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NEW DELHI: California has become the first US state to prohibit the official classification of “excited delirium” as a cause of death. An increasing number of physicians and medical associations have distanced themselves from this diagnosis, asserting its lack of scientific or medical credibility.
The term has frequently been applied to explain the deaths of individuals from diverse racial backgrounds, thereby introducing a racial aspect to this controversial diagnosis. Assembly member Mike Gipson, the legislator behind the bill to ban the term, emphasized “The only place where this term is continuously used is to describe deaths that occur in police custody”.
Gipson added, “From the beginning, this terminology has been disproportionately applied to communities of color and has only been used in specific contexts pertaining to encounters with law enforcement”.
“Excited delirium” is a roughly defined term that characterizes symptoms like high tolerance for pain, aggressive conduct, emotional distress and intense agitation.
A report by Physicians for Human Rights revealed that the “excited delirium” diagnosis started appearing on death certificates, police records, and coroners during the crack cocaine epidemic in the 1980s. It soon became a broad classification for deaths occurring in the context of law enforcement restraint, often in conjunction with substance use or mental health issues.
By 2009, the American College of Emergency Physicians (ACEP) had officially recognized excited delirium as a legitimate cause of death. Additionally, the term was incorporated into police training manuals and promoted at conferences attended by medical examiners and police chiefs, as highlighted in the Physicians for Human Rights report.
Despite widespread use and endorsements, excited delirium was never acknowledged by psychiatrists or other mental health experts.
Gipson said, “Excited delirium is not a reliable, independent medical or psychiatric diagnosis”. “There are no diagnostic guidelines, and it is not recognized in the DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition], which is the main diagnosis guide for mental health providers. Neither the American Medical Association nor the American Psychiatric Association recognizes this term as a legitimate diagnosis”, he added.
In fact, both the AMA and APA have consistently refrained from recognizing “excited delirium” as an actual medical condition, and critics have repeatedly criticized it as unscientific and rooted in racial bias.
Dr. Roger A. Mitchell Jr., chair of the pathology department at Howard University in Washington, D.C., told the AP, “Excited delirium is often used when there’s a death associated with a physical altercation between a citizen and law enforcement’. “It’s not a real explanation for the death,” he added.
Recently, “excited delirium” has been invoked to account for the fatalities of people from black, Latino, and other racial backgrounds in incidents involving white police officers.
In 2021, the term was used to explain the death of Daniel Prude, a 41-year-old black man in Rochester, New York. In this case, a grand jury declined to press charges against the police officers involved.
The concept of excited delirium resurfaced during the 2021 trial of former Minneapolis police officer Derek Chauvin, who was subsequently found guilty in the death of George Floyd. Moreover, this term has been reintroduced in the ongoing trials of police officers facing charges related to the fatalities of Elijah McClain in Colorado and Manuel Ellis in Washington state.
“In 2020, Angelo Quinto, a Filipino-American Navy veteran dealing with a mental health crisis, stopped breathing while two police officers knelt on his back and neck. Mr. Quinto’s official cause of death was determined to be excited delirium”. “That is absolutely absurd, Gipson said.
By March 2023, the National Association of Medical Examiners took a decisive stance against the controversial term, proclaiming that “excited delirium” or “excited delirium syndrome” should not be cited as a cause of death.
Furthermore, just recently, ACEP formally renounced any usage of excited delirium as a valid diagnosis, deeming their 2009 endorsement as outdated.
Dr. Brooks Walsh, an emergency physician in Connecticut, told the AP that this implies that if an individual dies while in custody, “excited delirium” can no longer be invoked as the reason, and ACEP’s previous endorsement of the concept cannot be used to support such claims.
Dr. Joyce deJong, the president of the National Association of Medical Examiners, explained that the organization’s decision to disavow excited delirium stemmed from concerns that the term could potentially be exploited to rationalize the use of excessive force by the police. A medical examiner in Michigan, deJong, said, “Anything we can do to avoid perpetuation of a phrase that might be causing harm”.
The term has frequently been applied to explain the deaths of individuals from diverse racial backgrounds, thereby introducing a racial aspect to this controversial diagnosis. Assembly member Mike Gipson, the legislator behind the bill to ban the term, emphasized “The only place where this term is continuously used is to describe deaths that occur in police custody”.
Gipson added, “From the beginning, this terminology has been disproportionately applied to communities of color and has only been used in specific contexts pertaining to encounters with law enforcement”.
“Excited delirium” is a roughly defined term that characterizes symptoms like high tolerance for pain, aggressive conduct, emotional distress and intense agitation.
A report by Physicians for Human Rights revealed that the “excited delirium” diagnosis started appearing on death certificates, police records, and coroners during the crack cocaine epidemic in the 1980s. It soon became a broad classification for deaths occurring in the context of law enforcement restraint, often in conjunction with substance use or mental health issues.
By 2009, the American College of Emergency Physicians (ACEP) had officially recognized excited delirium as a legitimate cause of death. Additionally, the term was incorporated into police training manuals and promoted at conferences attended by medical examiners and police chiefs, as highlighted in the Physicians for Human Rights report.
Despite widespread use and endorsements, excited delirium was never acknowledged by psychiatrists or other mental health experts.
Gipson said, “Excited delirium is not a reliable, independent medical or psychiatric diagnosis”. “There are no diagnostic guidelines, and it is not recognized in the DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition], which is the main diagnosis guide for mental health providers. Neither the American Medical Association nor the American Psychiatric Association recognizes this term as a legitimate diagnosis”, he added.
In fact, both the AMA and APA have consistently refrained from recognizing “excited delirium” as an actual medical condition, and critics have repeatedly criticized it as unscientific and rooted in racial bias.
Dr. Roger A. Mitchell Jr., chair of the pathology department at Howard University in Washington, D.C., told the AP, “Excited delirium is often used when there’s a death associated with a physical altercation between a citizen and law enforcement’. “It’s not a real explanation for the death,” he added.
Recently, “excited delirium” has been invoked to account for the fatalities of people from black, Latino, and other racial backgrounds in incidents involving white police officers.
In 2021, the term was used to explain the death of Daniel Prude, a 41-year-old black man in Rochester, New York. In this case, a grand jury declined to press charges against the police officers involved.
The concept of excited delirium resurfaced during the 2021 trial of former Minneapolis police officer Derek Chauvin, who was subsequently found guilty in the death of George Floyd. Moreover, this term has been reintroduced in the ongoing trials of police officers facing charges related to the fatalities of Elijah McClain in Colorado and Manuel Ellis in Washington state.
“In 2020, Angelo Quinto, a Filipino-American Navy veteran dealing with a mental health crisis, stopped breathing while two police officers knelt on his back and neck. Mr. Quinto’s official cause of death was determined to be excited delirium”. “That is absolutely absurd, Gipson said.
By March 2023, the National Association of Medical Examiners took a decisive stance against the controversial term, proclaiming that “excited delirium” or “excited delirium syndrome” should not be cited as a cause of death.
Furthermore, just recently, ACEP formally renounced any usage of excited delirium as a valid diagnosis, deeming their 2009 endorsement as outdated.
Dr. Brooks Walsh, an emergency physician in Connecticut, told the AP that this implies that if an individual dies while in custody, “excited delirium” can no longer be invoked as the reason, and ACEP’s previous endorsement of the concept cannot be used to support such claims.
Dr. Joyce deJong, the president of the National Association of Medical Examiners, explained that the organization’s decision to disavow excited delirium stemmed from concerns that the term could potentially be exploited to rationalize the use of excessive force by the police. A medical examiner in Michigan, deJong, said, “Anything we can do to avoid perpetuation of a phrase that might be causing harm”.
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