After made the difficult decision to undergo spinal surgery last year for chronic back pain, he became a proponent of the procedure that changed his life for the better.
He repeatedly posted on Reddit about his recovery and offered words of encouragement for people with similar conditions, telling them to push back against doctors who suggested they had to live with pain.
But notably absent from the posts are explicit concerns about corporate greed in the health insurance industry. Those appear to have surfaced only later: in a handwritten note found after Mangione was detained as a suspect in the killing of UnitedHealthcare CEO Brian Thompson.
That short document references 鈥減arasites鈥� in the health care system and laments the power and profits of health insurers, according to law enforcement officials. During his first public words since his arrest in Pennsylvania, Mangione emerged from a patrol car shouting about an 鈥渋nsult to the intelligence of the American people鈥� while sheriff鈥檚 deputies pushed him into a courthouse.
There鈥檚 no indication Mangione was ever insured by UnitedHealthcare, a senior New York City police official said in an .
The killing has nonetheless prompted about whether he had a But after his 2023 surgery, Mangione鈥檚 Reddit posts suggest he was overwhelmingly pleased with the outcome and finally relieved of chronic pain. He encouraged others not to be frightened by horror stories of surgeries gone bad. He also referenced a backpacking trip to Asia earlier this year.
The appears to have stopped posting on social media roughly six months ago, around the time he lost touch with loved ones.
Family and friends expressed shock at news of Mangione鈥檚 arrest, but little information has emerged about his recent mental and physical health.
Mangione鈥檚 Reddit posts reference a spinal condition called spondylolisthesis, which occurs when a fracture causes a vertebra to slip out of alignment. It can result in severe pain if the bone puts pressure on spinal nerves.
The condition, which can originate in childhood or from an injury, started negatively impacting Mangione鈥檚 life in recent years, according to his social media posts.
After earning his bachelor鈥檚 and master鈥檚 degrees from the University of Pennsylvania, he worked at the Santa Monica-based car-buying website TrueCar until 2023 and lived in Hawaii for some time starting in January 2022. During a six-month stay at Surfbreak, a 鈥渃o-living鈥� space in Honolulu, Mangione鈥檚 back pain worsened in part because of a surfing incident.
Josiah Ryan, a spokesperson for the owner and founder of Surfbreak, R.J. Martin, said Mangione had expressed growing concerns about the pain. In addition to missing out on recreational activities and exercise, he was worried about how it could affect romantic relationships.
鈥淭hat was definitely a theme in his time there,鈥� Ryan said. 鈥淗e wasn鈥檛 a big complainer. So it wasn鈥檛 like he was bringing it up constantly. But the people who knew him knew this was a significant part of his life.鈥�
In July 2023, Mangione wrote in a Reddit post that he had decided to get surgery.
鈥淚 got caught in this loop for a year, all the while putting my life on hold in my 20鈥檚 and damaging my nerves while I waffled on the decision. I have surgery scheduled in two weeks and I keep wondering why I was so afraid of it,鈥� he wrote.
According to his posts, the operation was a success.
An image posted to an X account linked to Mangione showed what appeared to be an X-ray of a metal rod and multiple screws inserted into his lower spine.
鈥淪urgery was painful for the first couple days, but I was shocked that by day 7 I was on literally zero pain meds,鈥� Mangione posted on Reddit in August 2023. 鈥淥bviously will be awhile until I get into rigorous activity, but it was way less of a big deal than I had anticipated.鈥�
Medical experts say treating back pain is almost always a challenge.
鈥淚n the gross majority of treatments, surgery is when everything else has failed to provide relief,鈥� said Dr. Jason Pittman, co-director of the Spine Center at Boston鈥檚 Beth Israel Deaconess Medical Center. He said doctors generally try conservative treatments like physical therapy, injections or medications before surgery.
Even people with health insurance can face thousands of dollars in bills from a surgery depending on their deductible and other factors, though it鈥檚 unclear whether Mangione experienced any of those issues.
Experiencing chronic back pain can also significantly impact mental health, said Dr. Padma Gulur, a pain specialist with Duke Health.
鈥淚f you have underlying mental health issues 鈥� anxiety, depression 鈥� your pain can be worse because you have way more suffering,鈥� Gulur said. 鈥淏ut, the second aspect is pain can push you into anxiety and depression.鈥�
Little is known about Mangione鈥檚 mental state in recent months, but it appears he was withdrawing from close relationships. Since-deleted posts on X show a friend repeatedly reaching out and getting no response.
His family reported him missing to San Francisco authorities in November, police said.
Earlier, 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 suffering and he had considered dropping out of school. But ultimately, 鈥渟taying in college has at least let me maintain some semblance of normality,鈥� he wrote.
His last Reddit post is dated May 17, but other statements around that time suggest he wasn鈥檛 experiencing unexpected complications or renewed back pain. He appears to be advocating for the type of surgery he received months earlier.
He posted in early April about the gear he brought on a two-month backpacking trip through Asia that included some cross-country motorcycling, saying he had found 鈥渢he perfect balance between minimalism and practicality.鈥�
In late April, he advised another Reddit user with a back problem to 鈥渒eep trying different surgeons鈥� and, if necessary, convey an inability to keep working.
鈥淲e live in a capitalist society," he wrote. "I鈥檝e found that the medical industry responds to these key words far more urgently than you describing unbearable pain and how it鈥檚 impacting your quality of life.鈥�
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Kelleher reported from Honolulu. Associated Press writers Tom Murphy in Indianapolis and Devi Shastri in Milwaukee contributed to this report.
Lea Skene And Jennifer Sinco Kelleher, The Associated Press
