Anton Black was 19 years old when police officers chased him, shackled him, and left him face-down on the ground, struggling to breathe. He died from asphyxiation. Despite tireless objections from his family, the Maryland Medical Examiner called his death an accident.

Until now. After Maryland’s former head medical examiner testified in 2021 that Derek Chauvin was not responsible for George Floyd’s death, concerns arose that his pro-law enforcement bias may have affected his office’s decisions during his seventeen-year tenure. The resulting independent audit released in May 2025 revealed Mr. Black is not alone — almost forty additional in-custody deaths that had been deemed accidental or undetermined should have been categorized as homicides.

Anton Black was a Black man, a demographic more likely to face police violence. And he had a mental disability — severe bipolar disorder — which, also, made him more likely to experience police violence. But officers at the scene of his death claimed he exhibited “superhuman strength” to justify their use of extreme violence against him.

“Superhuman strength” is an apparent reference to the now debunked “excited delirium.” For too long, excited delirium has been a tool in the back pockets of police, medical examiners, and coroners used to cover up killings in police custody, leaving families without answers — or justice. Maryland’s audit is a good start at righting this wrong, but a national reckoning is needed.

That’s because this is not just a Maryland problem. Excited delirium was cited by police and other officials in the widely known police-perpetrated killings of George Floyd and Elijah McClain. But it is a pseudoscientific concept that no national medical organization recognizes, and which the Maryland Medical Examiner is no longer permitted to use. It’s nevertheless still a part of policing across the country (including in Maryland where excited delirium remains part of law enforcement training materials). Sometimes linking excited delirium to drug use or mental illness, proponents of its validity have for years argued that it causes an array of amorphous “symptoms,” including extreme violence and aggression; superhuman strength; imperviousness to pain; unresponsiveness to police; hallucinations, paranoia, or fear; and notably, sometimes sudden death.

Miami coroner Charles Wetli and psychiatrist David Fishbain created the concept of excited delirium in 1985 to explain the deaths of seven recreational drug users, five of whom died in police custody. Though the authors themselves acknowledged their article was largely speculative, they continued to promote the concept.

In the 1980s, Wetli attempted to explain the deaths of thirty-two Black women found dead in Miami with excited delirium. It turned out the women had been murdered — many of them showed clear signs of strangulation. Wetli nevertheless persisted for decades in suggesting at least some of the women died of excited delirium. But the medical evidence never supported his claims.

Modern-day proponents of this pseudoscience remain a small community of “experts” steeped in pro-law-enforcement bias who have engaged in what appears to be an ideologically-driven promotion of excited delirium. They have successfully convinced law enforcement agencies, medical examiners, and coroners (who often have no medical training and are sometimes just the local prosecutor or sheriff) across the country that excited delirium is real.

Excited delirium is not merely a discredited pseudoscience that law enforcement continues to accept. Its vague symptoms give officers the latitude to “diagnose” any number of people with excited delirium. They serve to transform normal responses to fear and distress into “symptoms” of a “disease” that purports to cause hyper-dangerousness and threaten the lives of police officers. It is then used to justify using more violence against people in distress and serves as a cause of death if they die afterwards. It’s a veritable multitool. And, these “symptoms” mirror stereotypes of Black people (especially Black men) and persons with disabilities, putting them even more at risk of police violence.

Since its invention, excited delirium’s prevalence in the law enforcement community has never waned. In 2015, Natasha McKenna, a 130-pound Black woman, was incarcerated in Fairfax County, Virginia, when her mental health started deteriorating. During a time of psychiatric crisis, six deputies repeatedly stun gunned Ms. McKenna — who was naked and already handcuffed — causing cardiac arrest. The deputies later claimed Ms. McKenna exhibited “super-human” or “demonic” strength, but video of the incident does not support those fantastical claims. The medical examiner, again, claimed excited delirium was the culprit.

Excited delirium allows law enforcement’s use of extreme force to go unchecked and unexamined. As a post hoc explanation, it serves to justify uses of extreme violence against and — and even the killing of — people in crisis, especially people with disabilities, and particularly those of color. What happened with the Maryland audit, pointing to dozens of lost lives erroneously explained away, should be the canary in the coal mine for jurisdictions throughout the country who still use excited delirium.

A few jurisdictions have banned use of the term excited delirium — and New York is currently considering a bill that would prohibit public officials from referencing the syndrome in trainings, policies, procedures, death certificates, and autopsy reports. But simply banning the term does not remove excited delirium’s influence. The racist and ableist underpinnings of the term and the unexamined ease with which law enforcement adopted it, suggest the need for deeper structural changes.

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