By Courtland Milloy
What killed Michael Jackson?
This autopsy does not require a scalpel. A mirror will do.
"He had the nose of a black male, and he didn't want one," Scott L. Spear, chairman of the plastic-surgery division at Georgetown University, told me. "He was a black man who wanted to look like a white Diana Ross."
That's not a cut - just a clue. Spear's diagnosis: acute body dysmorphic disorder, from the Greek dys, meaning "bad" or "ugly," and morphos, meaning "shape" or "form."
For Jackson, who died Thursday at the age of 50, it meant a world of pain.
Ironically, Jackson had emerged on the music scene just as the "black is beautiful" movement was becoming all the rage. In 1968, the Jackson brothers made a demo tape in which Michael, then 10, sported an Afro and danced like James Brown. He was a handsome little man, black and proud. He had soul, and he was super-bad.
And in a little more than 10 years, he would start looking like a white woman.
Margo Jefferson, the author of On Michael Jackson, called him a "postmodern shape-shifter." But the history of race and skin color in America suggests something more pathological.
Evidence abounds that self-loathing can have dire consequences. Young black men, for instance, have killed other black men just because they didn't like the looks on their faces - faces that, more often than not, resembled their own.
Jackson obviously did not like the black man he saw in the mirror.
Studies have shown that many African Americans obsess about facial features and skin color that conflict with images of beauty promoted in the mass media - images that are usually based on some notion of a white ideal.
Black people spend as much as five times more on personal-care products as do whites, according to some surveys, with skin-lighteners high on the list.
"The word was that Michael had vitiligo, which started on his hand and around his fingertips," said Cheryl Burgess, a dermatologist in Washington who is part of an elite circle of skin specialists that includes one of Jackson's dermatologists. "Eventually, though, he opted for a treatment that involved complete depigmentation. One day, I looked up, and Michael was almost white."
Although the condition affects only the skin, the definition of vitiligo seems to reflect Jackson's mental state as well: autoimmunity in which the body attempts to reject its pigment cells. It was as if Jackson had become vitiligo personified.
Distortions in self-perception are made all the worse when a parent is overly critical of a child's physical features, as Jackson's father was said to have been.
There was nothing wrong with Michael's face. And yet he spent years and millions of dollars slicing and chiseling and burning away at it. A once perfectly fine nose - from which he so abundantly inhaled the breath of life - came to appear as if made of Silly Putty by a 2-year-old.
"He probably had at least four or five, if not 10, cosmetic procedures on the nose," Spear said. I asked if that was because the doctors couldn't make it right. "No, it's because Michael Jackson could not be made happy," he replied.
If longtime friend Deepak Chopra is correct - that Jackson was a chronic abuser of OxyContin, Demerol and other mind-altering drugs - then his despair was far worse than anyone could have imagined.
In the wake of his death, an adoring fan declared, "He didn't have plastic surgery on his heart." But his heart was troubled nonetheless. For drug addiction steals the spirit, creating pain so great that it sometimes seems only death can bring relief.
Paramedics who tried to revive Jackson say he went into cardiac arrest. That's a disturbance in the rhythm of the heart, possibly due to a lack of oxygen.
In this postmortem, however, the cause of such a disturbance would not be a lack of oxygen so much as a loss of the soul. The emptiness was etched in his face.
Courtland Milloy is a columnist for the Washington Post, where this appeared.