Luigi Mangione made the challenging choice to have spinal surgery last year due to chronic back pain, which led him to become a strong advocate for the procedure that eventually transformed his life for the better.

After his surgery, he actively shared his journey on Reddit, encouraging others suffering from similar ailments to challenge medical professionals who would suggest they simply endure their pain.

However, his posts lacked any direct mention of the corporate greed prevalent in the health insurance sector—an issue that only appeared later on, specifically in a handwritten note discovered after Mangione was apprehended as a suspect in the murder of UnitedHealthcare CEO Brian Thompson.

In this brief note, he referred to the healthcare system as infested with “parasites” and expressed discontent with the dominance and profits gained by health insurers. Following his arrest in Pennsylvania, Mangione was seen emerging from a police vehicle, vocally expressing outrage over what he described as an “insult to the intelligence of the American people,” as law enforcement escorted him into the courthouse.

There is currently no evidence suggesting that Mangione was ever covered by UnitedHealthcare, as confirmed by a senior police official from New York City during an interview.

The incident has sparked rampant speculation concerning possible negative experiences Mangione may have encountered within the healthcare system. Yet, Mangione’s online activity post-surgery portrayed a greatly satisfied individual, free from chronic pain for the first time.

His posts exhibited encouragement to others, urging them not to fear surgery because of alarming anecdotes regarding surgical failures. Additionally, he mentioned embarking on a backpacking journey through Asia earlier this year, signifying a return to an active lifestyle.

The 26-year-old Ivy League alumnus seemingly ceased his social media activity around six months prior, aligning with the time frame in which he disconnected from friends and family.

His loved ones expressed astonishment upon hearing the news of his arrest, but there remains a lack of concrete details surrounding his recent physical and mental wellness.

Mangione had previously referenced living with spondylolisthesis, a spine condition wherein a vertebra shifts out of alignment, often causing distress if it compresses the spinal nerves.

This condition, which can stem from injuries, began to adversely affect his quality of life in recent years, as he documented on social media platforms.

After completing his degrees at the University of Pennsylvania, he was employed by TrueCar in Santa Monica until this year and spent time in Hawaii starting January 2022. During a six-month period at a co-living space called Surfbreak in Honolulu, Mangione’s back pain escalated, partly due to an incident while surfing.

Josiah Ryan, a spokesperson for Surfbreak’s founder, R.J. Martin, noted that Mangione had shared his increasing concerns regarding his discomfort. He expressed that the pain not only hindered recreational activities but was also a source of anxiety in terms of his personal relationships.

Ryan commented, “That was definitely a recurring theme during his stay. He wasn’t overly vocal about it, but those who knew him were aware that it was a significant issue in his life.”

In July 2023, Mangione announced online his decision to proceed with surgery.

He reflected on how he had been stuck in a cycle for a year while delaying his life decisions and inflicting damage on his nerves before finally getting surgery scheduled for two weeks later, questioning his initial fears concerning the procedure.

Based on his social media updates, the surgery yielded positive results.

A post from an X account linked to him displayed what resembled an X-ray of metal rods and screws placed in his lower spine.

Mangione recounted on Reddit that while the first few days post-surgery were painful, he was astonished to find himself free of pain medication by the seventh day. He admitted, “Getting back into rigorous activity might take some time, but it turned out to be much less daunting than I had expected.”

Medical professionals assert that managing back pain poses significant challenges, often reserving surgery as a last resort after other treatments have failed.

Dr. Jason Pittman, co-director of the Spine Center at Boston’s Beth Israel Deaconess Medical Center, stated that typically, doctors will first explore conservative methods like physical therapy or medication before considering surgical options. Even those with health insurance may face significant expenses related to surgical procedures, depending on various factors, although it remains unclear if Mangione dealt with such financial burdens.

Chronic back pain can also detrimentally affect mental well-being, as noted by Dr. Padma Gulur, a pain specialist at Duke Health.

She clarified that pre-existing mental health challenges, such as anxiety or depression, could intensify pain perception, leading to an exacerbation of suffering. Furthermore, chronic pain can also trigger anxiety and depressive symptoms.

Details surrounding Mangione’s mental health in recent months remain scarce, but indications suggest he was isolating himself from important relationships. Previous posts that have since been deleted on X indicate that a friend tried reaching out numerous times to no avail.

Family members reported him missing to authorities in San Francisco in November, according to police statements.

When he was in college, Mangione shared experiences regarding debilitating brain fog and restless nights on Reddit.

In a post from July 2018, he mentioned the impact these issues had on his academic performance, even contemplating dropping out of school. However, he ultimately decided that remaining in college allowed him to maintain a degree of normalcy.

His last message on Reddit appeared on May 17, while other communications from around that time imply he was not facing unexpected surgical complications or a resurgence of back pain. He seemed to continue advocating for the type of surgery he underwent months prior.

Earlier in April, he talked about the equipment he brought on a two-month backpacking excursion in Asia, which included cross-country motorcycling, stating he found a perfect blend of minimalism and practicality.

By late April, he encouraged another Reddit user dealing with back issues to continue seeking out different surgeons and indicated that framing the situation in terms of financial capability to work could evoke a more prompt response from the medical industry.

“In a capitalist society,” he wrote, “I’ve observed that using those key terms tends to elicit a far more urgent reaction from the medical field than merely recounting unbearable pain and its effects on your daily life.”