Opinion: ‘Excited delirium’ is racist pseudoscience. NY must ban it as a diagnosis.

It sometimes feels that the line between misinformation and fact has never been blurrier. Our federal government is recently back in the business of pedaling reckless and dangerous conspiracy theories that endanger the public and erode public trust. Unfortunately, even in New York, we are not immune to insidious fictions creeping into our legal system. One such example is “excited delirium,” a purportedly medical, but widely discredited, term frequently cited as a cause of death for people who die in police custody. 

Excited delirium is a non-scientific term used primarily by police, coroners and emergency medical personnel to describe a state of extreme agitation and aggression. But this basic description – which fits many mental health crises – is supplemented with three completely fake symptoms: An individual experiencing “excited delirium” allegedly has superhuman strength, is impervious to pain and is liable to spontaneously die. As a result, “excited delirium” is conveniently cited both as a justification for excessive force and as a cause of death in cases where individuals die in police custody after having been subjected to excessive force. Every major American medical organization – including the American Medical Association, the American Psychiatric Association, and the National Association of Medical Examiners – takes the position that excited delirium is not even a valid medical diagnosis, much less a potential cause of death. 

Harvard neurologist Altaf Saadi describes excited delirium as a “convenient diagnosis” because its supposed symptoms of “agitation, confusion, hallucination, elevated temperature, rapid heart rate, and sweating” are so wide-ranging that they are potentially characteristic of numerous real medical conditions, including a mental health crisis. Hiding behind a fictional medical term enables police to justify ultra-aggressive tactics and then shirk accountability when those tactics wind up killing someone in their custody. 

The concept of excited delirium emerged from a 1985 research paper by Charles Wetli and David Fishbain, in which the researchers, baffled by the sudden deaths of several Black women, coined the term. It was later discovered that the women had actually been murdered by a serial killer. While working as a medical examiner, Wetli repeatedly pushed the theory of “excited delirium” to explain deaths of Black people, proposing that Black men are uniquely genetically predisposed to die of excited delirium. In the early 2000s, a major producer of tasers, a company then called TASER International (now known as Axon Enterprises) began distributing literature on excited delirium to police chiefs and medical examiners. As police departments began purchasing and using tasers, and as their overuse led to deaths in custody, the term gained widespread use. To this day, the term “excited delirium” is used predominantly as a justification for the deaths of Black men in custody.

The consequences of this misrepresentation have been horrific. Across the U.S., the false diagnosis of excited delirium is the listed cause of death for more than 150 deaths in police custody in the last decade. Publicized cases include Manuel Ellis, Elijah McClain, and Daniel Prude. It was also raised as a defense by Derek Chauvin in his trial for the murder of George Floyd. In New York City, police are still trained to respond to excited delirium with excessive force, and emergency medical service personnel are trained to treat it with potentially lethal doses of tranquilizers. In Rochester, health department training materials for law enforcement and first responders show images of the Hulk, with symptoms including the victim saying, “I can’t breathe.”

The states of Colorado, California and Minnesota have largely banned the use of the term “excited delirium” by law enforcement, coroners and other government employees. We must do the same here in New York. My bill with state Sen. Samra Brouk, (A.697/S.1714) aims to prevent instances of excessive force and ensure accurate cause of death reporting by retiring the term excited delirium in New York once and for all. 

While we battle the misinformation, racism and xenophobic policies infiltrating our systems, we must fight to eliminate the relics of our painful past and move forward with scientifically proven terminology. Excited delirium is not only harming marginalized communities, but also preventing our law enforcement and first responders from doing their jobs well. We are clear that misinformation is deadly and ultimately disrupts order in our communities. The elimination of the use of this term will give our law enforcement and first responders the correct tools to do their jobs, helping them to respond to emergencies according to proven methods and support a community that is crying out for a more holistic and cohesive relationship with our police force. New Yorkers have asked for fairness, truth, empathy, good training and accountability. 

This moment presents a chance for our state to step up in defense of science and civil rights. New York has an opportunity to set an example for the nation on how to lead with facts and empathy at the forefront of governance. Now is the time for the people of New York to make clear to Gov. Kathy Hochul and the state Legislature that we want racist, debunked pseudoscience out of our legal system.