October 19th, 2011 12:16 EST
Uncovering the Truth in Michael Jackson's Death
Dr. Judy Kuriansky is a noted clinical psychologist, radio and TV reporter and personality, Main NGO representative at the United Nations, adjunct faculty at Columbia University Teachers College, expert commentator on news and trends from a psychological point of view.
As people around the world follow the case against Michael Jackson`s personal physician, many are stunned and riveted. As the trial of Dr. Conrad Murray, charged with involuntary manslaughter in the King of Pop`s tragic death by administering a fatal drug dose, unfolds, many aspects of the case reveal victims on all sides - the King of Pop, his children, Dr Murray himself and the public - and provide lessons and cautionary tales.
I. Michael Jackson as victim
* Victimized as an "oddity". Superstar Michael Jackson has long been perceived as strange (sleeping in hyperbaric chambers, building "Never Neverland," keeping a baboon for a best friend); a misunderstood man-child; or the object of con artists and gold-digger opportunists, leaving the"Gloved One" perpetually distanced from the ability to live a "normal" life.
* Victimized by ongoing addiction. Despite protests to the contrary, evidence prevails that the King of Pop was addicted to drugs. Jackson had a veritable panoply of medications prescribed by many doctors who were only too- happy to indulge a celebrity patient, much like the tragedy of Anna Nicole Smith. Michael`s family reportedly attempted "interventions" but were unsuccessful in getting his participation. The lesson: families must persist in efforts to get the addict help, prevent the addict from obtaining meds from any source, make compliant doctors accountable, and take extreme measures, including involuntary commitment to hospital, as happened in cases of Hollywood celebs like (B)ritney Spear(s) - all of this short of tough love (abandonment) when efforts are thwarted and frustrating.
* Victimized by others` enabling or denying psychiatric distress. Members of the inner circle of celebs like Jackson are clouded by co-dependence, fears of disapproval, and being booted out of the gravy train. Some around Jackson (erroneously in my view) touted Michaels` stable state when he was about to launch his tour. Granted, when I saw the film of the rehearsals, his performance and demeanor looked energetic and in control. But reports have surfaced that he missed rehearsals and lost his temper. Research shows that patients can have times of "peak alertness" that mask the severity of their disorder. Thus, Jackson can be seen as what I call a "functional depressive" or a "functional insomniac" - similar to a "functional alcoholic" where addicts appear to be functioning when necessary but in fact, fall apart when not having to perform publicly.
* The victim of post-traumatic stress disorder. Years of stressful events and traumas take their toll, stemming from two child abuse charges and criminal and civil trials which damaged his reputation; betrayals; financial ruin; numerous physical problems; bizarre behavior; public outrage questioning his fathering and poor judgment over his "baby dangling" of Blanket over a German hotel balcony; a scathing television documentary; the frightful scalp burning accident during the Pepsi commercial taping and subsequent scalp reconstruction that led to his admitted drug addiction to pain-killers; and the persistent questioning over his paternity of his three children (none of whom fully resemble him).
Research has shown tat such traumas are not easily resolved and last a long time. In a publicly released statement during one of his trials, Jackson admitted that the situation was "increasingly stressful [causing] pressures psychologically and physically...and dependence on painkillers." Notoriety of his oncoming concert tour would only revive these past traumas, and resulting anxieties, shame and stress. Jackson, who had been visibly "weak" from the second trial of child molestation in 2003, would no doubt buckle under the strain of tour dates. The trauma of such a past as his can easily erode anyone`s psychological stability, confidence and self-esteem, and arouse intense fears and anxieties when subjected to public scrutiny.
Intense psychological treatment and "talk therapy" would have been called for, not just medications (which turned out to be a dangerous cocktail).
* Jackson as a "suicide risk." In my opinion, Jackson was a suicide risk at the time of his death. Years ago, during Jackson`s trials for s(e)x abuse, I wrote about his potential suicide risk. Now, I disagree with the godfather of Jackson`s children, Mark Lester, who has said on TV that he spoke to Michael four days before his death and that he "did not strike me as so desperate [and was] not nervous at all...really confident... so `up`...[and the] best I`ve seen him in a long time." Michael apparently told Lester that he could "perform with the greatest show ever seen." While Michael`s comeback tour could have boosted his narcissistic needs to restore his image as the greatest pop star of all time, the concert series, the outcome could have lead to Jackson being either a "hero" or a "zero" (the emotionally swing narcissists face). Inevitably, rumors would resurface of his checkered past. Proof of this suffering is evident in the escalation of his insomnia - the trigger which led to his death.
Other Hollywood stars have admitted such stress - and even cracked - under pressures when facing their anticipated-spectacular world tours. But the performance anxiety would be particularly intense for Jackson given his fragile state and traumatic past experiences. Such intense "performance" anxiety" can cause terror - which can lead to unconscious desire to sabotage its occurrence.
Michael may have been able to muster up enough positive mood and energy to rehearse, yet sink into a state of depression and anxiety off-stage and at night-time, when alone with his internal demons - and suffering from drug abuse and possible hormonal imbalances.
He may even have had a cyclothymic disorder - a roller coaster of "up" and "down" moods.
Other experts supported my hypothesis of Michael as a suicide risk back in March, 2005 at the time of one of his trials. Wanting to be loved, the once-heralded King of Pop suffered a deep ego blow when dubbed "Wacko Jacko" by the media. Signs of suicide-risk include a history of childhood/s(e)xual abuse; exposure to extreme stress; chronic co-morbidity in the form of disorders like substance abuse and sleep disorder, and access to drugs or other means of suicide which can appear "accidental." While things appear to be on the upswing with Jackson`s comeback tour, even positive events, according to a Life events Scale, can add high levels of stress that can spell danger, especially if success is uncertain. Certainly reprising his characteristic s(e)xually suggestive pelvic moves in any performance will arouse negative associations.
Jackson`s suicide wish can be seen as unconscious. This hypothesis is fueled by a number of factors: ongoing PTSD, underlying isolation and feeling "different` from society, "body dysmorphia" evidenced by his extensive surgery to refashion his face (revealing self-hate and self-dissatisfaction and not an innocent desire to look like his hero Diana Ross, and which some plastic surgeons advised against further operations). Even Michael predicted his untimely death at some point, according to an associate.
II. Jackson`s children as victims
Prince, Paris and their younger brother Blanket were long shielded from the public eye (literally and figuratively) by having masks and burkas covering their heads whenever they went out. Now unmasked (literally and figuratively), they face harsh realities their father tried to hide from them. Adjustment can be difficult and take a long time, especially since the experience of being hidden persisted throughout their childhood, thereby become imprinted on their minds.
While it was traumatic for the children to be present at their father`s memorial, at least there was widespread sympathy and public support at that time. Now, in the trial over their father`s death, more "dirt" is being discussed, that can trigger early traumatic memories. Strict attention must be paid to the impact on children of any father`s death; but when this father is a world icon and shrouded in scandal, the children suffer from repeatedly public reminders, and public grief on top of their personal grief. The Dr. Conrad Murray trial has heightened not just the public mourning that happened during Jackson`s death, but controversy surrounding his life. Not the least of this is Jackson`s drug abuse, and worse yet, suggestions that he administered the fatal dose of propofol himself - a suggestion of desperation, poor judgment and even an unspoken "unconscious death wish" I mentioned above. The Jackson children are old enough to understand all these dynamics, and especially vulnerable as they are at a developmental stage of forming their own social identity.
In my opinion, the children need therapy during and after this trial. Apparently in his testimony to the LAPD, Dr Murray mentioned the children`s social worker. I suggest their psychological treatment be more intensive at this time, and include psychiatric and psychological attention.
I am more in agreement with the children`s godfather, Mark Lester, who predicted that the impact of the Dr. Conrad Murray trial will be "horrendous for them...especially only two years since their father`s death... seeing their father dead on a slab." Paris may be especially traumatized, seeing the video replayed on TV of her comments at her father`s memorial where she professed how good her "daddy" was, her love, and missing him.
The Jackson children will always live under the cloud of their father`s death, and now the trial. Peers will likely always look at them with curiosity, suspicion and myths about their life and their father (including the specter of child abuse accusations).
Lesson: Families in the public can use this issue as an opportunity to talk to their children about many important issues raised by Michael Jackson`s life and this trial. If the topic arises, they can even address the issue of child s(e)x abuse - and warn their children not to go with strangers or to be seduced by strangers - or celebrities - into s(e)xual behavior.
Regarding the debate about whether the Jackson children should see their dead father`s body, I agree with the Jackson children`s social worker that this gives psychological "closure" about his death and a chance to say "goodbye." Most importantly, seeing the dead body psychologically prevents delusions and fantasies that the person is still alive (witness the constant rumors that Elvis is still alive). Visual confirmation puts to rest the hopes expressed to Dr. Murray (which he explained in his statement to the LAPD) when he was asked, "Will you save my daddy?" Having their grandmother present, and her tears, also consolidates the reality of the experience that their father is indeed gone.
III Other family members as victims.
When a family member dies, survivors are left to deal with the loss psychologically. To cope, they can deny; confabulate; or rationalize, posing explanations to cover shame or protect the deceased`s reputation. As a result, some family opinions must be taken with a grain of salt. Naturally, Jackson`s family members would try to defend Michael. For example, Jermaine has reportedly claimed that his brother (Michael) was "not an addict...he was an insomniac, desperate for sleep." This contradicts reports that the family tried to do an intervention, and the report of a friend on HLN-TV that Michael contacted her when he was in London to request that she ask relatives in the medical profession to get him Diprivan (propofol) and painkillers (which she refused to do).
Family protection was evident in Jermaine Jackson`s presentation at an appearance and book signing for a small group at a private club I attended for his book "You are not Alone. Michael: Through a Brother`s Eyes." In response to my question, "How will the children fare in such a trial?" Jermaine glanced away and said, "They`ll be okay." Yet, some pundits agree with my view that the kids will likely be under great distress. When I asked, "Who will support them?" Jermaine answered, "My mother. She has always helped them." This seems unlikely in my view given Katherine`s own past distress levels. Likely Michael`s sisters will have to play a major role as they did during the memorial.
At this event, Jermaine was also asked, "Did Michael really have a relationship with women?" Jermaine responded, "Oh yes, he loved girls..." and named Lisa Marie (Presley), Debbie Rowe and Brooke Shields. Then he recounted a story - presumably to back up his point: He (Jermaine) was in bed with some woman after a gig (as the older boys often did), and Michael reached up from the floor where he was, onto the bed and over the girl." Jermaine smiled, telling this story as if it were proof of Michael`s interest in girls. I had heard this story recounted before, and wondered how it proved Michael`s heteros(e)xuality.
It is inevitable that a family in the case of the death of a loved one, shrouded with controversy and murder charges, could feel guilty, of what they "could have, should have, would have" done. Jackson` family might especially feel guilty about not finding a way to force him into a "family intervention" even thought they tried and Michael refused.
IV. The physician as Victim.
The trial of Jackson`s personal physician has publicly revealed a doctor`s failing - in fact, through six deviations of standard care outlined by a doctor at the Murray trial. These include: improper use of a medication (e.g. administering the sedative propofol when not medically indicated for insomnia) and in someone`s home without proper equipment (e.g. an EKG monitor); administering propofol without proper backup personnel in attendance; administering propofol with inadequate preparation in case of emergency; improper care during Jackson`s respiratory arrest; failure to call 911 in a timely manner; failure to maintain proper medical records that could have been handed over to emergency-room personnel.
Also exposed is the dangerous practice of doctors succumbing to becoming seduced and co-dependent on famous, high-paying patients - as happened in the Anna Nicole Smith death - leading to unprofessional and unethical "dual relationships" (being friend and attending physician) and indulgent prescription-writing.
Dr. Conrad Murray gave up his practice in his offices in other cities, to be the personal attendant to one patient - famous Michael Jackson, to the tune of compensation worth $150,000 a month (likely considerably more than he would make from all his other practices). The temptation of this compensation is a sad reflection on the state of medical practice in America today, where doctors` income have been drastically cut in years (due to insurance practices), to the point where in order to make a living, they have to see many patients for a very short amount of time. Patients suffer from getting little attention, and possibly inferior care.
Doctors like Murray in this situation are prey to what`s called "counter-transference" (a dynamic I described in my website posting on any female psychiatrist treating Casey Anthony, www.DrJudy.com). This means health professionals who should maintain objectivity and distance with patients instead project past experiences onto the patient relationship.
What is the future for Dr Murray? Whatever the verdict, he will suffer from public outrage and shame, his life and medical career ruined. If he is acquitted, thousands of Jackson fans will cry for retribution, targeting him anyway as the cause of their hero`s death. As in the Casey Anthony case, he can become `the most hated man in America," and may have to leave the country to avoid harassment. His inside story may be worth millions from a press outlet.
While the justice system is supposed to be unbiased, and convictions based on judgments "beyond a reasonable doubt," personal feelings and psychological dynamics can influence juries. Murray could be found guilty to serve as an "example." While celebrities on trial in Los Angeles have been thought to get prejudicial acquittals, by the opposite token, the source of a celebrity demise can get reverse prejudice and blame. Some, like a former Jackson defense counsel, have called for prosecution of Murray to help vindicate the family and send a message that physicians should not behave as Murray did.
Other doctors are now on alert about the six deviations from standard care. While patients` rights have been more insured of late, the Conrad Murray trial has given patients` more ammunition to insist on proper care.
Doctors must be vigilant about patient care and identify appropriate treatment for a problem. Michael`s problems are more serious psychologically than can be adequately handled by just having a personal physician who administers medication, or even seeing a therapist for a few times a week. Psychiatrists these days usually see patients for short periods of time, mainly to check on their meds, and do not typically have the 45- minute "talk" sessions that psychologists and other mental health counselors typically do. In my opinion, Jackson should have been in extensive residential treatment, in a protected environment with a myriad of treatment sessions.
V. Millions of American insomniacs are victims.
The lesson from Jackson`s demise is that insomnia can lead to desperation, a death wish, and real death. Jackson`s sleep troubles are a warning knell for a third of Americans who complain of sleeplessness, which wreaks havoc on their lives. Americans spend nearly $24 billion a year on sleep-related goods and services. By 2012, the market for insomnia drugs is expected to grow 78 percent, to nearly $3.9 billion. Chronic sleep deprivation- even over the course of one week can lead to a myriad of cognitive and behavioral problems, including difficulties with memory, concentration, coordination, proper judgment, decision-making, and confusion. The effects are like intoxication, and worse, lead to death.
Sleep disorders must be assessed to determine their type, cause and appropriate treatment. Insomnia is only a symptom of an underlying disorder, like depression, anxiety or even brain abnormalities. Medications used to induce sleep, after long term use, can lead to reverse effects, causing more sleeplessness, and be dangerous when used in combination with other drugs.
VI. Adolescents as victims of arrested development. Many people who have met Michael Jackson over the years have strong impressions. In my own experience years ago, backstage at one of his concerts, I found him, in my psychological judgment, to be a delicate, fragile, vulnerable and adolescent-like, not just from his physical slender state, but emotionally. (At the time, when I was holding a t-shirt of his (which I still have), he tore off the sleeves to make it sleeveless).
At Murray`s trial, a tape was played of Michael`s slurred voice saying, about children, "I love them because I never had a childhood... I feel their pain." This is consistent with my hypothesis that Michael lived vicariously through children, and that activity with them - s(e)xual or otherwise-was of a childlike nature (e.g. where touching is a part of young children`s playing doctor and exploring their bodies). In my view, Michael was in a state of "delayed adolescence" and "arrested development," feeling no older than the children he adored, despite his chronological age.
VII. Victimization by other physical illnesses.
Other conditions that cause symptoms and impact psychological and physical behavior have gotten little attention. For example, the doctor who performed Jackson`s autopsy testified at the Conrad Murray trial that among conditions like vitilago, previous injury and irregular pigmentation in his scalp (from the Pepsi` commercial accident), an extra rib and some arthritis, Jackson also had an enlarged prostate. An enlarged prostate, short of an indication of cancer, is usually Benign Prostatic Hyperplasia or benign prostatic hypertrophy, a Common Part of Aging (like grey hair) after men pass middle age. About half of men in later age have symptoms. The gland presses against the urethra "like a clamp on a garden hose" leading to narrowing of the urethra and irritation causing frequent urination, or the inability to fully empty the bladder. The result is discomfort, and even s(e)xual problems. A cause can be hormonal imbalances, specifically a decrease in testosterone and increase in the female hormone estrogen (which can explain other aspects of Michael`s behavior). Treatment has attempted to shrink or stop the growth of the prostate, short of surgery, using FDA-approved drugs to relieve symptoms, like alpha blockers (to relax the smooth muscle of the prostate and bladder neck) Finasteride (Proscar)and dutasteride (Avodart); terazosin (Hytrin) and doxazosin (Cardura) - first developed for high blood pressure; tamsulosin (Flomax) and alfuzosin (Uroxatral) developed specially for BPH.
Viewers watching the Conrad Murray trial have much to learn. Lessons extend from addiction, to proper medical care, to attention to loved ones problems. Ultimately, Jackson`s life - and tragic death - is a lightning rod to teach all fans and detractors about how to avoid being trapped in such a tragedy.