The brutal shooting of a health care CEO in Manhattan, the days-long manhunt and the arrest of an Ivy League graduate have gripped the country in its twists and turns.
But doctors are fascinated by the revelation that the alleged killer – who seemed stable, sociable and highly intelligent to his friends – had suffered from chronic back pain in the lead-up to the shooting.
Experts say this would not only explain his distaste for the health care system and insurance companies, but also point out that research shows a direct link between back pain and psychosis.
A large-scale 2016 study of almost 200,000 people showed that people with back pain were 2.6 times more likely to suffer from psychosis, or a loss of connection with reality, than their peers, making them more likely to withdraw from society and end up in isolation.
Friends say the alleged killer, Luigi Mangione, 26, has suffered a lifelong back injury worsened by surfing. He broke off contact with many of them in the months leading up to the shooting.
Dr. Betsy Grunch, an upper spine surgeon in Atlanta, Georgia, said her patients often endure “life-altering” misery and pain as a result of similar injuries.
Other experts told this website that lack of sleep due to the pain and isolation of not being able to socialize also increases the risk of delusions.
Meanwhile, doctors pointed out that the analgesic drugs used to treat back pain can also have serious psychological effects.
Luigi Mangione, 26, of Maryland, is pictured above. He is accused of shooting the CEO of UnitedHealthcare
The above is an image from his Twitter account that appears to have several screws implanted in his spine
Back pain is a debilitating disease that affects 20.9 percent of Americans, or 51.6 million people. Estimates suggest that among Generation Z people, one in four reported back pain in the past 12 months.
Doctors also say this is one of the most common reasons people seek medical care, with about 16 million Americans saying it limits their daily activities.
Sarah Nehemiah, who knew Mangione while staying at a co-living space called Surfbreak in Hawaii, said he left the community in April 2022 due to a lifelong back injury.
Mangione is said to have been bedridden for a week after taking part in a basic surf training session in the community.
He reportedly underwent spinal surgery this year and told his friends he needed to have screws placed in his spine.
An image posted to his Twitter account and shown above appears to show an x-ray of his spine after surgery.
Many doctors – and studies – warn about the link between back pain and feelings of depression, anxiety and suicidal thoughts.
But doctors also said it was possible the injury could drive someone into psychosis, or loss of touch with reality.
Dr. Gbolahan Okubadejo (Dr. Bo), Board-Certified Spine Surgeon at the Institute for Comprehensive Spine Care, said it is possible for back pain to cause someone to snap.
He blamed a range of factors, including the pain itself, and the disruption to sleep, medications and connection with others it would cause.
But doctors are fascinated by the revelation that the alleged killer – who appeared stable to his friends – had been suffering from chronic back pain in the lead-up to the shooting (Mangione in Pennsylvania today)
The graph above shows the percentage of adults aged 18 and over who have had low back pain in the past three months. It is divided by men and women
“In general, back pain is very disabling,” he said, “it is a constant symptom and a 24/7 ordeal, and can leave people in a heightened state.”
‘Chronic back pain can also lead to lack of sleep, which in turn causes problems.
‘There may be cases where patients try to be given stronger medications to help manage symptoms, but these may be denied by doctors or health insurers, and that can also cause problems.
‘There is also social isolation with severe back pain. Patients can end up revolving their entire lives around it and no longer being able to spend time with family and friends.’
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Previous studies have shown that people with chronic pain suffer from a loss of gray matter in the prefrontal cortex of the brain, the area of the brain involved in decision-making and working memory.
They have also shown that patients with chronic pain are more likely to become exhausted due to disrupted rest, which can also impact decision-making.
Some painkillers can also trigger the release of dopamine, a feel-good hormone, which research shows can increase the likelihood that a person will engage in impulsive behavior.
Mangione was reported missing by his mother a month before the shooting, reports show. Friends also say they have lost contact with him.
At the same time, he appears to have been an avid reader, with his Goodreads account listing more than 100 books he had read.
He also talked about “Unabomber” Ted Kaczynski, who initially tried to live as a hermit in nature before planting bombs that killed three Americans and injured many.
Dr. Bo said it was possible that these factors could have caused Mangione, or others, to suffer from a disconnect from reality, leading to actions that would not normally be expected.
But he emphasized that many questions remain unanswered.