‘Excited delirium’ used to justify excessive police force, doctor says
After George Floyd died under the knee of Officer Derek Chauvin and the police officers accused of failing to intervene went on trial, their defense said Floyd was suffering from a condition called “excited delirium.”
Cases of “excited delirium” in police custody go back years. Police said Hamden's David Mills was in a state of “excited delirium” when he was shocked with a Taser stun gun and died soon after in 2007. Something similar happened in 2010 to Middletown's Efrain Carrion.
A 2011 paper in the National Library of Medicine defines “excited delirium” as “bizarre and/or aggressive behavior, shouting, paranoia, panic, violence toward others,” as well as “unexpected physical strength.”
But Brooks Walsh, an emergency room physician at Bridgeport Hospital, does not believe excited delirium is a legitimate diagnosis.
Walsh has partnered with researchers at Yale to publish an article arguing that excited delirium does not actually exist but is used by police to justify excessive force, most often against young, Black men.
Walsh's paper, "Revisiting 'Excited Delirium': Does the Diagnosis Reflect and Promote Racial Bias?" was published last month in the Western Journal of Emergency Medicine.
“The critical thing about this phenomenon or diagnosis is that, supposedly, this condition can cause sudden death of uncertain origin,” he said.
Walsh has never himself diagnosed excited delirium, though he has seen “plenty of people who have been very agitated, either intoxicated from whatever or severe psychiatric disease or injured, and they required sedation to calm them down and be able to allow us to evaluate them and treat them.”
The term “excited delirium” was first used in the 1800s, but the source that is cited most often is a 2009 paper published by the American College of Emergency Physicians, of which Walsh is a member.
As defined in that paper, “the core symptoms would be unusual superhuman strength and imperviousness to pain, bizarre animal-like, violent behavior,” Walsh said. “Sometimes ‘not responding to the police or authorities' is listed.”
Walsh said that several of the authors of the ACEP paper “had strong ties to law enforcement organizations.” Among the authors, all members of the ACEP's Excited Delirium Task Force, were physician and Santa Barbara, Calif., police officer Donald Dawes, Joseph Heck, who was medical director at the Las Vegas Metropolitan Police Department, and Jeffrey Ho, who was both an associate professor of emergency medicine at the University of Minnesota and deputy
An emergency room physician at Bridgeport Hospital has authored a paper arguing that the diagnosis of “excited delirium” is inherently racist.
sheriff in Meeker County, Minn.
Those connections, Walsh said, puts the paper's veracity into question.
“I was concerned that the language was oddly defensive and in some places argumentative and unscientific,” he said. “The levels of evidence they presented where it just would not be permitted in almost any other publication.”
Walsh is not alone in his critique. A 2017 Swiss study showed that Black people are disproportionately diagnosed with “excited delirium,” researchers writing that, “Male sex, young age, African-American race, and being overweight are independent risk factors.”
“The effect that we see is that the diagnosis of excited delirium is seen much more often in Black people,” Walsh said. “Being Black is actually a risk factor for dying from excited delirium.”
The American Medical Association issued a policy statement in 2021 opposing the use of “excited delirium” as a medical diagnosis.
“As physicians and leaders in medicine, it is our duty to define the medical terms that are being used to justify inappropriate and discriminatory actions by non-health care professionals,” AMA President-elect Gerald E. Harmon said then in a release.
Though Walsh said the ACEP has since revised its 2009 paper, he hopes medical professionals will cease to use and validate the diagnosis.
“The first thing would be that we stop using the term ‘excited delirium' because it adds nothing to the description of the event and it's already been shown to be a biased term,” he said. “It evokes racial stereotypes, and it may be encouraging inequitable treatment.”
There is some precedence, Walsh said: “We don't call people ‘Mongoloid' or ‘hysterical' any longer.”
“There are people who would say that those of us who criticize the term ‘excited delirium,' we're arguing semantics, that if it pleases us we can call it by a different name,” he said. “But I think there's a lot in a name in setting up how we approach patients.”