Back trouble and brain fog bothered suspect in UnitedHealthcare CEO killing, his posts show

After Luigi Mangione After making the difficult decision to undergo spinal surgery last year for chronic back pain, he became an advocate for the procedure that changed his life for the better.

He repeatedly posted on Reddit about his recovery and offered words of encouragement to people with similar conditions, telling them to push back against doctors who suggested they live with pain.

But noticeably absent from the messages are explicit concerns about corporate greed in the health insurance industry. These appear to have surfaced only later: in a handwritten note found after Mangione was arrested as a suspect in the murder of UnitedHealthcare CEO Brian Thompson.

That short document refers to “parasites” in the health care system and laments the power and profits of health insurers, law enforcement officials said. In his first public words since his arrest in Pennsylvania, Mangione emerged from a patrol car and shouted about an “insult to the intelligence of the American people” as sheriff’s deputies pushed him into a courthouse.

There is no evidence that Mangione was ever insured with UnitedHealthcare, a senior New York City police official said in a statement interview Thursday with NBC New York.

The murder led to it after all widespread speculation about whether he has a bad personal experience with the healthcare system. But after his surgery in 2023, Mangione’s posts on Reddit suggest he was overwhelmingly satisfied with the outcome and was finally free of chronic pain. He encouraged others not to be afraid of horror stories of botched operations. He also referenced a backpacking trip to Asia earlier this year.

The 26 year old Ivy League graduate appears to have stopped posting on social media about six months ago, around the time he lost contact with loved ones.

Family and friends were shocked by the news of Mangione’s arrest, but little information has emerged about his recent mental and physical health.

Mangione’s Reddit posts refer to a spinal condition called spondylolisthesis, which occurs when a fracture causes a vertebra to slip out of alignment. It can cause severe pain if the bone puts pressure on the spinal nerves.

The condition, which can develop in childhood or from an injury, began to negatively impact Mangione’s life in recent years, according to his social media posts.

After earning his bachelor’s and master’s degrees from the University of Pennsylvania, he worked at Santa Monica-based car buying website TrueCar until 2023 and lived in Hawaii for a time starting in January 2022. During a six-month stay at Surfbreak, a co-living space in Honolulu, Mangione’s back pain worsened in part due to a surfing incident.

Josiah Ryan, spokesman for Surfbreak owner and founder RJ Martin, said Mangione had expressed growing concerns about the pain. In addition to missing out on recreational activities and exercise, he worried about how this would affect romantic relationships.

“That was definitely a theme during his time there,” Ryan said. “He wasn’t a big complainer. So it wasn’t like he kept bringing it up. But the people who knew him knew that this was an important part of his life.”

In July 2023, Mangione wrote in a Reddit post that he had decided to undergo surgery.

“I was stuck in this spiral for a year, putting my life on hold at the age of 20, damaging my nerves as I debated the decision. I have surgery scheduled in two weeks and I keep wondering why I was so afraid of it,” he wrote.

According to his reports, the operation was a success.

An image on an X account linked to Mangione showed an X-ray of a metal rod and multiple screws inserted into his lower back.

“The surgery was painful for the first few days, but I was shocked that I was literally not taking any painkillers on day 7,” Mangione posted on Reddit in August 2023. much less bad than I expected.”

Medical experts say treating back pain is almost always a challenge.

“The vast majority of treatments involve surgery when all else has failed to provide relief,” says Dr. Jason Pittman, co-director of the Spine Center at Beth Israel Deaconess Medical Center in Boston. He said doctors generally try conservative treatments such as physical therapy, injections or medications before surgery.

Even people with health insurance can face thousands of dollars in surgery bills, depending on their deductibles and other factors, although it is unclear whether Mangione has experienced any of these problems.

Experiencing chronic back pain can also have a significant impact on mental health, says Dr. Padma Gulur, a pain specialist at Duke Health.

“If you have underlying mental health issues — anxiety, depression — your pain can be worse because you’re suffering a lot more,” Gulur said. “But the second aspect is that pain can push you into anxiety and depression.”

Little is known about Mangione’s mental state in recent months, but it appears he has withdrawn from close relationships. Since-deleted messages on X show a friend reaching out repeatedly and getting no response.

His family reported him missing to San Francisco authorities in November, police said.

Previously, while in college, Mangione posted on Reddit about experiencing severe brain fog and restless sleep.

In a July 2018 post, he said his grades were slipping and he had considered dropping out of school. But in the end, “staying in college at least allowed me to maintain some semblance of normalcy,” he wrote.

His last Reddit post was dated May 17, but other statements around that time suggest he experienced no unexpected complications or renewed back pain. He seems to be advocating for the type of surgery he had months earlier.

He posted in early April about the gear he took with him on a two-month backpacking trip through Asia, which included cross-country motorcycle riding, saying he had found “the perfect balance between minimalism and practicality.”

In late April, he advised another Reddit user with back problems to “keep trying different surgeons” and, if necessary, indicate that he could not continue working.

“We live in a capitalist society,” he wrote. “I have noticed that the medical industry responds to these key words much more urgently than you describing excruciating pain and how it affects your quality of life.”

___

Kelleher reported from Honolulu. Skene reported from Baltimore. Associated Press writers Tom Murphy in Indianapolis and Devi Shastri in Milwaukee contributed to this report.