Health and appearance of Michael Jackson
Michael Jackson (August 29, 1958 – June 25, 2009) was an American singer who spent over four decades in the public eye, first as a child star with the Jackson 5 and later as a solo artist. From the mid-1980s, Jackson's appearance began to change dramatically. The shape of his face, particularly his nose, triggered widespread speculation of extensive cosmetic surgery. His skin tone became much lighter. Although Jackson was diagnosed with the skin disorder vitiligo, which results in white patches on the skin, and said that he had not purposely bleached his skin but had used makeup to even out his skin tone, it was widely suggested that his lighter skin tone was partly due to skin bleaching.
Jackson and some of his siblings said they had been physically and psychologically abused by their father, Joseph Jackson. In 2003, Joseph admitted to whipping them as children, but he emphatically rejected the longstanding abuse allegations. The whippings deeply traumatized Jackson and may have led to the onset of further health problems later in his life. Physicians speculated that he had body dysmorphic disorder.
At some point during the 1990s, it appeared that Jackson had become dependent on prescription drugs, mainly painkillers and strong sedatives. The drug use was later linked to second- and third-degree burns he had suffered years before. Jackson gradually became dependent on these drugs and his health deteriorated. He went into rehabilitation in 1993.
While preparing for a series of comeback concerts scheduled to begin in July 2009, Jackson died of acute propofol and benzodiazepine intoxication after suffering cardiac arrest on June 25, 2009. His personal physician was convicted of involuntary manslaughter in his death and sentenced to four years in prison.
Jackson's skin was a medium-brown color throughout his youth. However, starting in the mid-1980s, it gradually grew paler. This was partly due to vitiligo (a long-term skin condition characterized by patches of the skin losing their pigment) and also considered to be due to skin bleaching. The cause of vitiligo is unknown, but it is believed to be due to genetic susceptibility triggered by an environmental factor such that an autoimmune disease occurs.
Biographer J. Randy Taraborrelli said that Jackson began making his nose smaller around the same time his skin became gradually lighter and was using the over-the-counter skin-bleaching cream, Porcelana, to achieve the lighter skin. Jackson's physical changes gained widespread media coverage and provoked criticism from the public. Some African-American psychologists argued Jackson was "a lousy role model for black youth". Dr. Dennis Chestnut said Jackson had given "black youth a feeling that they can achieve", but might encourage them to believe they had to be esoteric and idiosyncratic to be successful. Dr. Halford Fairchild said Jackson and other African-American celebrities would try "to look more like white people in order to get in films and on television". Jackson has also been confronted with the reaction of the people around him. Filmmaker John Landis, who directed two music videos for Jackson, said when Jackson showed him his bleached chest, he told him the doctor who had done it was a criminal.
However, in 1993, Jackson told Oprah Winfrey "there, as I know of, there is no such thing as skin bleaching. I've never seen it, I don't know what it is." He said he had a hereditary skin disorder (vitiligo), and would use make-up to even out the uneven skin tone. "It is something I cannot help," said Jackson. "When people make up stories that I don't want to be who I am, it hurts me. It's a problem for me. I can't control it. But what about all the millions of people who sit in the sun to become darker, to become other than what they are. Nobody says nothing about that." Winfrey's interview of Jackson was watched by 62 million Americans. It also started a public discourse on the topic of vitiligo, then a relatively unknown condition.
Jackson publicly said that he was proud to be black. He also wrote a letter to photographer William Pecchi Jr. in 1988 which reads: "Maybe I look at the world through rose colored glasses but I love people all over the world. That is why stories of racism really disturb me. [...] Because in truth I believe ALL men are created equal, I was taught that and will always believe it. I just can't conceive of how a person could hate another because of skin color. I love every race on the planet earth. Prejudice is the child of ignorance. Naked we come into the world and naked we shall go out. And a very good thing too, for it reminds me that I am naked under my shirt, whatever its color."
Shortly following Jackson's death, tubes of Benoquin and hydroquinone were found in Jackson's home. Both creams are commonly used to treat vitiligo; Dr. David Sawcer said some patients with vitiligo remove dark areas of skin when most of their skin has become pale. Darkening depigmented skin is also extremely difficult. Depigmentation causes a permanent and extreme sensitivity to the sun. Vitiligo patients are at risk to contract melanoma, and an annual cancer check-up is recommended. Another common way of treating vitiligo is using makeup to camouflage depigmented skin. The treatments Jackson used for his condition further lightened his skin tone, and with the application of pancake makeup to even out his skin tone, he could appear very pale. Jackson also covered his skin disorder with clothing wearing long sleeves and long pants. In the music video for "Remember the Time", all dancers and actors except for Jackson are lightly dressed following the example set by ancient Egyptians. Jackson usually avoided wearing patterned clothing to avoid attention to the disorder.
Jackson's autopsy confirmed that he had vitiligo. His skin was found to have reduced (though not absent) melanocytes, the cells active in skin pigmentation. Vitiligo occurs in three different patterns. Segmental depigmentation means only one side of the body is affected, whereas generalized depigmentation means many parts of the body are affected. Jackson's autopsy report states a "focal depigmentation of the skin" (i.e., the depigmentation occurs on one or a few areas of the body). In Jackson's case, there were five affected areas. When Jackson was diagnosed with vitiligo in the mid-1980s, he started to learn more about the disease. He would often call his dermatologist's nurse and future wife Debbie Rowe to get medical information as well as emotional support.
Taraborrelli said that Jackson was diagnosed with discoid lupus. To treat this condition, Jackson had hydroxychloroquine injected directly into his scalp regularly. He also used Solaquin, Retin A and Benoquin and had to avoid sun exposure more than ever. Taraborrelli said the lupus was on remission later. Jackson's autopsy did not confirm or refute the claim that he had lupus.
Over time, Jackson's facial structure changed as well. Surgeons speculated he also had a forehead lift, cheekbone surgery and altered his lips. Those close to the singer estimated that, by 1990, he had undergone around ten procedures. However, in the biography's original edition published in 1991, Taraborrelli said Jackson had had a total of six nose surgeries including two secondary operations (not considered complete rhinoplasties). According to Taraborrelli, Jackson had his first rhinoplasty after breaking his nose during a rehearsal session while dancing. However, the surgery was not a complete success, and he complained of breathing difficulties that would affect his career. He was referred to Steven Hoefflin, who performed his second rhinoplasty in 1981. Taraborrelli said Jackson had a third rhinoplasty three years later and a fourth in 1986. Jackson wrote in his 1988 autobiography Moonwalk that, in addition to the two rhinoplasties, he also had a dimple created in his chin. From 1986 onward he was a regular client of Arnold Klein, a dermatologist who specializes in dermal filler injection, a non-surgical cosmetic procedure.
In his book, Jackson attributed the changes in the structure of his face to puberty, a strict vegetarian diet, weight loss, a change in hair style and stage lighting. Jackson denied allegations that he had altered his eyes. In June 1992, the Daily Mirror ran a full front-page picture, allegedly of Jackson's face, which they described as "hideously disfigured" by plastic surgery. Jackson sued and, in 1998, the Daily Mirror agreed to an out-of-court settlement. At the High Court, the former Daily Mirror editor acknowledged that after meeting Jackson in person, he believed that Jackson was neither hideously disfigured nor scarred. A Daily Mirror solicitor maintained that the paper had not tampered with the picture.
Media reports stated that Jackson's autopsy reported one scar beside each of his nostrils, one scar behind each of his ears, and two scars on his neck, "probably" from cosmetic surgery, plus cosmetic tattoos on his eyebrows, around his eyes and lips, and on his scalp (at his receding hairline).
In the unedited version of the documentary Living With Michael Jackson, which was shown in court in 2005, Jackson said he had two procedures on his nose so that he could breathe better. When he was asked about his cheeks, Jackson answered: "These cheekbones? No. My father has the same thing. We have Indian blood."
Over the years, Jackson had various medical problems that were covered by the media. In early 1984, Jackson was treated for scalp burns after his hair caught fire during a commercial shoot. In June 1990, Jackson was admitted to a Santa Monica hospital with chest pains. According to Dr. Mark Zatzkis, "laboratory and X-ray tests of Jackson's heart and lungs revealed no abnormalities"; the pains "were caused by bruised ribs suffered during a vigorous dance practice".
Various concerts were canceled owing to illness, and a remaining tour was called off due to addiction. On March 12, 1988, Jackson canceled a show in St. Louis which was rescheduled for March 14; on March 13, Jackson performed in St. Louis although he was fighting a cold. The cold progressed to laryngitis; the show on March 14, was also canceled. Three shows in Tacoma, scheduled from October 31 to November 2, 1988, had to be canceled on his physician's advice because Jackson had the flu. Two shows in Los Angeles were canceled due to swollen vocal cords; three shows in Los Angeles scheduled for November 20, 21 and 22 were also canceled; these five concerts were rescheduled for January 1989.
In August 1992, a concert in London, England had to be postponed due to a viral infection. Four days later, Jackson performed in Cardiff, Wales. In September 1992, a concert in Gelsenkirchen, Germany was canceled because Jackson was taken ill with the flu. In Lausanne, Switzerland, an ambulance took Jackson back to his hotel after the show held on September 8; another show in Basel, Switzerland, scheduled for September 11, was also canceled. In October 1992, two concerts in Turkey, Istanbul and Izmir, and another one in Athens, Greece had to be canceled due to loss of voice caused by a cold. His private doctor attended to Jackson in Istanbul. According to organizers, Jackson's "vocal cords were irritated." These concerts were supposed to be the last three shows of the tour's European leg. Jackson was seen by a throat specialist in London and was advised to seek further treatment in Los Angeles.
In August 1993, two shows of Jackson's Dangerous Tour in Thailand had to be canceled due to dehydration. On August 27, 1993, Jackson "returned to the concert stage". On August 30, 1993, a show in Singapore had to be canceled due to nausea and a severe headache. In the opinion of his physician, Dr. David Forecast, Jackson "was in no condition to perform." A neurology specialist attended to Jackson. The specialist confirmed Forecast's diagnosis of "late-onset migraine," and medication was prescribed for Jackson who also underwent tests in a hospital in Singapore. The show was held two days later. Jackson consumed a lot of water, preventing dehydration and voice problems.
The first concert in Santiago de Chile, scheduled for October 21, 1993, was canceled due to lumbar problems; two days later, Jackson performed at Estadio Nacional. Another concert in Lima, Peru, scheduled for October 26, 1993, was canceled due to a torn muscle suffered during a show in Brazil. Several concerts in Mexico City were canceled due to tooth problems. Two abscessed molars were pulled. However, there were five shows in Mexico City. The last concert of the Dangerous Tour was held in Mexico City on November 11, 1993.
In November 1993, Jackson announced the cancellation of the remaining Dangerous Tour due to an addiction to painkillers which had been prescribed after a recent constructive scalp surgery. It was also reported Jackson canceled shows in Russia and Israel; however, these two concerts did take place. The rescheduling of the concert in Israel was not due to health problems.
In late 1995, Jackson was rushed to a hospital after collapsing during rehearsals for a televised performance. Medics cited irregular beats, gastro-intestinal inflammation, dehydration, and kidney and liver irregularities.
According to Dr. Neil Ratner, Jackson suffered a back injury in July 1997 after one of the stages collapsed during a concert in Munich, Germany. However, the History Tour continued; there was only one concert canceled after the fatal accident of Princess Diana about two months later. In fact, such an incident happened during a charity concert in Munich in 1999. Jackson was later taken to a hospital. Jackson's promoter Marcel Avram said he [Jackson] received abrasions and bruises. Jackson left the hospital the next morning.
On February 15, 2005, Jackson was admitted to the Marian Medical Center in Santa Maria with "flu-like symptoms." According to Dr. Chuck Merrill, Jackson was in stable condition and would recover within a few days. Jackson left the hospital on February 16, 2005; Dr. Todd Bailey said Jackson "continued to need care for some persistent viral symptoms, but otherwise he was in good spirits." One week later, the jury selection for the child molestation trial resumed in Jackson's presence.
On March 10, 2005, Jackson appeared late in court after having received treatment in a hospital due to a back problem. During the trial, Jackson occasionally needed help to get to his seat. On June 5, 2005, Jackson was taken to the emergency room at the Santa Ynez Valley Cottage Hospital to seek treatment of a back pain. Jackson's spokeswoman, Raymone Bain, said "stress contributed to the back problem." During the trial, Jackson had briefly been in hospital several times. The BBC reported that during his 2005 trial, the singer again suffered from stress-related illnesses and severe weight loss.
Dr. Christopher Rogers testified in the trial against Dr. Conrad Murray that, in his opinion, Jackson "was healthier than the average person of his age."  Rogers said the arteries around Jackson's heart were free of fat and cholesterol, which is unusual for a 50-year-old individual.
Childhood and mental health
Another publicly discussed aspect of Jackson's private life is his childhood, particularly his relationship with his father, Joseph. Although Jackson credited his father's strict discipline with playing a large role in his success, he and some of his siblings said they were physically and mentally abused by Joseph from a young age through incessant rehearsals, whippings, and the use of derogatory names such as "big nose" for Michael; this abuse affected Michael throughout his life. In one altercation—later recalled by Marlon Jackson—Joseph held Michael upside down by one leg and "pummeled him over and over again with his hand, hitting him on his back and buttocks." Joseph would often trip the boys or push them into walls. One night while Jackson was asleep, Joseph climbed into his room through the bedroom window. Wearing a fright mask, he entered the room screaming and shouting. Joseph said he wanted to teach his children not to leave the window open when they went to sleep. For a number of years afterward, Jackson suffered nightmares about being kidnapped from his bedroom.
By the early 1980s, Jackson was deeply unhappy; he said, "Even at home, I'm lonely. I sit in my room sometimes and cry. It's so hard to make friends... I sometimes walk around the neighborhood at night, just hoping to find someone to talk to. But I just end up coming home."
Although it had been reported for a number of years that Jackson had an abusive childhood, he first spoke openly about it in his 1993 interview with Oprah Winfrey. He grimaced when speaking of the childhood abuse at the hands of his father; he believed he had missed out on much of his childhood years, acknowledging that he often cried from loneliness. In the same interview, speaking of his father, Jackson said, "There were times when he'd come to see me, I'd get sick... I'd start to regurgitate. I'm sorry... Please don't be mad at me... But I do love him." In an interview with Martin Bashir for the 2003 documentary Living with Michael Jackson, Jackson covered his face with his hand and began crying when talking about his childhood abuse, recalling that Joe often sat in a chair with a belt in his hand as he and his siblings rehearsed, and that "if you didn't do it the right way, he would tear you up, really get you." Also that year, Joe acknowledged that he regularly whipped Jackson as a boy, but he and Jackson's mother, Katherine, have disputed the longstanding allegations of abuse, with Katherine stating that while whipping is considered abuse today, it was a common way to discipline children at the time.
In 2003, Jackson was accused of child sexual abuse and was acquitted two years later. During the investigation, Jackson's profile was examined by Stan Katz, a mental health professional, who also spent several hours with the accuser. According to Taraborrelli, the assessment made by Katz was that Jackson had become a regressed ten-year-old. Some medical professionals believe Jackson also had body dysmorphic disorder, a psychological condition whereby the sufferer has no concept of how his or her physical appearance is perceived by others.
Taraborrelli states the entertainer took Valium, Xanax and Ativan in 1993. While Jackson himself does not mention sedatives, he said that painkillers were prescribed to soothe excruciating pain that he was suffering after recent reconstructive surgery on his scalp resulting from his accident in 1984. In a court deposition unrelated to alleged child abuse, Jackson was visibly drowsy, lacked concentration, and repeatedly slurred while speaking. He could not remember the dates of his prior album releases or names of people he had worked with. It took him several minutes to name some of his recent albums.
Jackson said during the 1993 interview that he began taking painkiller medications regularly in 1984. On January 24 of that year, Jackson was filming a Pepsi commercial when his hair caught on fire from faulty pyrotechnics on stage that were intended to be part of one of many being filmed. He sustained second-degree burns to his scalp and never fully recovered from the injury or from the lingering pain. He reportedly began taking the painkillers after refusing at first in order to deal with the intense pain.
On November 9, and November 10, 1993, Jackson was questioned about a copyright matter. According to the sworn declaration from the plaintiffs' lawyer, he had been told that Jackson "was taking painkillers because of recent oral surgery."
In November 1993, Jackson announced that he was addicted to painkillers; he said he had recently undergone a scalp surgery, and the painkillers had been prescribed. Jackson said due to the pressure caused by the child molestation allegations and the energy he needed for the Dangerous Tour, he was "physically and emotionally exhausted." He said he had "become increasingly more dependent on painkillers," and would seek treatment. His lawyers said Jackson would be treated for addiction overseas for one and a half months to two months. In December 1993, Jackson returned to the United States.
Jackson was taken to Charter Nightingale Clinic where he was searched for drugs on entry; vials of medicine were found in a suitcase. He was put on Valium IV to wean him from painkillers. The singer's spokesperson then told reporters that Jackson was "barely able to function adequately on an intellectual level." While in the clinic, Jackson took part in group and one-on-one therapy sessions. According to Taraborrelli, in January 2004, as his trial approached, Jackson became dependent on morphine and Demerol and was being treated for this dependency by herbalist Alfredo Bowman in Colorado.
In an interview with Aphrodite Jones, Patrick Treacy, a cosmetic surgeon who treated Jackson between July 2006 and early 2007, as well as shortly before his death, said that he would have known if Jackson would have been also treated by another physician and that he never saw any drugs in the house. He also said that Jackson did not have insomnia and never asked him for narcotics. Treacy said Jackson was in good physical health; he said Jackson always insisted on the presence of an anesthetist when Propofol was administered.
Jackson was 5 ft. 9 in. and weighed 136 lbs, which would be within a normal weight range, although he was thin, Dr. Rogers testified in court. According to his costumer Michael Bush, Jackson lost so much weight during a concert due to loss of water that the costumes Jackson wore at the end of the show had to be smaller than those he wore at the beginning of the show; usually, he was a 28-inch waist. According to Dr. Nader Kamangar, a sleeping expert at UCLA, drugs such as Demerol can cause insomnia. In the case of Jackson, insomnia could have been caused by "anxiety for performing" as well.
Following Jackson's death, a police warrant issued against his attending physician, Conrad Murray, said that Jackson's many doctors had used nineteen distinct aliases, such as "Omar Arnold," "Josephine Baker," "Fernand Diaz," "Paul Farance," "Peter Madonie," "Faheem Muhammad," "Roselyn Muhammad," "Blanca Nicholas," "Jimmy Nicholas," "Bryan Singleton," "Frank Tyson," and "Rob Kaufman" while prescribing medications for Jackson. He also took prescriptions as "Prince," "Michael Amir," and "Kai Chase," the names of one of his sons, his spokesperson, and his former personal chef, respectively. Police found a CD mentioning the "Omar Arnold" alias when they raided the Las Vegas, Nevada home and office of Conrad Murray, Jackson's personal physician. Use of pseudonyms by celebrities' doctors is common practice for maintaining the confidentiality of patients' medical history  and does not necessarily indicate addiction.
Following Jackson's death on June 25, 2009, reports of his use of pethidine (Demerol) surfaced. Cherilyn Lee, a nurse who provided nutritional counseling to Jackson, said that on April 12, 2009, he had asked her for unspecified "products for sleep". On April 19, 2009, he told her the only medicine that would help was propofol. Lee refused, telling him, "Michael, the only problem with you taking this medication ... is you're going to take it and you're not going to wake up." Jackson dismissed the warning, telling her he had been given the drug before by IV injection and that his doctor told him it was safe. He did not name the doctor. An overdose of propofol can cause the patient to stop breathing, leading to a shortage of oxygen and a buildup of carbon dioxide in the body which can lead to arrhythmias and cardiac arrest. It was the last time they met.
Due to an inquiry about a cancellation insurance for the upcoming tour, insurance carriers demanded a medical exam by a doctor they trusted. In February 2009, Jackson had an examination performed by Dr. David Slavit of New York. Later, the broker told an AEG senior vice president Jackson had only slight hay fever and had passed the exam "with flying colors". A second medical exam was supposed to take place on July 6, 2009.
According to Lee, she received a frantic call on June 21, 2009, from an aide on Jackson's staff. The aide reported that Jackson was feeling ill. Lee reported overhearing Jackson complain that one side of his body was hot, the other side cold. She believed that somebody had given him something that affected his central nervous system. She advised the aide to take him to the hospital.
After his death, the autopsy report revealed that Jackson had a strong heart and was a "fairly healthy" 50-year-old. According to BBC, his weight was in the acceptable range for a man of his height, but he had punctured arms[H 1] and suffered from lung damage and some arthritis. The document shows that Jackson's most serious health problem was his chronically inflamed lungs, but this was not serious enough to be a contributing factor to his death. The post mortem did not uncover any physical problems that may have limited Jackson's ability to perform. "His overall health was fine," said Dr. Zeev Kain of the University of California, who reviewed the report for AP but was not involved in the post-mortem examination, "The results are in normal limits." The autopsy also revealed that he was partially bald and that his lips, eyebrows, and scalp were tattooed.
In 2011, Rogers said in his testimony: "The theory that seems less reasonable to me is that Mr. Jackson woke up, and although he was under the influence of sedative medications, managed to give himself another dose." Toxicologist Dan Anderson testified that Demerol was detected in Jackson's system.
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