‘Excited Delirium’: The Junk Science That Covered Up a Serial Killer

This article contains a spoiler for the first episode of the second season of Jon Ronson’s BBC Radio 4 show Things Fell Apart. 

In the new season of his BBC Radio 4 show Things Fell Apart, writer and broadcaster Jon Ronson tells eight mind-blowing stories about the unlikely origins of the culture wars. You know, the ones that see us ripping chunks out of each other online like it’s a sport. If you’re planning on listening to the entire season (available now as a box set on BBC Sounds), buckle up because it’s a wild ride. 

The season’s first story starts in 1980s Miami. In that decade, the lifeless bodies of 32 Black women who worked as sex workers were discovered in various car parks, junk yards, and alleyways. They were all naked from the waist down, and they all had small levels of cocaine in their systems. 

There wasn’t much media attention at first—conceivably because the women were Black sex workers. But investigators were perplexed. They had no cause of death, no idea how the women had died, nothing at all to go on. One detective remarked that they were “the most mysterious deaths you could find”. 

Then, Charles Wetli, then Deputy Chief Medical Examiner for Dade County in Miami, put forward an unusual theory. After examining the bodies of the deceased women, he concluded that they had all spontaneously dropped dead “due to a combination of cocaine and sex.” His bizarre prognosis continued: “Autopsies have conclusively shown that these women were not murdered” and “for some reason, with chronic cocaine use, the male of the species becomes psychotic and the female of the species dies in relation to sex.”

Wetli coined a term for this phenomenon: excited delirium syndrome, a condition that caused women to die during sex if they’d taken coke and for men, Black men specifically, to just go berserk. (“It may be genetic,” he once said.) According to Wetli, when a man is in the throes of excited delirium, they transform into a raging, supernaturally strong, uncontrollable beast. One that is hellbent on the frenzied destruction of themselves and others. They must, he argued, be subdued at any cost. 

The problem with Wetli’s discovery is that it was total horseshit. The real cause of the Miami deaths was discovered a year later, in 1989. A man—Charles Henry Williams, 38 years old—was found to be forensically linked to the murders. He was suspected of killing his victims by choking them during forced oral sex. He died from complications relating to AIDS just before he was due to stand trial for murder. 

The excited delirium story was debunked, but you wouldn’t know that from talking to Wetli. He went on to write a book about the spurious “medical condition” and made it his life’s work to promote the concept. And he wasn’t alone: The people who make tasers and the police also lobbied for acceptance of excited delirium syndrome because it was a handy excuse to rely on when someone (usually Black people) had died in police custody and there was no reason for their death other than brutality. It is understood that the phrase “excited delirium” was even mentioned by one of the officers who murdered George Floyd on the scene of that tragic incident in 2020. 

Over the years, Wetli was called into court 276 times—well into the 2000s—as a paid expert witness when a suspect had died after being tasered. Every time, he would argue that the force was necessary as the victim was in an uncontrollable state of excited delirium. 

Why did Wetli continue to bang the excited delirium drum, even when it was obviously not a real medical condition? “I can't answer that question because I just don’t know,” Ronson told VICE. “I wish he was still alive [he died in 2020] and I could have interviewed him for the show. I could only speculate, but when I was writing The Psychopath Test, I did learn that academics do get very involved in their pet projects.” He added: “Clearly, you know, he invented excited delirium, and it's gonna be hard to give that up.” 

Today, the phrase excited delirium is becoming less common. “I think sometimes they're just changing the name to ‘agitated delirium’ and in other places phasing it out completely,” Ronson says. But it has not totally disappeared. “I gave a talk in Belgium a couple of months ago at a podcast festival, and I gave a little preview of the excited delirium story,” he continues. “And afterward, a woman who works for one of the big papers there said that there were two ongoing cases in Belgium where excited delirium is being listed as a cause of death.” 

Now that we know that the diagnosis of excited delirium has no basis in science and no basis in reality, should the 276 cases where Wetli was an expert witness be reopened and re-examined? “Well, it would be interesting,” Ronson believes. “If excited delirium has been completely debunked, then perhaps some of those cases would be worth reopening. It’ll be interesting to see what happens next.” 

Societal commentary around crackpot science (along with conspiracy theories, public shaming online, and culture wars) is Ronson’s bread and butter. “I've always been fascinated by pseudoscience in high places,” he explains. “That's something I've been writing about since The Men Who Stare at Goats.” That was his 2004 masterpiece about the US Army's bonkers exploration of paranormal concepts. “That's a story about pseudoscience in important places; all of these army colonels and generals tried to kill goats just by staring at them.” 

But why did he think this particular story should be told? “The excited delirium story is shocking for many reasons,” he said, tilting back into his chair, a cup of coffee in his right hand. “Firstly, it's clearly racist and misogynist. The fact that women who have excited delirium die as a result of a combination of cocaine and sex. And for the men who die of excited delirium, it just fits into all of the sort of racist tropes: that Black men can have superhuman strength or be impervious to pain. I think it’s really shocking that that sort of casual racism and misogyny went unchecked for decades.” 

You don’t want to be a science denier, but look at what happened when people blindly believed someone merely because they were wearing a white lab coat. “Yeah, how shocking it is that people don’t use their critical thinking skills just because it's a doctor or a scientist saying it,” Ronson concluded. “They just accept it. You have to keep your critical thinking skills intact at all times.”