Michael Jackson: Frail, scarred and haunted by a fear of death

MICHAEL Jackson's health problems – both physical and mental – have been a constant source of conjecture since the 1980s.

First and foremost was the change in his appearance from the naturally dark-skinned young man of the 1970s to the pale skin, reconstructed nose, cheekbones and chin of his final years.

Despite the obvious changes in his appearance – his skin began to lighten in the mid-Eighties, his nose and mouth became both markedly thinner and Caucasian and his jawline became increasingly square – the singer refused to acknowledge he had undergone plastic surgery.

Jackson's publicists claimed his skin colour was due to a condition called vitiligo, which causes patches of skin to go white, and lupus, which causes the body's own immune system to attack itself.

He was diagnosed with lupus in 1986, but was said to have recovered from the condition during the early 1990s.

However, it was rumoured that Jackson was so obsessed with changing his appearance that he underwent 11 separate procedures and at one point had an operating theatre set up in his home.

Dr Eileen Bradbury, a consultant psychologist and expert on psychological consequences of cosmetic procedures, said the singer's obsession with surgery was part of a vicious circle.

"In my experience, people who have multiple procedures are quite fragile in their self-esteem and have difficulty accepting themselves," she said. "People with a history of abuse are more likely to have multiple procedures. If you can't change what is inside, then you try to change what is outside.

"Then, of course, the problem is that it never achieves what you set out to achieve, so it becomes a quest that will ultimately fail.

"The trouble with cosmetic surgery, especially if you have all the resources to have whatever you want and nobody is going to say no to you, is that procedures can go wrong or they are too extreme, so you need the next one to sort out the one before, and it goes further and further and there's no going back."

She said that, in extreme cases such as Jackson's, it was possible for sufferers literally not to recognise themselves in the mirror.

The destructive effects of repeated plastic surgery on the singer's face became increasingly apparent towards the end of his life. During 2002 he appeared to develop a "third nostril", and further work was needed to correct this.

Jackson was widely reported to have become addicted to the painkillers he had been given for burns that he suffered in an accident while filming a Pepsi commercial in 1984. Sparks from a stage pyrotechnic device set fire to his hair.

It was only in 1993, during his first trial for child abuse, that this addiction was confirmed by the singer's doctor.

But even before this, Jackson's health had seemed to be declining. He was taken to hospital with chest pains in 1990 and then forced to postpone a concert because of dehydration. During a rehearsal at the Beacon Theatre in New York in December 1995, the entertainer collapsed onstage, again from apparent dehydration and low blood pressure, and was taken to hospital.

However, he continued to self-medicate right up to the end, and it was suggested yesterday that painkillers may have contributed to his death.

Jackson was also said to suffer from a phobia of becoming fat and would eat only once a day in order to maintain a weight of less than nine stone, rendering his appearance frail and gaunt and fuelling rumours about his failing health. Those were exacerbated towards the end of his life by pictures of him using walking sticks or in a wheelchair.

Jackson's body had also suffered from the wear and tear of years of energetic performing.

He had suffered a broken leg and a broken vertebra in a fall from the stage during a concert, resulting in a recurring back problem that came to the fore during his most recent trial on child molestation charges, in 2005. The trial was interrupted by hospital visits and absences for treatment of the problem – which he claimed was exacerbated by stress – and on one occasion he appeared in court dressed in his pyjamas.

After his acquittal, Jackson retreated to Bahrain and little was known about his health, but reports were not good.

Last year, celebrity biographer Ian Halperin claimed Jackson suffered from Alpha-1 antitrypsin deficiency, a rare genetic condition, and was in need of a lung transplant. He said he was suffering from gastrointestinal bleeding, could not see out of his left eye and was so winded by his lung complaint that he could barely speak most of the time. Jackson's publicist denied any of the claims were true.

When the O2 shows were announced earlier this year, Jackson's publicity team had sought to silence the rumours surrounding his health by saying the singer had undergone a rigorous health check before agreeing to take on the shows.

However, during rehearsals for the concerts, backing dancers booked to perform with him exchanged messages on social networking website Twitter casting doubts over his ability to sing and dance his way through 50 shows.

The rumours seemed to be confirmed when several of the comeback dates were postponed, although this was said to be to allow more rehearsal time.

A previous attempt by Jackson to relaunch his career was side-tracked, amid reports of ill-health.

There were reports that Jackson had undergone painful shave biopsies on his chest, arm and nose to remove potentially lethal growths after a skin cancer diagnosis last month – all of which played to the singer's fear of dying.

However, although those who knew him have claimed that the pressure and stress of undertaking such a long run of concerts may have been the final straw for Jackson's health, it may be weeks before the results of the post-mortem examination reveal what killed the already ailing performer.