your brain when force is applied to your carotid artery.

Either way, oxygen stops flowing to your brain. If the pressure continues, you will lose consciousness within 10-20 seconds, and your brain can be dead within 4 minutes.

Strangulation is a type of “asphyxia;” this is the umbrella term for loss of consciousness or death due to lack of oxygen. Asphyxia has been prominent news for almost a year, because of George Floyd dying under the knee of Officer Chauvin.

According to trial testimony, George Floyd died with Officer Chauvin’s knee on his neck for over 9 minutes. Officers held him face down on the street, with his hands cuffed behind him, preventing any movement.

The medical experts who testified explained that being held down in this position prevented Mr. Floyd from being able to breathe; his lungs could not expand. They also said that being able to speak enough to say “I can’t breathe” is not the same as being able to breathe enough to survive. Being alive and talking does not mean you are not in imminent danger of dying from lack of oxygen if the compression continues.

Starving the brain of oxygen, either by stopping oxygen-carrying blood from flowing through the carotid arteries or by so compressing the chest that only shallow breaths are possible, will cause the heart to stop.

There are common myths about strangulation, chokeholds, and restraint. Some myths are more common with interpersonal violence, and others with police restraint. These include that (1) If you can talk, there is no real problem. Those who accept this myth dismiss pleas of “I can’t breathe” as a meaningless chant instead of a genuine cry to stop the pressure, that life is ending. They are not medically trained, and they are wrong.

This also leads to another mistaken conclusion: (2) that cutting off blood flow is not potentially lethal, only cutting off breathing is. Blood carries oxygen to the brain, and returns blood from the brain through veins in the neck. These functions are essential to staying alive. Unless the hold is released as soon as the person goes unconscious, death can swiftly result.

(3) There are no bruises, so they weren’t really strangled. Studies show that half of those who are strangled, including those who are killed that way, do not have bruise marks. Of those who are bruised, 35% are too faint to be seen by a camera.

(4) Once the pressure is released, the person is fine. Not so; physical, neurological and psychological symptoms can persist for months.

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