On May 25, 2020, George Floyd was arrested for allegedly using a counterfeit $20 bill to buy cigarettes in Minneapolis. The senior officer in command, Derek Chauvin, knelt on his neck for over nine minutes, killing him.
The initial police statement reassured the public that officers were assisting Floyd with a “medical incident.” This gave the false impression that Floyd had just spontaneously died, shortly after interacting with police. At the scene, while police knelt on Floyd, a rookie officer, Thomas Lane, is tellingly heard on body camera footage asking whether this might be a case of “excited delirium.”
While awareness that “excited delirum syndrome” is an illegitimate diagnosis is increasing, this completely fabricated condition, driven by racist medical biases, still corrupts the criminal justice system today, four years after Floyd’s death.
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Excited delirium syndrome was contrived in the 1980s by the late forensic pathologist Charles Wetli, then Miami-Dade County chief assistant medical examiner, who speculated that Black people might have a genetic defect that caused them to die spontaneously after using a small amount of narcotics. Even after medical evidence disputed his assertions about Black people and cocaine, Wetli doubled down on his racist argument. In a 1991 interview, he stated, “Seventy percent of people dying of coke-induced delirium are black males, even though most users are white. Why? It may be genetic,” Wetli argued.
According to those who have asserted the existence of such a condition, people with excited delirium syndrome supposedly exhibit superhuman strength and an imperviousness to pain; become aggressive, excited, sweaty and agitated; and are said to then “suddenly die” around police. This makes police officers into innocent bystanders who just happen to witness the inexplicable deaths of so-called criminals, ones subsequently blamed for having caused their own demise. Almost all these deaths have occurred during police interactions, however, and they have almost always involved use of force, such as hog-tying people, applying carotid choke holds, kneeling on people’s bodies, stunning them with tasers, injecting them with sedatives, or imposing other forms of forceful restraint.
During Chauvin’s trial, his defense attorneys argued that excited delirium syndrome was real and that Chauvin’s lethal force was justified because of Floyd’s superhuman strength.
If 17-year-old Darnella Frazier had not posted her bystander video to Facebook showing Chauvin kneeling on Floyd’s neck, the world might never have known that this was far from a person suffering medical distress; rather, it was a public lynching.
As a result, people increased their scrutiny of excited delirium syndrome. The National Association for the Advancement of Colored People and the American Civil Liberties Union argued that excited delirium serves as a medical scapegoat for police abuse and is not an actual medical diagnosis. The syndrome is not listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and has no International Classification of Diseases code, which means that it cannot be studied statistically as a diagnosis. It is also not recognized by the American Medical Association, the American Psychiatric Association or the World Health Organization. Until last year, however, it was accepted as a valid condition by the National Association of Medical Examiners (NAME), which legitimated its use as a cause of death in the U.S. CBS News reported in 2018 that a review of studies found that more than 10 percent of deaths in police custody that year were attributed to excited delirium.
After Floyd’s death, other high-profile cases of excited delirium came to light: Elijah McClain was diagnosed with excited delirium syndrome by paramedics after he was placed in a carotid hold by police. Body cam footage shows a prone and restrained McClain pleading with officers in desperation, letting them know that he could not breathe as their collective weight bore down on his chest. When paramedics arrived, they quickly injected him with a dose of ketamine, used as a “chemical restraint,” that was too high for his body weight. Three days after McClain’s arrest, he was declared brain dead and taken off life support.
As I write about in my book Excited Delirium: Race, Police Violence and the Invention of a Disease, the examples are numerous, with cases in Virginia, New York, Florida and California, where this baseless diagnosis has conveniently concealed police involved deaths for decades.
Since George Floyd’s murder, there is increasing acknowledgement from legal and medical communities that excited delirium is a “misappropriation of medical terminology”—in essence it is a term invented to cover up police violence. California banned its use as a cause of death last year, and three others states, Colorado, Florida and New York, moved to eliminate it from law enforcement trainings in recent months. Finally, NAME and the American College of Emergency Physicians, the only two medical organizations that had officially supported its validity, rejected excited delirium syndrome as a legitimate cause of death just last year.
When the world watched George Floyd take his last breaths, protests erupted globally. It was the height of the global COVID pandemic, and people masked up and took to the streets. There was a sense of historic reckoning. Demands for police reform, reparations and an acknowledgment of the structural injustices against Black people became part of public discourse, if only for a short time. The attention exposed how medical examiners and paramedics have also used excited delirium to conceal and perpetuate racist violence.
Still, there is work to be done. Even as the term “excited delirium syndrome” is out of favor and is beginning to be removed from documentation and police training manuals, the medical cover-up for police violence persists. We see this explicitly in the 2023 death of Keenan Anderson, who told people the police were trying to “George Floyd” him. He was tased multiple times; however, the coroner claimed his death was a result of heart failure and cocaine.
Anderson’s death was essentially attributed to excited delirium syndrome without the use of the term. Just this past April, Frank E. Tyson, another Black man, was asphyxiated by a police officer. Attorneys of Tyson’s family members described him as “George Floyd 2.0.” Similar to Floyd, Tyson was suffocated while handcuffed, subdued and on the ground, complaining of being unable to breathe.
Despite hopes that Floyd’s death had led to the reexamination of a fabricated disease, medical justifications continue to mask the murders of Black men and women at the hands of police. We must work to undo the use of medical excuses to hide police violence and understand how intertwined police and medical abuse perpetuates racist injustice.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.