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Systemic Racism in Excited Delirium

Updated: Oct 20, 2023

Excited delirium is a controversial diagnosis sometimes characterized as a potentially fatal state of extreme agitation and delirium.

It is typically diagnosed postmortem in young adult males, disproportionally black men, who were physically restrained at the time of death, most often by law enforcement personnel. Source

The term was first used in 1985. Black men were more than three times as likely to have their cause of death labeled as excited delirium than their white counterparts. More contemporary studies continue to demonstrate the disproportionate impact on Black people. Source

Even after being debunked, the man who first coined the term; Miami-Dade County Deputy Medical Examiner Charles V. Wetli. Continued promoting excited delirium as a cause of death. In 1990, he claimed that 70% of people who die of excited delirium are Black men and said, “it may be genetic.” Source

Despite limited medical evidence, police departments across the country began training their officers to identify excited delirium as a potentially deadly medical condition. The diagnosis quickly emerged as a defense for police in cases of people who died in police custody and who were later found to have alcohol and other drugs present upon autopsy. Source

A new policy addresses reports that show a pattern of using the term “excited delirium” and pharmacological interventions such as ketamine as justification for excessive police force, disproportionately cited in cases where Black men die in law enforcement custody. Source

There are no national database tracking cases of "excited delirium," but in one study, data showed that from 2010 to 2020, "there were 166 reported instances where a person died in police custody and excited delirium was described as a possible cause of death." Black people made up 43% of those deaths, despite composing only 13% of the US population, according to the US Census. Source

Law enforcement officers nationwide are routinely taught that “excited delirium” is a condition characterized by the abrupt onset of aggression and distress, typically in the setting of illicit substance use, often culminating in sudden death. However, this “diagnosisis not recognized by the vast majority of medical professionals. In fact, “excited delirium” is not recognized by the American Medical Association, the American Psychiatric Association, or the World Health Organization, and it is not listed in the Diagnostic and Statistical Manual of Mental Disorders.

In 2021, the American Medical Association released a policy which opposed the use of the “Excited Delirium” diagnosis. AMA President Gerald E. Harmon specifically condemned its use as “a manifestation of systemic racism that has unnecessarily dangerous and deadly consequences for our Black and Brown patients.” Source

The American Psychiatric Association have equally affirmed that “The concept of "Excited Delirium" has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term Excited Delirium is disproportionately applied to Black men in police custody." These statements reflect widely held concerns in the medical community that the diagnosis of Excited Delirium has been appropriated by law enforcement agents in order to justify persecution and violence against racial minorities. Source

When Black men are subjected to brutal violence in police custody, an informal diagnosis of ED effectively inoculates law enforcement agents against claims of racial discrimination. Institutional narratives surrounding Excited Delirium thereby engage in a form of discursive deracialization, “in which racial categories are attenuated, eliminated, or substituted and racial explanations are omitted or de-emphasized.” Source

Evaluation of the diagnostic criteria for ExD proposed in a 2009 report shows that it relies on persistent racial stereotypes: eg, unusual strength, decreased sensitivity to pain, and bizarre behavior. Research indicates that use of such stereotypes could encourage biased diagnosis and treatment. Source

Excited delirium is no longer an official cause of death in California.


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