In the annals of modern policing, there’s a term that flares up in the headlines when a routine arrest turns fatal, when bodycam footage sparks protests, or when another Black or brown body ends up lifeless on the asphalt. That term is excited delirium—a medical-sounding phrase with a murky past and a troubling present, one that has become a catch-all explanation for deaths that occur under aggressive police restraint.

Though it sounds like a legitimate diagnosis—a sudden psychotic episode with superhuman strength, erratic behavior, and death by internal combustion—excited delirium is not officially recognized by the American Psychiatric Association, the World Health Organization, or the American Medical Association. And yet, in police reports, courtroom defenses, and media statements, it’s often the ghost in the machine: the thing that killed the suspect before the knee ever met the neck.

A History Built on Bias

The concept of excited delirium traces its roots back to the 1980s, when forensic pathologist Dr. Charles Wetli began using it to explain sudden deaths among cocaine users—particularly Black men. Wetli’s theory suggested that the combination of drug use and agitation led to cardiac arrest. But critics say what Wetli was describing wasn’t a syndrome—it was systemic racism in a lab coat. His early theories ignored the role of force, stress, or positional asphyxia—the known dangers of being restrained face-down for extended periods.

Despite its shaky scientific foundation, the theory grew legs. Medical examiners began citing excited delirium in autopsies involving police restraints. Law enforcement adopted it in training manuals. And companies like Axon—the makers of the Taser—embraced it as a way to deflect blame from their products.

The phrase gained broader recognition in the 2000s, especially in cases involving Tasers, where deaths would follow electric shocks and violent restraint. The victims—often under the influence or experiencing mental health crises—would thrash, scream, resist. And when they stopped breathing, excited delirium was there, like a forensic magic trick, to absolve the system.

The Science that Isn’t

Here’s the problem: excited delirium is not a real medical diagnosis. It doesn’t appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The National Association of Medical Examiners doesn’t endorse it. And a 2020 position paper from the American Psychiatric Association flatly stated: “There is no clear diagnostic criteria or accepted definition of excited delirium.”

So why does it keep showing up in autopsy reports?

Because it’s convenient.

“It’s a diagnosis that only ever seems to appear when someone dies in police custody,” says Dr. Michele Bratcher Goodwin, Chancellor’s Professor of Law at UC Irvine. “It’s not a syndrome that’s seen in emergency rooms. It’s seen in courtrooms and morgues, usually after a violent arrest.”

Indeed, a review of cases from the past two decades shows a pattern. The suspect—usually male, often Black, frequently mentally ill or intoxicated—is described as acting erratically. Police intervene. A struggle ensues. The person is restrained, often face-down, often for minutes on end. They lose consciousness. And then the narrative kicks in: excited delirium.

It happened with George Floyd. Though the Hennepin County medical examiner ultimately ruled his death a homicide due to restraint and neck compression, initial police statements referenced possible “medical distress” and drugs. It happened with Elijah McClain, a 23-year-old Black man in Colorado who was forcibly sedated with ketamine by paramedics after being tackled by police. And it happened with Daniel Prude in Rochester, NY—naked in the snow, hooded by a “spit sock,” pinned to the ground for two minutes while officers laughed.

In all these cases, excited delirium was floated. And in all these cases, the public saw the video, heard the cries for help, and began to ask questions that no tidy pathology report could answer.

Policing, Power, and the Need for Control

Excited delirium fits neatly into the mythology of modern policing: the suspect was too strong, too crazed, too dangerous. The officers had no choice. It reinforces a narrative of fear, particularly racialized fear. And it underpins a system where police encounters become deadly not because of tactics or training, but because of an unpredictable, unpreventable syndrome.

Critics argue that the term is weaponized. “It’s used post-mortem to clean up messes,” says civil rights attorney Andrea Ritchie. “It erases responsibility and dehumanizes the person who died. They’re no longer a victim—they’re a cautionary tale.”

Law enforcement agencies defend its use, claiming they’re merely describing observed behavior. Some cite the 2009 report by the American College of Emergency Physicians (ACEM), which provided tentative support for the concept—though that report has since been heavily criticized for conflicts of interest and lack of peer review. Notably, some contributors had financial ties to Taser International.

The Tide Is Turning

In recent years, the tide has begun to turn. Medical organizations are distancing themselves from the term. In 2023, the National Association of EMS Physicians denounced excited delirium as a “misleading and potentially harmful” diagnosis. Some states are even banning its use in legal contexts. California, for example, passed legislation in 2023 prohibiting coroners from listing it as a cause of death.

But the term still lingers, particularly in police training. Axon only discontinued references to excited delirium in its materials after years of criticism. And some medical examiners—often appointed by sheriffs or working closely with law enforcement—continue to cite it.

The persistence of excited delirium speaks to a deeper issue: the medicalization of state violence. When someone dies at the hands of police, there is an urgent need to explain it away—to protect the badge, the budget, the brotherhood. And excited delirium, with its pseudoscientific aura and lack of diagnostic rigor, does just that.

What Comes Next?

The death of a person in police custody is not a medical mystery. It’s a matter of force, of fear, of accountability. Until the criminal justice system reckons with its own role in these deaths, no amount of jargon will hide the truth.

Reform may come slowly. But with each bodycam video, with each protest chant, with each community that refuses to forget, the lie of excited delirium is unraveling.

In the end, it’s not a syndrome—it’s a story. One that America has told itself for too long.