Edited by Dr. Sonia Dal Ben, Psychologist and Psychotherapist.

 

Five years after the death of Michael Jackson, Karen Faye, his make-up artist from the time of Thriller, she recalled, in a series of tweets, the events that have marked the last days of his life until June 25. The lawsuit filed by Jackson against concert promoter AEG, which ended only in November 2013, that saw Faye on the witness stand for the plaintiff, had not so far allowed to make public the details of a social network of those terrible days that led to MJ death.

 

 

Here Karen Faye's mail to Dileo on June 6, 2009:

 

 

 

 

 

The information shared by Faye reminded us of the testimony disseminated by the followers of the artist soon after his death

(http://www.facebook.com/note.php?note_id=10150137469043798 http://www.michaeljacksonthelastangel.com/)

all agree in describing a Michael Jackson "strange" in those few weeks of 2009 in preparation for the tour This Is It .

 

 

From here, the encouragement to examine what could be the cause, or causes, of this "strangeness" in his personality.

 

Having already suspected from the start of the effects of benzodiazepines (anxiolytics that Murray administered in large quantities in the last period), I decided to write this article by referring to the best and most reliable available scientific literature on the subject, which will be provided a list complete bibliographic, in addition to my dissertation Specialty Psychotherapy on Benzodiazepines, from which I took some informations. We begin by recalling the scientific data that emerged from the results of the autopsy and the sworn testimony of Dr. Anderson, the toxicologist who analyzed them.

The following substances were present in the Michael's body.

Between brackets you find the description.-BDZ is the abbreviation of Benzodiazepine , named anxiolytic or sedative in common language; - The half-life indicates how long it remains in the body and how long the effect may be : -short- a few hours-, medium -until 24 h, and long -more than 24 hours:

• Propofol (general anesthetic used in surgery for sleep during surgery); • Lidocaine (is added to propofol to reduce the burning sensation during injection)

• Diazepam (BDZ, trade name Valium in Italy, long half-life);

• Nordiazepam (BDZ, medium half-life);

• Lorazepam (BDZ, trade name in Italian Tavor, medium half-life)

•Midazolam (benzodiazepines, often used in anesthesia because they are very fast and strong, short half-life) • Ephedrine (Amphetamine, used to wake up the adrenaline if you are too sedated in an attempt to awaken a patient) • Flumazenil (benzodiazepine antagonist, is used to reduce the sedative effect when benzodiazepines are many, also used for detoxification in patients dependent on benzodiazepines during hospitalization, it acts a bit 'like methadone for heroin)

 

The cause of death was "acute intoxication (= fatal) of propofol" that inhibited the respiratory system and has "fallen asleep" Michael Jackson forever.

Benzodiazepines already present in his body, have facilitated the process, as they have prevented MJ to be able to wake up.

MJ HAS NOT ingested Propofol, the amount found in his stomach is compatible with a cortrosyn intravenous, as the blood circulates throughout the body, so even in the stomach, and is not compatible with oral intake.

In addition, propofol has a very unpleasant taste, and it is really hard to swallow. Propofol is a anesthetic, not a BDZ and to date there are NO data that can be addictive.

 

MJ suffered from chronic insomnia, a condition that worsens with stress.

The first choice treatment for the cure of insomnia by drugs is by the administration of benzodiazepines with short and ultrashort half-life (Midazolam between those found at autopsy), since these drugs provide a good hypnotic effect and a rapid elimination from the body, with less risk of creating dependency and tolerance. This is particularly advantageous in cases where it is necessary to provide the patient with a good cognitive and psychomotor performance the morning following the administration of an hypnotic dose. Only in the case of patients with sleep disorders particularly resistant to other drugs (and Michael Jackson had insomnia very durable) may be usedcompounds such as Flunitrazepam (Rhoypnol, banned in the USA, also called "date rape" drug, medium half-life, very powerful), the Flurazepam (Dalmadorm, long half-life), the clordesmetildiazepam (long half-life). The use of these drugs such as benzodiazepines of choice (so not short half-life and therefore not to fast elimination), in a patient who has never made use of hypnotics or in the elderly, it is instead a practice not recommended, since it can were to cause excessive sedation, confusion, severe impairment of cognitive and psychomotor performance the next day. Therefore, in the practice of general medicine drugs should be considered as hypnotics (that help you sleep and drowsy) first choice, short or ultrashort BDZ elimination.

 

We know that in the body of MJ were found, however, not only to short half-life benzodiazepines, which would be the first choice treatment for insomnia, but also to intermediate half-life as Nordiazepam (whose main indication is the alleviation of the states anxious) and Lorazepam (also very strong and excellent care for panic attacks and insomnia, but for short periods!), and long half-life such as Diazepam.

 

From the testimony of the pharmacist Lopez surrender to the process, we also know that between March and mid-June 2009 Murray bought from the pharmacist said, 20 vials of Lorazepam and 60 vials of Midazolam.

All this suggests that: 1 - Michael Jackson could not sleep 2 - was very rough, and this no doubt because of the upcoming concerts for which AEG controlled him and threatened to "pull the plug" taking away all economic support and even take away his children.

Therefore, it is very likely that his insomnia was exacerbated, you do not need a degree in psychology to know that anxiety and agitation worsened insomnia doubling the effort to relax to get to sleep, and even if you manage to fall asleep , a restless sleep is not restful sleep.

For all these reasons, it is realistic to assume that Michael Jackson had much need to be very sedated to be able to fall asleep.

That said, let's examine the available information to try to make sense of his being "weird."

The fact that the body of Michael were present all these BDZ, with half-lives long, medium and short, leads one to think that : 1 - Murray gave him BDZ regularly in large amount 2 - MJ had developed a "tolerance" to BDZ.

With the term "tolerance" means a complex phenomenon in which the effect is less the drug-effect over time (Pharmacokinetics), or increases the need to increase the dosage to maintain the same effect

(Pharmacodynamics). The first type of tolerance that occurs with benzodiazepines is pharmacokinetic, then the drug is no more effective over time, its effect does not last long; Then, there is the pharmacodynamic effect, ie to have the same effect must increase the dose of the drug. There are two intertwined concepts that are contained under the term tolerance. It's an acquired notion that the tolerance to the sedative effects of benzodiazepines develops rapidly and selectively, so as to talk of acute tolerance. Some studies show the development of tolerance with special effects on the central nervous system within 24 hours of treatment with benzodiazepines. Little is known of tolerance that develops with long-term use of benzodiazepines (chronic intake), although some patients seem to quickly become tolerant to the anxiolytic effects and do not reduce the dose when the stress and discomfort appear exceeded, it is likely that this phenomenon is more typical of chronic treatment with benzodiazepines. It was also observed that chronic tolerance is favored by the length of treatment and that there is cross-tolerance between benzodiazepines and drugs of the same class, such as barbiturates and alcohol, but the autopsy tells us that Michael had not been administered.

 

The BDZ, in addition to tolerance, dependence also can give. It is classically defined as "drug addiction" the appearance, the abrupt discontinuation of a drug treatment, a clinical syndrome called "Syndrome Sleep". The clinical features that define a syndrome suspension are in most cases represented by anxiety, irritability, dysphoria, insomnia, hand tremor, sweating, tachycardia, headache, and nausea. Less frequently observed more specific symptoms such as hypersensitivity to sounds of high tones and bright light (Michael in TII complains about the height of the volume in

the headphones and often leads glasses, may be likely reactions to loud sounds and bright light), paresthesia, dizziness, impaired balance, metallic taste in the mouth. More rarely, have seizures, and hallucinations. Symptoms usually occur within the first week of the suspension and regress spontaneously within 10-15 days. Among the risk factors for the onset of the phenomenon of dependence, the most important are: the duration of treatment and the use of high doses (for example, 10 mg per day of Lorazepam, present in the body of Michael). It has been shown that the period of onset, intensity and duration of the symptomatology which characterizes the withdrawal syndrome vary half lives of BDZ. More precisely, with a short half-life benzodiazepines (midazolam in the case of Michael) syndrome occurs earlier (usually 1-2 days), has a greater intensity of symptoms and regress more quickly (within 5-6 days); with BDZ to medium-long half- life (for Michael Diazepam) the onset is later (within 4-8 days), the intensity of symptoms less, while their remission occurs in a period of longer time (within 10 - 15 days).

As long as the drug has been used and how much higher doses were used, the greater will be the tendency to develop a severe abstinence. Dosages of approximately 40 mg of Diazepam (BDZ found in the body of MJ) per day produce more easily clinically relevant symptoms of abstinence, and even higher doses (eg., 100 mg of Diazepam) occur more easily withdrawal seizures or delirium, characterized by disturbances of consciousness and cognition, with visual hallucinations, tactile, or auditory.

Finally, some authors believe that the short half-life benzodiazepines (midazolam to Michael) can more easily induce withdrawal phenomena in comparison to the long half-life benzodiazepines. Marks (1978) describes two types of benzodiazepine withdrawal: 1) a minor syndrome, characterized by anxiety, weakness, lethargy, tremors, dizziness, insomnia, nausea-vomiting, anorexia, hypotension and postural myoclonus, and 2) a syndrome with greater delirium, convulsions and hypothermia. The same way as alcohol, addiction to benzodiazepines can cause withdrawal phenomena such as: autonomic hyperactivity, tremors, insomnia, delirium, delirium tremens and grand mal seizures (moments of alienation of which the individual is not conscious).

 

Having said that, and thinking that the body of Michael were as many as 3 types of benzodiazepines, it is likely to assume that he could better develop abstinence syndrome or suspension in the event that the treatment had been discontinued to make Michael glossy, with the aim, for example, go to rehearsals.

 

But there are also side effects and toxicity in overdose they do much thinking:

 

side effects of benzodiazepines, which are among those drugs more manageable (and often administered lightly because of it), very often are nothing more than an accentuation of their pharmacological properties. Those most frequently reported are: excessive sedation; asthenia (fatigue); decrease in performance (performance) psychomotor and cognitive; effects 'residues' on the morning after taking a hypnotic dose, the latter characterized by general malaise, headache, dizzy similar to a hangover (when the president of AEG, Randy Phillips, Michael Jackson jumped in the shower In London, saying that it seemed drunk ... is it possible to be "just" already intoxicated by the BDZ?) and are defined in the international literature the term hang-over.

More rarely, have been reported: mental confusion (especially in the elderly); anterograde amnesia; gastrointestinal disorders; ataxia; dizziness; hypotension; effects "paradoxes" such as restlessness and psychomotor agitation and excitement (which some followers say they have noticed Michael).

 

But now we come to the point that I consider most important:

Acute ingestion of very high doses (non-therapeutic) of BDZ does not cause toxic effects such as to jeopardize the vital functions. From the point of view of toxicity, all BDZ can be considered quite safe. Acute intoxication does not cause, in fact, the phenomena of respiratory depression, cardiovascular or central nervous system (CNS), but simply profound muscle weakness and drowsiness. Have also been described symptoms such as orthostatic hypotension (a sudden drop in blood pressure that occurs moving from sitting to standing station), hypothermia, confusion, ataxia (motorial incoordination, for me visible in TII in the so-called "step of the Penguin" step, which makes Michael) and dysarthria (difficulty in articulating words). The last 4 were all symptoms seem to be present in the final days of Michael's life, as witnessed by Karen Faye, from the followers (who reported seeing him confused and "weird"), and, in my opinion, some visible even in TII, such as motor incoordination and hypothermia (the layers of clothes on at the end of June with temperatures of 25 degrees, for more while it was in motion, and the testimony of the fireplace in the house).

 

There have been no reported deaths so far after ingestion or injection of high doses of benzodiazepines taken without other drugs, however, in the event of an overdose (as confirmed by the autopsy findings and the testimony of the toxicologist Anderson at AEG process) the simultaneous intake of depressant drugs for the central nervous system such as barbiturates, narcotic-analgesic,ANESTHETICS (like Propofol) tricyclic antidepressants, antiepileptics, etc.., it may often be LETHAL!

This is clearly written in ANY leaflet and well known to every physician, but not by Murray, at least from what appears from the facts. Dr. Anderson, during the deposition process for AEG, confirmed this as the cause of death of Michael Jackson.

 

It is now available a specific antagonist of benzodiazepines, which has proved capable of displacing the specific BDZ receptor sites to the level of the Central Nervous System: Flumazenil, also administered by Murray when it was too late, but he had ordered in pharmacy as many as 10 vials in April 2009, a fact that leads to thinking about his realization that Michael was "used" to be sedated by him and he needed to be "awakened" in case of need .

In addition, in June 2009 Murray ordered by the pharmacist Lopez 30 capsules ECA (Ephedrine, Caffeine and Aspirin).

Ephedrine, taken orally, acts at the level of the Central and Peripheral Nervous System. In particular, between the therapeutic effects recordable at the peripheral level, you have vasoconstriction with increased blood pressure, increased stroke and heart rate, and in the last bronchodilation.

At the level of the central nervous system, the Ephedrine acts as a stimulant, an effect that has resulted in the illegal use. The person taking Ephedrine, as a result of an overactive sympathetic nervous system (the one that is operated under the command of adrenaline and noradrenaline, to allow the body to act quickly, for example during a threat or a fight), has loss of appetite , insomnia, feel little sense of fatigue, lose weight because fat mass is attached, is in a constant state of alert; characteristics having often sought by athletes and people who want to lose weight, which is why Ephedrine is sold illegally in the form of additional mixtures, especially in gyms.

 

The demand for pharmacist that do Murray was specifically that of an "energy mix" over the counter, adding that Lopez got aspirin caffeine and ephedrine. These substances have serious side effects: cardiovascular fitness, you have increased pressure and cardiac activity, with severe cell stress miocardichee; lack of appetite in the long run may turn into anorexia; insomnia persists even after discontinuing use of the substance, therefore, the body suffers from a lack of sleep and ultimately rest; states of anxiety and nervousness conclude with

depression.

Often, these mixtures are promoted as dietary supplements and slimming properties, energizing and improvement of athletic performance and not. In Italy Ephedrine is classified as a doping substance, thus illegal (source and further details athttp :/ / www.my- personaltrainer.it/farmacologia/efedrina-54.html).

Terms such as "loss of body fat", "appetite" and "anorexia" were often appointed by the witnesses of the last dramatic weeks of Michael Jackson's life.

To get a picture as complete as possible, we take a look also to studies on insomnia.

 

Recent research shows that one of the effects of sleep deprivation on cognitive response times are slow and many falls in the visual processes.

In particular, Neuroimaging studies (carried out with the Nuclear Magnetic Resonance and contrast media) have shown that subjects deprived of sleep, in addition to having more difficulty in recognizing visual stimuli correct, are slower to correct, and that periods of functionality apparently normal may give a false sense of competence and safety, when in fact highlighted the cognitive deficits might give serious consequences.

This means that a person is deprived of sleep can have a false sense of competence, feel good and actually be very slow.

Remind you of anyone, for example the London Conference on TII?

This data comes from the prestigious Journal Of Neuroscience from research done in 2008 by Dr. Chee and other neuroscientists of the Graduate Medical School at Duke-NUS in Singapore.

 

Sleepiness slows down the thinking processes. The scientists who studied the sleepiness have found that sleep deprivation reduces the level of attention and concentration. When it is difficult to focus and pay attention, you feel more confused. This hinders an individual's ability to perform tasks that require the application of a logical or a complex thought.

 

Sleepiness also impairs decision-making capacity. Making decisions then becomes more difficult, precisely because it is not able to properly evaluate situations and to choose the right behavior.

 

• sleepiness negatively affects memory. The research suggests that nerve connections, which are the basis of our memories are strengthened during sleep. Sleep incorporates in short-term memory the things we have learned and experienced over the course of the day.

It seems that the different phases of sleep play different roles with regard to the consolidation of new information in memory. If your sleep is disturbed or interrupted, it is inevitable that everything is passed on these cycles. When you are sleepy, you often forget things and you tend to make mistakes more easily. The inability to concentrate, due to sleep deprivation also further weakens the memory.

• A poor quality of sleep makes learning more difficult. Sleep deprivation affects the ability of learning since, in view of the low level of concentration, it is more difficult to incorporate new information and, consequently, the efficiency of the learning mechanism is inevitably compromised.

Even the memory, which is essential for learning, is affected.

Drowsiness makes slower reaction times, a problem that is particularly risky when you are driving a vehicle or when you are in employment (and not) that require fast response times.

The impact on mood and mental health

The lack of sleep can affect your mood significantly. It causes irritability, anger, and may reduce the ability to cope with stressful episodes. With the passing of time, impaired memory, mood and other functions can become chronic negative influence on employment and on interpersonal relationships.

The chronic sleepiness increases the risk of depression.

A study conducted by researchers at the University of North Texas has found that people who suffer from insomnia are 10 times more likely to develop depression and 17 times more likely to suffer from anxiety.

Sleep deprivation and depression are so closely related to each other that sleep specialists often have difficulty in identifying which of the two phenomena has appeared first in their patients. Sleep and mood affect each other. It is not uncommon that people who are depressed do not get enough sleep, as is also common for people who suffer from depression are not able to get enough sleep.

 

BOTTOM LINE: Michael suffered from chronic insomnia, anxiety worsened, and benzodiazepines were used to try to make him feel better because he could not blame the symptoms of sleep deprivation because he could not work well or concentrate, then the doses of benzodiazepines were high and, as we have seen, too high doses create side effects not least, is due to an overdose that the tolerance that abstinence (in upper case because it refers to the relative syndromes explained in detail above). To "help" Michael in his performances and rehearsals, Murray decided to "give a hand" to not be stunned by BDZ, which he administered the in large quantities, giving ephedrine, and dopandolo substantially worse so not only state of anxiety, but especially insomnia, eventually generating a vicious circle.

At one point, Murray began to administer an anesthetic (propofol) to see if under anesthesia , the poor Michael would be able to rest, because complaining about the impossibility of making a regular sleep for several months, and the high doses of benzodiazepines and lthe massive use of anesthetic (in 2 months, Murray took 255 vials pharmacist!) prove just that, otherwise there would have been no need to use them together (but note that, according to AEG, MJ was just fine ....) Propofol, like all anesthetics, does not give a good night's sleep, but sleep artificial, chemical, in which the patient may not have the various stages of sleep that occur regularly and frequently (here you can find an explanation of the well-made sleep and its stages http://www.dimensionesonno.it/dormirebene_qualitaequantitadelsonno.html),

so he can enjoy a true "rest." In NO treatment for insomnia there is the use of anesthetics, because, as we have seen, the first choice cure for the pharmacological treatment of insomnia, according to the manuals of psychiatry, is the use of benzodiazepines and is dangerous to use hypnotic drugs in patients already sedated by BDZ, then the anesthetic really no good!

So why Murray used Propofol?? Total incompetence? Despair because who pulled out the money to pay him, required to do everything to make "feel good" Michael Jackson and let it rest?

Two processes have provided enough evidence to understand what were the roles of Dr. Murray and the company that hired him, AEG, whose president Phillips baptized the TII concerts a moment "DO OR DIE" for Michael Jackson.

In this context, it is necessary to stress, however painful it may be, to understand what could have caused the "strangeness" of poor Michael in his last months of life, and this is what I hope to be able to do in this article.

 

Postscript: I have thoroughly with a medical colleague specialist in Forensic Medicine,the issues related to the weight of Michael Jackson's autopsy examination found, about 62 kg, and the resulting BMI (body mass index), slightly higher than 20.

Whilst bearing in mind the testimony of Dr. Rogers, who performed the autospia, in the AEG process, according to which the weight can be changed because the fluids received by Michael Jackson during resuscitation attempts may have affected the data he found, and that in any case, when the body of Michael Jackson arrived at the morgue, had already changed all, respect to the time when he was on the bed where Murray killed him, it is likely not to have changed very relevant, because this was analyzed 24 hours after death and after proper storage in the refrigerator.

 

The detection of BMI in autopsies is unusual, at least in Italy, where he focuses on the calculation of the percentage of body fat and muscle mass, as they are considered more reliable and relevant.

 

On Michael's body during the autopsy NOT these data were recorded, as specified by the toxicologist who analyzed the autopsy findings, the well-known Dr. Anderson, and this lack is at least strange.

 

I want remember that a BMI greater than 20, such as that found on MJ, indicates an individual of normal weight, while an underweight individual has a BMI of less than 18: and overweight over 24. Calculation of BMI ago by multiplying the height in inches squared , and dividing by the weight in kilograms, but are easily accessible on the web calculators machines. I am 175cm (as Michael) and weight 55 kg, my BMI is equal to 18, the limit of underweight, but no one would describe me as a skeleton, as it is defined MJ in the email of the TII staff , the followers and the Phillips himself, and as anyone can see by looking at his pictures of the last days. All the witnesses at the time reported that he had always cold, further evidence of a lack of subcutaneous fat. On this basis, I think it very unlikely that it could weigh more than me, even considering a bone and muscle mass greater than mine, so that weighs more, are precisely the percentage of body fat and muscle mass than those who matter to have a clear idea of his state of health, given that in his autopsy strangely missing!

It may also be that his weight was around 60 kg (I, however, rest heavily skeptical), but bone and muscle, and if the fat mass was very little, it was still underweight.

 

In this context, we can only make assumptions about the data that we have, no presumption of certainty, but it really does not come back that the data on fat mass, which usually, for practice, it is essential to detect in an autopsy, Michael Jackson is not available. Maybe they were afraid that enshrinement in a given scientific reality than was starving?!

I repeat that this is only a hypothesis, but the doubt on this data are real, because it is cold to drown out any analysis on the numbers, there is only one devastating certainty : NOT Michael Jackson had to die, Michael Jackson was murdered!

 

By Sonia Dal Ben, Psychologist and Psychoterapist.

 

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