Looking back at superstar Michael Jackson's mental state

As millions of mourners lament the death of superstar MichaelJackson, the question has been pondered about the beleaguered yet also beloved pop icon.“What was his state of mind?” is the issue being asked on many media and in many minds.

No doubt he couldn’t sleep, as evidenced by revelations about the serious psychiatric prescription medications he had or sought. A sure sign of depression. Sure, he was on the road to a comeback, but that amounts to serious pressure for someone already under strain.

While one cannot say Jackson was suicidal now, he certainly has been in such a fragile mental state before. In that regard, I went into my files to see what I wrote years ago about MichaelJackson’s mental state history.

On March 21, 2005 I submitted this article about the emotional dangers facing MichaelJacksonin the midst of his trial about sexual abuse charges. While he emerged from one case paying monetary damages, and the other acquitted, and over four years have elapsed, the scars of such an ordeal can last. And while he unmasked his children to reveal their faces to the world – perhaps symbolic of his own facing reality -- fantasy and hiding from oneself and others can still remain.

ARTICLE:

Stress and shame surround everyone involved in the MichaelJacksonlawsuit, puttingJackson, his accuser, and even members of the public, at psychiatric risk.

That’s my opinion, backed up by experts in depression and suicide.

At the center of the controversy and concern isJacksonhimself. “The tremendous amount of stressJacksonis under is certainly one of many signs of mental health problems, including the potential risk for suicidal behavior,” says James Mazza, President-elect of the American Association of Suicidology. For this reason, says Mazza,Jacksonshould be psychologically evaluated and monitored, as a preventive measure, to protect him from any self-inflicted or self-sabotaging behaviors, as well as to address any current mental health problems.

A factor inJackson’s favor is that he hasn’t already cracked under the years-long pressure of sexual abuse allegations and dueling television documentaries.In December, 2002, a number of professionals including myself were interviewed about whetherJacksonwas crumbling and on his way to a mental hospital. All agreed the once heralded King of Pop subsequently dubbed Wacko Jacko by the press could slip into a suicidal mode, especially if he thought that the world was against him.

ButJacksondid not attempt suicide at that time, even though his behavior was more bizarre then, compared to now. During his 2002 civil trial over breach of contract, the black-and-white costumed defendant was munching on candy, giggling and humming into the microphone when on the witness stand, and making weird faces and gestures like pointing his fingers on either side of his head as if they were horns.This time, he appears more cool and collected in court.

Also at that time, his baby-dangling off his Berlin hotel balcony showed signs ofJacksonbeing capable of irrational acts.Flaunting the helplessness of his namesake, infant Prince Michael II, was symbolic of the elder Prince Michael’s own precarious position.

But, under constant pressure, a person can become somewhat immunized to pain.Having been through the mill already, and cut off from reality as he already is,Jacksoncan become depersonalized, to protect himself against current pain – as if events are not really happening; as if he, like his children, is covered with a burkha separating himself from society.

Ex-brother-in-law Jack Gordon (once married toJacksonsister LaToya) told a reporter in December 2002, “It’s only a matter of time before he (Jackson) commits suicide…And in his state of mind, he may end up harming his three children as well. He’ll want them to go with him, too.”The children – son Prince Michael Jr., 8 and daughter Paris Michael Katherine, 6, from his marriage to nurse Debbie Rowe, and his adopted son, toddler Prince Michael II – have been kept out of the limelight and public scrutiny, so their condition can only be speculated as stressful. That stress would undoubtedly be increased by Rowe’s custody battle to get her kids back.

Several signs bode poorly forJackson’s mental health now, including rumors of financial ruin and a flailing career. Hard as it would be for anyone to face such public disapproval, the fall from grace and adoration is even harder for a superstar likeJackson.Where once there was a sea of fans screaming their support, now on a given day only two hundred have shown up outside the courtroom – surely a depressing sight in contrast to the adoring and screaming crowds once assembled for him.

Then there was the day a month ago whenJacksonshowed up late for court – just in the nick of time to forestall the judge from taking action against him.Jacksonhad been hospitalized for two days, and while speculation flew about a nervous breakdown, reports blamed a viral infection or back problem.The former reveals a breakdown of the immune system, and the latter tempts my psychoanalytic bent and some back pain specialists to suspect deeper emotional troubles symbolic when something is “breaking your back.”

Showing up in slippers and pajama bottoms could have been a sign of rushing to make the court deadline, or a ploy for sympathy and credibility about his medical drama, but in any case, it is consistent with bizarre behavior.

Another factor not inJackson’s mental health favor is speculation about what could happen to his parenthood post-trial.True, in 2002, he weathered calls for investigation by feminist attorney Gloria Allred, and a complaint filed to Child Protective Services by California psychiatrist Carole Lieberman. But if deemed an unfit parent this time, and separated from his cherished children, the fragile father could crack.

IfJacksonwere her client now, Allred has said, letting him take the stand in this case would constitute “legal suicide.”

While not diagnosing Jackson, psychologist Alec Miller, Director of the Adolescent Depression and Suicide Program at the Department of Psychiatry and Behavioral Sciences at Montefiore Medical Center in the Bronx, lists suicide risks as:

• A history of childhood physical/sexual abuse.A VH1 documentary saidJackson’s father whipped his kids with an electrical rod and forced 11-year old Michael to sing in strip bars, while his mother preached about the sins of sexuality.
• Being a single adult male.
• Exposure to extreme shame and humiliation. Jackson is very likely experiencing these feelings as a result of the highly public trial and irreparable damage to his international reputation, fame and fortune.
• Life situation crises.Financial ruin, and extreme losses of health, important people in one’s life, and status, can make a person feel “there is no way out.”(Note, there were many cases of men jumping out of windows when suffering financial ruin during the 1920’s Depression).
• Legal problems. Accusations of child molestation have been dogging Jackson for years.
• Social isolation.While Jackson appears to have numerous people "around" him at all times, it is unclear whether he has true social-emotional supports which can be protective factors against suicide if he has them, and risk factors if he does not.
• Family problems, including poor parent-child communication. There are many reports of Jackson’s troubled childhood and disturbed relations with his siblings.
• Adult relationship problems. Jackson’s bizarre 19-month marriage to Lisa Marie Presley (the “King’s” daughter) and baby-making with nurse Debbie Rowe whom he subsequently paid off to not see their progeny, are the least of his disturbed “adult” relationships.
• Parental psychopathology, particularly if parents were ever suicidal, depressed, or had substance use problems.
• Extreme low self esteem. While Miller has never met Michael Jackson, he speculates that Jackson also suffers from body dysmorphic disorder, based on all of his surgeries.
• Accessibility to the means of suicide. If someone has access to drugs or a gun in the home, he becomes at much higher risk for suicide.

Comorbidity is also a risk factor. Each disorder is a potential risk factor in and of itself, but each time you "add" a psychiatric disorder, the suicide risk increases significantly, says Miller, President-elect of the Clinical Emergencies and Crises Section of the Clinical Psychology Division of the American Psychological Association. Over 90 percent of people who attempt and commit suicide have a psychiatric disorder coupled with a precipitating event such as a major trauma or loss. “A psychological evaluation would have to rule out mood disorders, personality disorders, and substance use disorders that would spell risk,” Miller says.

In the past three years, Jackson’s family supposedly tried to get him admitted to a rehab clinic, to no avail. Reportedly, he currently has trouble sleeping and a diminished appetite – both symptoms of stress, anxiety or depression.

Teens seen at the adolescent depression and suicide program at the Montefiore Medical Center usually suffer from psychiatric disorders like anxiety, substance use disorders, andborderline personality disorder, and face a myriad of academic, social, and familial challenges, says Miller. They are treated with psychotherapy to change their behavior and thinking, and in some cases, also with medication.

Could the risks be reversed if Jacksonis acquitted? Experts agree that the outcome can be bleak for all concerned, whatever the verdict.

“The worst situation for the teen accuser is if Jackson is acquitted and the abuse actually happened,” says Mazza, school psychologist and associate professor at the University of Washington.Such a young man may feel devastated that he was discredited and his abuse not believed.

“But if Jackson is convicted,” adds Mazza, “the young man may feel guilty, and marked, for the rest of his life for sending the famous King of Pop to jail.”

I am reminded of the case of a youth I know who committed suicide after testifying about being sexually abused by a man he was close to (similar to this teen’s attachment to Jackson).The abuser was found guilty but the whole affair was too emotionally confusing and wrenching for the teen to live with.

When it comes to suicide risk, an important clinical approach is not to be afraid to ask a person if he has a plan about how to die. Asking doesn’t make the person do it, but can prevent the tragedy by getting help.

The method in a suicide plan is revealing, and often consistent with the individual’s personality and state of mind. Gordon guessed Jackson’s method of choice would not be pills, but gassing himself in a parked car, or shooting himself with a gun. Of those Americans who die by suicide, sixty percent use firearms.While shooting himself might be too violent an end for a person consumed with appearance, it would be a dramatic end consistent with a dramatic personality caught in a fit of depression and impulsivity (as happened in the case of comic Freddie Prinz).

Jackson would certainly not fare well in jail, even in a “Camp Cupcake” prison like the one in which Martha Stewart lived out her sentence.Child sex abusers are the low-man on the totem pole in jails, and reportedly subjected to abuse by hard-core prisoners.It is likely the fragileJacksonwould be taunted, abused, and maybe even have his life threatened.

“With professional psychological help, such a disastrous outcome can possibly be prevented,” says Miller.That help would not be easy, however, sinceJacksonalready shows a distorted sense of reality and helping him see situations in a realistic way, and make decisions consistent with societal norms, would take long-term persistence.

One of my concerns is for youngsters who are following the trial and exposed to the media coverage. Certainly they can learn from their hero’s experience to avoid disastrous situations like these, but there is another danger.

“If Jacksonis acquitted, kids watching the case unfold who have been molested themselves, or who have witnessed another's molestation, are at risk,” says Miller. “These kids could bury the truth, and their feelings, if they become afraid that adults and the legal system will not believe them or protect them.”

For more information about depression and suicide, including the warning signs for suicide risk, contact:

• The American Association of Suicidology, 5221 Wisconsin Avenue N.W., Washington D.C. 20015, (202)237-2280, email:info@suicidology.org,www.suicidology.org.
• Crisis hotline, for immediate help, National Suicide Prevention Lifeline (800)273-TALK (8255).

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