A ‘city on fire’: How Miami shaped a disputed diagnosis used to justify deaths in police custody

One night in 2019, Elijah McClain, a 23-year-old Black man in Colorado, was walking home when he was approached by police. Someone had deemed him “suspicious” and called the cops. The police argued with McClain, tackled him to the ground, and restrained him with a carotid hold around his neck. Body camera footage shows an officer saying McClain, who was about 5’6” and 140 pounds, had “crazy strength.” Paramedics arrived and concluded McClain was showing signs of “excited delirium,” according to The Colorado Sun. A paramedic injected him with ketamine to sedate him, and McClain slipped into a coma. A few days after the encounter, he died. The words “excited delirium” appeared in the medical examiner’s opinion within the autopsy report.

“Excited delirium” is a controversial term that is used by some to describe a person who experiences an acute, extreme disruption in their behavior and ability to think, and often comes up in relation to people who have died in police custody. People with excited delirium are often said to display “superhuman strength.” But most medical authorities do not consider excited delirium to be real. Organizations such as the American Medical Association, American Psychological Association, and World Health Organization do not recognize it as a true medical condition.

To investigate the origins of excited delirium, we turned to my colleague Isabella Cueto, a Sharon Begley science reporting fellow at STAT. She traveled to Miami to learn more about the historical roots the term has in the medical examiner’s office there.

In this episode of “Color Code,” Marvin Dunn, a retired professor at Florida International University and a historian of Black Miami, describes the political and social landscape in Miami when excited delirium was being researched. Catherine Mas, an assistant professor of modern American history at Florida International University, tells us about the impact of medical authorities on legitimizing excited delirium during this time. We also hear from Norman Kassoff, a former law enforcement and Navy officer and the former director of operations in the Miami-Dade County Medical Examiner’s Office.

Next week, in a bonus episode, we speak with Altaf Saadi, a neurologist at Massachusetts General Hospital, and Brooks Walsh, an emergency medicine physician at Bridgeport Hospital in Connecticut, to learn more about the current state of the discussion over excited delirium. You can subscribe to “Color Code” on Apple Podcasts, Spotify, Google Podcasts, SoundCloud, and elsewhere. New episodes will be released every other Monday.

A transcript of this episode is available here.

To read more on some of the topics discussed in the episode:

• The Physicians for Human Rights report on “Excited Delirium” and deaths in police custody.
• NPR reporting on excited delirium and police killings.
• The American College of Emergency Physicians’s Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings
• The American Medical Association’s stance on “excited delirium.”

And check out some of STAT’s coverage on the topic:

• Excited delirium: valid clinical diagnosis or medicalized racism? Organized medicine needs to take a stand
• Listen: Two addiction specialists debunk the myth of ‘excited delirium’ used in police encounters

This podcast was made possible with support from the Commonwealth Fund.