California has become the first state to ban the use of “excited delirium” as a cause of death, prohibiting the pseudoscientific diagnosis that authorities have frequently cited to justify killings at the hands of law enforcement.
Excited delirium – a term rejected by major medical groups, including the American Medical Association – suggests that people can develop “superhuman strength” due to drug use. Medical examiners and coroners have argued that the condition caused victims of brutal police force to struggle and collapse from cardiac arrest, essentially excusing the role of officers who were holding them down, choking or suffocating them.
Governor Gavin Newsom signed a bill on Sunday prohibiting the term from being recognized as valid diagnosis or cause of death. The bill comes as a national emergency physicians’ group is also considering disavowing the term.
The legislation was prompted by the 2020 death of Angelo Quinto, who lost consciousness while two Antioch officers knelt on his neck and back, with the death certificate citing “excited delirium syndrome”. Quinto was suffering a mental health crisis in his mother’s home.
Law enforcement officials, death investigators and first responders have disproportionately applied the term to Black victims and cited it in a number of high-profile cases in recent years across the country. One of the former Minneapolis officers who pleaded guilty to aiding and abetting the murder of George Floyd was heard on video saying he was “concerned about excited delirium or whatever” as Derek Chauvin knelt on Floyd’s neck.
In Aurora, Colorado, officials cited excited delirium in explaining the 2019 killing of Elijah McClain, a 23-year-old stopped by police on a walk home and placed in a neck hold with multiple officers on top of him as he struggled to breathe. Officers said the 5ft 7in, 140-pound McClain had “incredible strength” and paramedics injected him with 500mg of the powerful sedative ketamine after one of them incorrectly estimated his weight to be 190 pounds. Three officers and two paramedics have been charged with manslaughter, and the first trial is finishing this week.
Despite growing backlash, Colorado officers are still taught the term in trainings.
Doctors have also increasingly scrutinized “excited delirium” as a diagnosis. This month, the American College of Emergency Physicians (ACEP) will vote on whether to formally disavow its 2009 position paper supporting its use. The organization will also consider discouraging physicians who serve as expert witnesses from citing the excited delirium theory in criminal or civil trials.
A 2022 report by the advocacy group Physicians for Human Rights found that the ACEP’s 2009 paper was influential in perpetuating racist tropes that were used to explain the deaths of mostly Black men in police custody. People with excited delirium are described as being impervious to pain while under the influence of drugs.
A 2021 data analysis found that at least 56% of deaths in police custody between 2010 and 2020 attributed to excited delirium involved Black and Latinx victims. The term “excited delirium has an ignoble history linked to racism and fraudulent forensic science”, wrote Osagie Kingsley Obasogie, a professor and bioethics at the University of California, Berkeley, in the analysis.
The American Medical Association, American Psychiatric Association, American Academy of Emergency Medicine, National Association of Medical Examiners, and American College of Medical Toxicology have all disavowed the term.
“Excited delirium was never scientifically proven. It was a work of fiction,” Lindsay Minter, a community organizer in Aurora, said Tuesday. “People were using their biases to diagnose. If you see African American men as bigger and taller than they are, you see them as stronger than they are. [Police] don’t look at our youth as children. They say this ‘suspect’ or ‘young man’, and the kid is 12 years old.”
She praised California’s legislation, noting how the diagnosis can traumatize grieving relatives and communities after killings by police: “The decision to get rid of that term will definitely help communities and families heal.”
