“Excited delirium”: can the world lose this controversial term, which is accused of covering up deaths in police custody?

When George Floyd died in police custody in Minneapolis in May 2020, the circumstances of his death while being restrained became the focus of significant controversy. Police officers attending the scene said that Floyd was experiencing “excited delirium,” which some people say can cause a person to become so agitated and delirious that they die. That was why he died, the police claimed.

The phrase “excited delirium” was used by two doctors working in Miami in the 1980s to describe what at the time were unexplained deaths of several black women.1 The doctors believed that drugs may have played a role in their death. In reality, the dead women weren’t victims of drug overdoses or “excited delirium”: they had been murdered by a serial killer.2

Subsequent analyses have never found a reliable medical basis for the use of “excited delirium” in the medical lexicon.3 Yet this and a related phrase more common in the UK, “acute behavioural disturbance” (ABD), have been mentioned as a cause of death or a contributing factor in 44 cases of UK police restraint since 2005, found an investigation published in March by the charity Inquest, the Royal College of Psychiatrists, and the Observer.4 An earlier study published in July 2023 found that mentions of ABD in mental health records at one London NHS trust had increased year on year from 2006 to 2021.5

Four years on from Floyd’s death, attitudes are changing: last month Colorado joined California in banning police, medical staff, and coroners from using the term “excited …