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‘Excited delirium’: the controversial defense that could be used in the Chauvin trial

Oliver Laughland
·4-min read
<span>Photograph: Chandan Khanna/AFP/Getty Images</span>
Photograph: Chandan Khanna/AFP/Getty Images

Throughout the first phases of the Derek Chauvin murder trial, the defense attorney Eric Nelson has made passing reference to the term “excited delirium” as he attempts to build a case for his client.

Nelson referenced the phrase during opening arguments, has asked a number of witnesses about the term and may well explore it when the defense gets to present its case.

But “excited delirium” is a controversial and disputed expression often used in fatal cases of police violence. While certain medical bodies and experts recognize the term, many others do not, and there is no universally accepted definition of what it constitutes. Others have argued the phrase carries racial biases and is often used to justify lethal use of force by police, disproportionately against Black men.

Related: The protesters who gather every day to demand justice for George Floyd

Broadly, the term has been used to describe individuals who become agitated or distressed after using drugs or during a mental health episode. In some instances, those described as experiencing “excited delirium” are perceived to exhibit higher pain thresholds and unusual levels of strength.

The term is not recognized by the World Health Organization, the American Psychiatric Association or the American Medical Association.

In a statement clarifying its position on the term last year, the American Psychiatric Association said: “The concept of ‘excited delirium’ … has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term excited delirium is disproportionately applied to Black men in police custody.”

In its reasoning for rejecting the phrase, the association added: “The term ‘excited delirium’ (ExDs) is too non-specific to meaningfully describe and convey information about a person. ‘Excited delirium’ should not be used until a clear set of diagnostic criteria are validated.”

The term has, however, been recognized by the National Association of Medical Examiners.

Despite this lack of consensus and accepted evidence, police departments around the country, including in Minneapolis, have trained their officers to identify “excited delirium” as a potentially dangerous medical condition.

In one body-camera video shown to the jury during the murder trial of Derek Chauvin, one of the officers involved in the arrest can be heard stating he was “concerned about excited delirium or whatever”. Nonetheless, Chauvin continues to hold George Floyd in a knee to neck restraint that has been described as a direct violation of police department policy.

The phrase has been used in a number of highly controversial officer-involved deaths of Black Americans and has often been used to justify a decision not to criminally charge police.

Defense attorney Eric Nelson cross examines a witness on the eighth day of the trial of former Minneapolis police officer Derek Chauvin.
Defense attorney Eric Nelson cross examines a witness on the eighth day of the trial of former Minneapolis police officer Derek Chauvin. Photograph: Jane Rosenberg/Reuters

In 2015, after the in-custody death of unarmed Black woman Natasha McKenna, who was repeatedly Tased by detention deputies in Fairfax county, Virginia, a prosecuting attorney appeared to reference the term when he declined to charge any of the six officers involved. The medical examiner’s report had specifically listed the term as a cause of death.

Speaking to the Guardian as part of a sprawling investigation into fatal police force, McKenna’s family attorney said the decision was based on “junk science”.

There are no national statistics on the number of times the term has been used in official autopsies. But a 2015 Guardian investigation into in-custody deaths where officers deployed a Taser, the “non-lethal” electrical weapon used by many police departments around the country, found it used in at least five of the 49 in-custody Taser deaths that year.

During prosecution evidence on Monday, Dr Bradford Wankhede Langenfeld, the physician who tried to resuscitate George Floyd at the hospital and called his death, said he had considered the term as a contributing factor to Floyd’s death, but ultimately rejected it.

“I’ve seen a lot of cases of mental health crises or drug use leading to severe agitated states,” he said. “That is almost always reported by paramedics, and so the absence of that information was telling.

The term is also not mentioned in the medical examiner’s report into Floyd’s death.

According to the Brookings Institute, the phrase was first coined in 1985 by a forensic pathologist named Charles Wetli, to explain a series of deaths in cocaine users, many occurring in police custody.

But the most extensive examination of cases involving “excited delirium” was published in 2020, which found that “excited delirium” was most often cited during forms of “aggressive restraint” by police.

Pointedly, the research concluded that there is “no evidence” that excited delirium can cause death “in the absence of restraint”.