Incident may fuel hatred of US CEO murder suspect

Luigi Mangione was living the dream life when he had a problem with his spine that required surgery, causing him a lot of suffering and possibly developing a hatred for the medical and insurance industry.

Luigi Mangione, 26, was arrested on December 9 in Altoona, Pennsylvania, five days after he shot and killed Brian Thompson, CEO of UnitedHealthcare, one of the leading health insurance companies in the United States.

The incident shocked the public, but the suspect’s true motive remains a big question. Police found three bullet casings at the scene engraved with the words “deny,” “protect,” and “depose,” phrases that refer to the insurance industry, leading them to hypothesize that Mangione had a personal grudge against Thompson or the entire U.S. health insurance system.

Luigi Mangione in court in Pennsylvania, December 10. Photo: Reuters

Considering the suspect’s medical history, many believe that an unexpected event two years ago may have completely changed Mangione’s personality and caused him to develop a real hatred, especially for the American health care and insurance system.

Coming from a prominent Baltimore family, Mangione enjoyed a life of luxury. His grandfather Nick Mangione, who died in 2008, was a successful real estate developer. The Mangione family purchased the Hayfields Country Club in Baltimore in 1986 and donated to numerous charities.

A relative of Luigi Mangione is a member of the Maryland state legislature. The young man also attended top schools and was the valedictorian at the prestigious Gilman High School.

Mangione received his degree in computer science from the University of Pennsylvania, an Ivy League school, in 2020. The athletic Mangione studied programming in college and hopes to become a video game creator.

Everything is looking bright for Mangione as he moves into Surfbreak, a private co-living community in Honolulu, Hawaii, in early 2022.

Co-living is a modern form of shared living, in which residents have private bedrooms in a house, with shared common areas. This model is mainly aimed at young people and remote workers.

Surfbreak founder RJ Martin said he ran a background check on Mangione before accepting him into the community and found no unusual issues.

“Luigi was considered a great guy, there were no complaints against him,” said Surfbreak spokesman Josiah Ryan. “There was no indication he would become a killer.”

Martin later learned that Mangione had suffered from severe back pain since childhood, which often caused him to experience severe pain that hindered many activities in his life, including surfing. “Luigi went surfing with RJ once, but it didn’t go so well because of his back,” Ryan said.

The first surfing lesson turned into a nightmare when it aggravated the spondylolisthesis Mangione had suffered from since childhood, leaving him bedridden for a week with his back and hips “in a bind”.

The moment CEO Brian Thompson was shot dead on the streets of New York on December 4. The video contains violent scenes, readers should consider before watching. Video: CNN

According to posts from a Reddit account linked to Mangione, the numbness became increasingly severe after the surf, leaving him in a state of “fear.”

Martin said Mangione told him that his spinal vertebrae was more than a centimeter out of alignment and appeared to be pressing on a nerve.

“You know, it’s really frustrating and difficult when you’re in your early 20s and you can’t even do the most basic of activities,” Martin said in an interview with CNN.

He said Mangione’s back injury was so painful that he couldn’t even have sex.

“He knew that dating and being physically intimate with his back was impossible. I remember him telling me that and it broke my heart,” Martin said.

After six months of living in Surfbreak, Mangione left. Martin speculates that Mangione flew back to the East Coast but then returned to Honolulu and rented an apartment in the same neighborhood before returning to the mainland in the summer of 2023 for back surgery.

In July 2023, an anonymous Reddit user whose profile matched Mangione’s said he had spinal surgery that resulted in some relief from his symptoms.

Mangione also sent Martin an X-ray of his spine. Mangione also posted an X-ray of the metal pins attached to his spine on social media X.

According to Martin, the shape of Mangione’s spine in the photo worried him and he texted to ask about the situation.

“It’s a long story,” Mangione replied to Martin in a text message. “I’ll tell you in person. I’ll be back in Hawaii as soon as possible, I have to learn some things about the spine here first.”

Mangione also expressed skepticism about the US health care system in an April 2024 response to another person asking how patients under 35 could get “spinal fusion surgery.”

Young patients should seek out surgeons who understand that they should be operated on based on symptoms rather than age, Mangione advises.

Mangione also suggests that patients can tell their doctors they “can’t work.” “I find the medical profession responds to these keywords much more urgently than if you describe unbearable pain and how it affects your quality of life,” Mangione explains.

“Plan Z: Pretend to fall or pee your pants. This is a last resort, but it’s ridiculous that people won’t do spine surgery on you if you act like that,” Mangione continued.

X-ray of a spinal surgery posted on social media X. Photo: X/ Luis Mangione

Mangione’s friends say the spinal surgery was the catalyst for his change in personality.

“I spoke to a source who had a lot of high school friends with Luigi Mangione,” Jack Mac, a reporter for the news blog Barstool Sports, posted on X. “What kept coming up was that a back surgery ‘changed everything’ for him and drove Mangione ‘totally insane.’”

“He suffered a back injury while surfing in Hawaii. The surgery didn’t go well. He moved to Japan and lost contact with his family about a year ago. His family recently reached out to his high school friends for information,” Mac said.

Some news reports say that Mangione turned to psychedelics, although there is no direct evidence of that beyond the cartoon mushroom image on the X-Files and his online reading list which includes a book by author Paul Stamets titled Psilocybin Mushrooms of the World.

Mangione also reposted a cartoon on X about “placebo-controlled trials of psychedelics.” He also reshared a controversial video discussing the benefits of psychedelics titled “What Research Says About the Personal and Social Risks of Some Psychedelics Compared to Alcohol.”

At the time of his arrest, Mangione was carrying fake identification, a gun, a silencer, and a three-page handwritten letter outlining his motives and reasons for the crime. In the letter, Mangione expressed anger at health insurance companies and his displeasure with the greed of such businesses.

Mangione reportedly accused insurance companies of exploiting America “for profit” and insurance agents like Thompson of being “freeloaders.” He claimed that America had the most expensive health care system in the world and that big business profits continued to rise while people’s life expectancy did not.

Mangione appeared to view the assassination of the UnitedHealthcare CEO as a “symbolic act” that directly challenged the “corruption and ‘power play’” of the American healthcare industry. Mangione stressed that he was “the first to confront that issue with brutal candor.”

According to an internal police report, Mangione “may have seen himself as a kind of hero, deciding that he had to take action against such injustices.”

Dr. Afton Hassett, director of pain and addiction medicine research at the University of Michigan, stressed that living with chronic pain is no excuse for revenge killings.

However, she notes that people with chronic pain can often feel frustrated when they receive conflicting information about treatment options.

The photo was posted by Mangione on his social media account. Photo: X/Luigi Mangione

“If a patient thinks the procedure is necessary to relieve their pain and is refused it, they may feel extremely frustrated, but this is never a reason to justify violence,” she said.

People with chronic pain have “higher rates of mental health conditions, particularly depression, anxiety disorders, post-traumatic stress disorder, sometimes substance use disorders,” says Robert Kerns, a senior research scientist at Yale School of Medicine.

He said depression “can arise from chronic pain but the relationship is much more complex than that” and other factors such as family history and social circumstances also need to be taken into account.

It is unclear what happened to Mangione after the spinal surgery and the associated health insurance costs, but those who knew him say it was an event that completely changed the thinking and behavior of a young man who seemed to have a very bright future ahead of him.