The ‘brain fog’-related health condition Luigi Mangione complained about prior to Brian Thompson killing

Alleged killer Luigi Mangione appears to have been plagued by a litany of health problems in the years before he became estranged from family and friends.

The 26-year-old Ivy League graduate underwent spinal surgery last year for chronic back pain, and he regularly posted online about his health struggles, including suffering from “brain fog” in college.

Little is known about Mangione’s mental state in recent months, but it appears he has withdrawn from close relationships.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 receiving 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.

After his back surgery last year, 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 advised them to endure the pain.

Mangione’s Reddit posts suggest that he was overwhelmingly satisfied with the outcome and was finally free from chronic pain. He encouraged others not to be afraid of horror stories of botched operations.

The inmate appeared 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 be caused by 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 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,” he wrote.

“I have surgery scheduled in two weeks and I keep wondering why I was so afraid of it.” 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.

“Obviously it will be a while before I start any rigorous activities, but it was a lot 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.”

Mangione also posted in early April about the gear he brought 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 a back problem to “keep trying different surgeons” and, if necessary, indicate that he could not continue working.

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

What is noticeably absent from Mangione’s social media posts, however, is explicit concern about corporate greed in the health insurance industry.

These appear to have only come to light later: in a handwritten note found after Mangione was arrested as a suspect in the murder of Brian Thompson, CEO of UnitedHealthcare and father of two children.

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 Thursday in an interview with NBC New York.

The murder has nonetheless sparked widespread speculation about whether he had a bad personal experience with the health care system.

Mangione has been charged with murder as an act of terrorism for the December 4 shooting death of Thompson, 50, in Midtown Manhattan.

The accused killer is being held at the Metropolitan Detention Center in Brooklyn and will appear in court in New York at a later date.