"Perspective: Labeling 'Excited Delirium' as a scientifically flawed racial construct should lead to its prohibition as a diagnostic category in New York."
In the late 20th century, a term emerged that has since sparked controversy and raised serious ethical concerns: "excited delirium." This term, primarily used by police, coroners, and emergency medical personnel, is characterised by extreme agitation, aggression, acute distress, and sudden death, often in the context of police restraint or custody. However, the medical validity of "excited delirium" is highly controversial and disputed.
The concept gained widespread use as police departments began purchasing and using tasers, and as their overuse led to deaths in custody. It was first introduced in a 1985 research paper by Charles Wetli and David Fishbain. However, major medical bodies such as the American Psychiatric Association and World Health Organization do not recognise "excited delirium" as an official diagnosis due to a lack of consistent clinical criteria and reliable scientific basis.
Historically, "excited delirium" has been used primarily in forensic and law enforcement contexts to explain sudden, unexplained deaths in police custody—frequently involving restrained individuals under the influence of drugs or with mental illness. Critics argue that this term can function as a "catch-all" that obscures potential misconduct or excessive force by police, thereby impacting accountability.
The controversy around its impact on police practices and deaths in custody includes several main issues. First, it has influenced police restraint techniques and medical examiner conclusions, sometimes justifying controversial restraint methods by attributing sudden deaths to an alleged medical syndrome rather than to potentially excessive use of force.
Second, several investigations and human rights organizations have challenged the use of "excited delirium" as a cause of death, citing its unclear pathophysiology, lack of diagnostic consensus, and frequent misuse to evade scrutiny in deaths involving police. The term’s application disproportionately affects marginalized groups, particularly Black individuals, raising concerns about systemic bias in policing and medical investigation.
From a medical standpoint, delirium—a well-established clinical syndrome with fluctuating disturbances in attention, awareness, and cognition—differs significantly from "excited delirium." Genuine delirium is common but does not inherently encompass the hyper-agitated and aggressive behaviors attributed to "excited delirium."
In summary, while "excited delirium" is invoked to explain some deaths in U.S. police custody, it lacks clear medical validation and remains deeply controversial. Its use shapes law enforcement practices and raises serious ethical and human rights concerns regarding its application and the accountability for use-of-force deaths.
- The use of "excited delirium" in forensic and law enforcement contexts, particularly when explaining sudden, unexplained deaths in police custody, has been highly contested in the realm of health-and-wellness, mental-health, and general-news, due to its lack of consistent clinical criteria and reliable scientific basis.
- The term "excited delirium" has been criticized for functioning as a "catch-all," potentially obscuring potential misconduct or excessive force by police and impacting accountability in crime-and-justice and policy-and-legislation discussions.
- In the context of science and politics, the continued use of "excited delirium" to justify controversial restraint methods raises concerns about its impact on fitness-and-exercise, war-and-conflicts, and human rights.
- As the term "excited delirium" disproportionately affects marginalized groups, particularly Black individuals, it also raises questions about systemic bias in policing, medical investigation, and public policy, making it a topic of general-news and social justice debate.
