‘Excited Delirium’: Are Police Using Junk Science to Justify Brutality?

Posted by News Beat on April 15, 2021  •  10 min read
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This is a segment from our April 14, 2021 edition of This Week In Social Justice. Scroll down for the  full stream.

If you've been following Derek Chauvin's murder trial over the last few weeks, you've no doubt heard witnesses reference a dubious and controversial term called "excited delirium."

The trial, which is in its waning days, has featured experts and Minneapolis Police Department brass who have testified that Chauvin deviated from training when he knelt on George Floyd's neck for more than 8 minutes, killing him. The defense has tried to argue that Floyd was still a threat, despite the 46-year-old being handcuffed and lying face-down on the ground, crying for his late mother and saying "I can't breathe."

Floyd's death sparked the largest racial justice protests since the 1960s and prompted calls for systemic change to policing under the banner of "defund."

In the courtroom, the disputed concept of "excited delirium" has been referenced to seemingly suggest that the force used in Floyd's slaying was reasonable. Its also been used in similar cases involving police, according to experts.

"Just three months shy of Floyd’s murder, officers in Tacoma, Washington had suggested 'excited delirium' as the cause of death in the case of another unarmed Black male, Manuel Ellis," according to an analysis published by the nonprofit public policy organization Brookings Institution. "And last year in Aurora, Colorado, paramedics injected Elijah McClain with ketamine, for 'exhibiting signs of excited delirium.' McClain later died of cardiac arrest after the injection."

However, the mainstream medical community, including the American Medical Association (AMA) and the World Health Organization (WHO), doesn't recognize "excited delirium" as a legitimate medical diagnosis.

"It's really a diagnosis that strung out of racist origins in the '80s without really any historical backing or any kind of unique features," Joshua Budhu, the neuro-oncology fellow at Massachusetts General Hospital, the Dana-Farber Cancer Institute, and Brigham and Women's Hospital, said on This Week In Social Justice, which is presented by News Beat podcast.

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In this interview, Budhu explains the origins of a concept he says is "junk science" and notes how it's used by police to justify brutality and potentially escape consequences.

Below is a transcript of our conversation with Joshua Budhu, which has been edited for clarity. You can watch This Week In Social Justice every Wednesday at 8 p.m. EST on various streaming sites and social channels. You can listen to This Week In Social Justice and our award-winning News Beat episodes on your favorite podcast app.


What is 'excited delirium'?

News Beat: What is 'excited delirium' and how is it being used by law enforcement?

Joshua Budhu: "I'll start off by saying, 'excited delirium' is not a medical diagnosis. It's not recognized by the American Medical Association. It's not recognized by the American Psychiatric Association, the WHO, it's not in the DSM-5. It's basically this kind of medical-legal construct that was developed in the 1980s to kind of explain away deaths in police custody and has evolved into this wastebasket, kind of catch-all diagnosis, that misappropriates different parts of real medical conditions, packages it all up, and then it's used as a convenient out because inevitably, this syndrome or so is fatal. It happens in police custody. And it really is a way for both law enforcement to honestly justify police brutality as well as absolve them of accountability."

NB: Can you describe the origins of this concept?

JB: "The term actually was first coined in 1985 by Charles Wetly, he's a forensic pathologists working out of Florida. And he had examined seven individuals who died. Each of them had cocaine in their system, they all had died within about one to two hours of interactions with the police with physical restraints, they died of respiratory distress, and five of them actually died in police custody. He kind of tried to link this and said, potentially, this is some type of new syndrome that has come out. This is 'excited delirium.' And that's when it was first put in the literature. He was also in charge of looking through all of that the deaths in Miami. And between 1980 and 1990, there were a series of 32 Black women who who were killed. Most of them were sex workers, they were found to have cocaine in their system. And this is where Charles Wetly kind of came up with they all died from this 'excited delirium.' There's a couple of really telling interviews that he says that he thinks cocaine does something to the brain, especially in relation to the sex of these of these people. And he says, this whole syndrome kind of starts with kind of drug intoxication, there's some type of receptors or neuro-chemistry that's going on that leads to to death.

Interestingly, for all of these 32 cases, these are actually re examined afterwards. And it was found that they actually died of asphyxiation. And a serial killer was actually found and caught, actually attributed all of these 32 deaths to the serial killer, whereas he had said, this was 'excited delirium.' But that was only years afterwards. By then, 'excited delirium' had kind of come into the scene. And this is when the early '90s to the mid-'90s, in which if you look at kind of the statistics as well, whites who died of cocaine use were called cocaine toxicity. Whereas Blacks who died of cocaine use, we're called 'excited delirium.' And that's when some of the this kind of syndrome stuff comes in, in which people started defining it as a syndrome in which you become impervious to pain, you have superhuman strength. You don't comply with police instructions, and all these racist tropes and stereotypes kind of come out, you know, 'the scary Black man,' really, those kind of stereotypes. And also at this time, this is when there's kind of this industrial kind of play going on as well, in which taser international, axon international embraces this diagnosis. It's showing up on a lot of different medical examiner's reports. The American College of Emergency Physicians wrote a white paper that kind of said that they had examined this and they said, potentially, it's a diagnosis. And that's when you'll see all literature kind of string back into that area. So it's really a diagnosis that strung out of racist origins in the '80s without really any historical backing or any kind of unique features."

NB: What's the significance of this concept being used in a criminal trial considering how it's not accepted by the medical community?

JB: "When you look at it, almost everyone who's a proponent of 'excited delirium' has some type of conflict. They're either being paid to testify, or they're people who are training in terms of how to react to 'excited delirium.' And there's all this kind of external conflict that comes into play. What I'll say is that from that 2009 white paper from the American Academy of Emergency Physicians, three of the people who wrote that were actually being paid by taser, wasn't disclosed at the time. And there's kind of been this whole industry that has come out of this term. And you have to really parallel that to what's happening in the medical community. So in medical school, 'excited delirium' is not taught, it's not in any textbooks, it's not a recognized medical diagnosis. So you have this 'syndrome' that's developed in the '80s, '90s, and now in the 2000s, in which it's kind of propagating in law enforcement and the legal community, but it's not in the medical community, because it's not a diagnosis that we came up with or support. So have it unrestricted, unrestrained. And if you look at almost all these reports, and all these studies about 'excited delirium,' they kind of all cite themselves. And there's this really poor science that's that's going on, in which someone writes a paper, then they write another paper, cite their old paper, and it just keeps propagating where, oh, now there's a body of literature about this condition, but it's not and really falls apart pretty, pretty quickly if you take a in depth analysis of it."

NB: How prevalent is it as a justification for police brutality cases or deaths within police custody?

JB: "That's honestly one of the biggest problems, we don't know the exact numbers. We don't know how widely this is being used. We tried to look back and there's not much data, but in Florida, over a period of 10 years about 54 deaths, I believe, were attributed to 'excited delirium.' And I think in Baltimore, Maryland, they said about 10% of deaths in police custody, were attributed to 'excited delirium.' But this is where it becomes a big problem for us because in the medical field, if you have something, you can even look at the kind of vaccine rollout, what's going on, everything is recorded meticulously. And everything's in numbers, you say, these are the adverse reactions, you say, this is how many times something happens. And that's how we form up with symptoms, the diagnosis, this is how medicine is scientifically advanced, whereas excited to learn, who knows how often this is being invoked. It's kind of almost cherry picked in terms of when it comes out. And also the description of it, all of the parts of it are really nondescript and unspecific. It really doesn't have any muster in terms of scientific validity. And that's a big problem, one of the hopefully ways to try to fix this, is someone has to go through and look and try to figure out how many times this is actually being invoked. And not only in the US, but it's actually a worldwide phenomenon."

NB: Have there been efforts to educate the medical community and law enforcement on this issue?

JB: "I will say for a lot in the medical field, this is the same as you, the first time that a lot of people are hearing about this. So it's it's not taught basically anywhere. So now there's a push, it's becoming a lot more publicized. We published these pieces in July, there's a recent article in Stat News denouncing it, asking for medical organizations to really come out and take a stance on it. But, you know, five, 10 years ago, almost no one in the medical community really heard about this. And that's when it becomes hard, it's because you're arguing with a fictional diagnosis that none of us believe in. There's two spectrums of field and medicine. And we had to talk about it, publish papers, and kind of figure out if this is a real or valid diagnosis, but for a lot of people, it just doesn't exist. And it actually has not been at the forefront, or even people have not even been aware of this. So I'm hoping over the next few months that major medical organizations besides just saying it doesn't exist, actually come out and denounce this diagnosis."

NB: In the context of COVID-19, can you comment on the critical need for diversity and inclusion to combat institutionalized biases within healthcare?

JB: "Even now, thinking back, it's a really traumatizing moment. But it was, honestly, the catalyst for both me and my family to really be involved in not only medicine but the diversity and inclusion and equity field. And I think COVID has just really exacerbated they already existing structural inequities in our system for healthcare. And it's kind of it's really shone a light in which, you know, Hispanics are hospitalized at three times the amount, compared to whites, the mortality rate for both Blacks and Hispanics is much higher than for whites. And in terms of when you look at both not only race, but kind of socioeconomic status in terms of poverty, you see that certain groups of our country are at risk, not just for COVID, but for so many other preventable medical conditions. And without a really strong and robust public health system, then it's going to continue to be perpetuated. And it's something in which I think a lot of us have become very comfortable to saying that honestly, racism is a public health crisis. And more people die from that each year then other specific diseases, and it's something we need to tackle.

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