Slain CEO and His Accused Assassin: The Backstories

Luigi Mangione, a suspect in the fatal shooting of UnitedHealthcare CEO Brian Thompson, is escorted by police in New York on Dec. 19, 2024. Pamela Smith/AP Photo

News Analysis

Brian Thompson, an Iowa farm boy and valedictorian at his small-town public high school in 1993, worked hard to reach the top of UnitedHealthcare’s corporate ladder.

Just three years after Thompson reached that career pinnacle, his life was cut short allegedly by Luigi Nicholas Mangione—a young man who had been blessed with a better-than-average chance for a happy, successful life.

Mangione is a 2016 private-school valedictorian and Ivy League graduate who hailed from a wealthy Maryland family.

The paths of these two apparent strangers from disparate backgrounds likely would have never intersected, if not for Mangione’s alleged actions along a darkened New York City street.

Just before dawn on Dec. 4, Thompson, 50, emerged from his Manhattan hotel and strode toward a nearby conference. A masked gunman, who had been lying in wait, walked behind Thompson and opened fire into the unsuspecting victim’s back.

Now, Thompson is dead and the gunman, alleged to be Mangione, 26, sits in a jail cell facing a possible death sentence if convicted of murder and other charges arising from Thompson’s slaying.

This so-called “spectacle crime” inspired strong reactions from the public. Many decried the slaying and expressed condolences for Thompson’s family and friends. People who knew Thompson describe a caring person who quietly pursued excellence.

The man accused of killing him drew unexpected levels of support from some critics of the health care industry; authorities say Mangione wrote in a notebook about his disdain for wealthy health care executives, and spent six weeks plotting his alleged ambush of Thompson.

Thompson’s employer, UnitedHealthcare (UHC), says neither Mangione nor his parents had been UHC clients—adding to the mystery as to why Mangione would specifically target Thompson, as alleged. Two doctors in specialized fields who spoke to The Epoch Times offered insights into the possible mindset and motivation for the alleged crime.

Meanwhile, as authorities continue to investigate and prosecute Mangione, people who knew the two men told The Epoch Times they grieved the loss of Thompson’s life and were sickened by the killing—and the actions of those cheering Thompson’s demise.

Two Lives, Two Futures Shattered

Freddie Leatherbury, a classmate of Mangione at Gilman School, said he feels for both families and for everyone experiencing the fallout.

In an interview with The Epoch Times, he bristled against people who might be trying to connect “the negative qualities that are alleged about Luigi to his family and his school.”

Leatherbury said Mangione’s family has been an upstanding one, that many Gilman graduates went on to achieve great things, “and we’re obviously mourning Brian Thompson.”

“His family is changed forever,” Leatherbury said, noting that Thompson was a married father of two.

At the same time, “the Mangiones are two parents wondering what they could have done differently,” Leatherbury said, “because the future they thought they were going to have with their son is now not going to happen.”

Mangione’s classmate thinks it’s possible that the robotics wiz somehow “got sucked into an ideology” that radicalized him. He remembers Mangione being “so normal and unassuming, with no sign of eccentricities.”

That’s why it was “surreal” to see his friend on TV, handcuffed, shouting at reporters as police led him into a building.

“He was never really the kind to make an outburst,” Leatherbury said.

Leatherbury said that, even before he knew that Mangione was the suspect, he was appalled to see comments from people celebrating Thompson’s assassination.

“I can’t help but just denounce all of that so completely; this isn’t how we solve things,” Leatherbury said about Thompson being slain.

Gilman School in Baltimore on Dec. 10, 2024. Madalina Vasiliu/The Epoch Times

Puzzling Turn of Events

Leatherbury said he has been in touch with many former classmates, and all of them are puzzled over what could have pushed Mangione to allegedly resort to violence.

“I would love to know what changed ... I’m just praying for his soul,” Leatherbury said.

His fondest memory of Mangione dates to eighth grade, when their class went on a weeklong outdoor camping trip. “I just remember he was kind of the ambitious one at the front of the line—helping set up tents, getting water, whatever,” Leatherbury said.

Although Mangione had leadership qualities, he was never boastful, Leatherbury said.

“I didn’t know he was valedictorian until he gave that speech,” Leatherbury said.

After their graduation, he and Mangione fell out of touch. But during that eight-year span, Leatherbury gathered that “Luigi was just being Luigi”—until six months ago or so.

That’s when he “went off the grid” and disconnected from his family, Leatherbury said. Mangione’s mother is said to have reported her son was missing in San Francisco, according to media reports. Police there did not respond to The Epoch Times’ attempt to confirm that report by publication time.

Leatherbury said he believes the timing coincides with Mangione undergoing a spinal surgery—as evidenced by an X-ray that Mangione posted on social media, showing screws in his lower spine.

“If the reported facts are true, then I think it’s fairly easy to connect the dots to a back surgery that caused him a lot of pain,” Leatherbury said.

Mangione’s former roommate in Honolulu, Hawaii, R.J. Martin, told several media outlets that Mangione had suffered from back pain. Mangione had retreated to Hawaii in hopes of getting healthier. But participating in a surfing lesson seemed to aggravate his condition, Martin said. The pair lived in Hawaii under the Surfbreak program, which offers “co-living” and “co-working” spaces to people whose jobs allow them to work remotely, via computer.

Josiah Ryan, a Surfbreak representative, told The Epoch Times that “the person who allegedly committed this crime, this has nothing in common with the person that we knew.” Ryan saw Mangione as “a positive, giving member of the community.”

Mangione lived with the Surfbreak group for the first six months of 2022, Ryan said. During that time, Mangione never mentioned Thompson or UnitedHealthcare as far as Ryan knows.

Sometime after leaving Hawaii, Mangione underwent the surgery and posted a photograph of the spinal X-ray online—without explanation.

Pain Doctor Poses Questions

Dr. David Clarke, who has helped chronic pain sufferers for more than 40 years, told The Epoch Times: “There are a lot of concepts that have been reported about Mr. Mangione that resonated for me.”

Asked whether back pain could have caused Mangione to turn violent as alleged, Clarke said “it’s very fair to say that it played some role.” However, in his experience, pain sufferers would tend to hurt themselves or commit suicide rather than lash out at others.

Without having examined Mangione or his medical records, Clarke said his commentary must remain limited. Clarke said Mangione’s case raises important questions about his pain. He also observed that some features of Mangione’s situation mirror those he has seen in some of his own pain patients.

For starters, Clarke noted, “the mean age for spinal fusion is in the late 50s,” causing him to wonder why Mangione had this surgery in his 20s.

“He may have had a trauma that was responsible for this ... he may have had a very solid medical indication for this,” Clarke said. Clarke wonders whether the root cause of Mangione’s pain was identified properly.

“Lots of spine surgery and other invasive procedures are done for pain that a person is feeling in the back, and the pain is actually being generated in the brain,” he said.

This can be called “chronic primary pain” or “neuroplastic pain.”

Such pain is “generated by the brain and not by a disorder in the spine itself,” Clarke said, estimating that 20 percent of adults suffer from this problem. “This is the biggest blind spot in healthcare right now,” said Clarke, president of the Association for Treatment of Neuroplastic Symptoms. That nonprofit, founded by physicians and psychologists, is dedicated to “sharing the new science of chronic pain and illness,” its website says, noting that it employs “Pain Relief Psychology” to address patients’ pain.

A Harvard University professor spoke about chronic primary pain in 1925, “but the concepts have kind of been lost amid the tsunami of technology that’s overtaken medicine,” Clarke said.

Clarke says he has seen people try to dismiss it as an “it’s-all-in-your-head” condition, “but this is not in people’s heads.”

“It’s in their brain, and it’s physiologically invasive, and it is 100 percent real,” Clarke said.

He, too, had been a skeptic until he saw the condition and its successful treatment in his practice and in recent scientific studies. Clarke, who is based in Portland, Oregon, said people don’t want to believe that “the brain could do such things to a person’s body, and that it could cause real symptoms that could be severe, that could put you in the hospital.”

One of his patients, a 17-year-old, had been hospitalized for 70 days and “was getting morphine around the clock for unexplained abdominal pain.” Try telling that patient that the pain was imaginary, he said, adding that the pain subsided after finding the source of the stress that touched it off.

Clarke finds it intriguing that Mangione reportedly read “Back in Control: A surgeon’s roadmap out of chronic pain.” One of the authors is Dr. David Hanscom, a former board member of Clarke’s nonprofit. The group is the only organization of its kind in the United States, Clarke said, and was known as the Psychophysiologic Disorders Association when Hanscom participated.

Hanscom’s book stresses the importance of evaluating people for brain-generated pain, and for underlying stresses and traumas, Clarke said.

“To find the exact nature of the pathway from pain to allegedly shooting somebody, you'd have to be ... talking to him in some detail to figure that out,” Clarke said.

Analyzing Mangione Theories

Dr. Michael Welner, a forensic psychiatrist who teaches at Mt. Sinai School of Medicine, rejects several popular theories about Mangione.

One is the notion that Mangione may have suffered a sudden mental breakdown before the alleged murder.

“A premeditated crime of this nature does not happen from a ‘snap,’” Welner said.

Even without a specific diagnosis yet, a few things are clear, he said.

The slaying of Thompson fits Welner’s definition of “a spectacle crime”—an attention-getting act intended to shock people and make a symbolic statement.

That alone reveals something about the alleged perpetrator.

Anyone who commits a spectacle crime is acting upon a belief that “my agenda is more important than your life,” Welner said. “It’s that fundamental.”

Further, he said, “people who carry out spectacle crimes inevitably have some degree, some significant degree, of pathological narcissism ... a grandiosity that has them ‘thinking big.’”

“It may not be the only diagnostic explanation,” said Welner, chairman of The Forensic Panel, a group of experts that aims “to expose hidden or misunderstood evidence” in various disciplines, its website says. Simply put, the panel includes “scientists who assist the courts,” Welner said.

“The grandiose agenda is a core part of the spectacle perpetrator,” Welner said.

‘Pathological Narcissism’ Perspective

Narcissism, or self-centeredness, can also manifest in healthy ways, Welner said. Positive regard for oneself can inspire a person to achieve valedictorian status and become physically fit, for example—goals that Mangione clearly achieved based on his school record and a shirtless photo of Mangione sporting a physique on his social media account.

But what happens when a high-achiever suffers a major setback, such as a debilitating back injury?

“We can’t answer that,” Welner said, “but that is a type of life-altering event ... that can pave the way for tremendous disappointment.”

When Mangione posted the X-ray of his back, he signaled that it was significant to him and his self-concept, Welner said.

If such a person sees life-altering setbacks as irreversible, “the disappointment can be a portal to pathological, destructive narcissism,” Welner said. Spectacle destruction for a “higher cause” could become an “alternative grand life path for his manhood,” Welner said, adding, “It’s really about him.”

Welner notes that Mangione made positive remarks about convicted serial killer Ted Kaczynski’s manifesto. Still publicly accessible on the Goodreads book-review site as of Dec. 29, Mangione’s four-star review says Kaczynski’s actions could be considered “those of an extreme political revolutionary.”

Mangione did opine that Kaczynski was “rightfully imprisoned” because he “maimed innocent people.”

In the review, Mangione cited a passage that another person wrote on Reddit in 2022 saying Kaczynski had the guts to acknowledge that “peaceful protest has gotten us absolutely nowhere” in reforming corporate America.

The Reddit post, as cited by Mangione, continued: “When all other forms of communication fail, violence is necessary to survive ... it’s not terrorism, it’s war and revolution.” The cited passage goes on to say that big companies prioritize profits over people.

“‘Violence never solved anything’ is a statement uttered by cowards and predators,” it concludes.

Past Comments Provide Clues

Mangione’s comments about Kaczynski demonstrate that he “identified with destructiveness as an ideal,” another characteristic of a spectacle-crime perpetrator, Welner said.

Kaczynski, who died in a North Carolina prison last year at the age of 81, began serving multiple life sentences in 1998 after admitting to a string of slayings. Three people were killed and 23 were injured in explosions of bombs that Kaczynski crafted in a Montana cabin, and then sent via mail. Kaczynski, a former mathematics professor, was called the “Unabomber” because his initial targets included people at universities.

Theodore Kaczynski looks around as U.S. Marshals prepare to take him down the steps at the federal courthouse to a waiting vehicle in Helena, Mont., on June 21, 1996. Elaine Thompson/AP Photo

Welner thinks that Kaczynski’s 17-year spree may have also lulled Mangione into believing he could similarly elude the authorities after allegedly committing the murder, especially coupled with lifelong recognition of Mangione’s intellect.

“I think that anyone can become enamored of their own brilliance,” and assume that they can “think of everything” to avoid getting caught, Welner said. Many movies, TV programs, and other popular media tend to give people the impression that “you can get away with killing and you can get away with ‘the perfect crime.’”

That runs counter to the adage ingrained in older generations’ psyches: “Crime doesn’t pay.”

A scenario such as the one that led to Thompson’s death required a considerable amount of planning. His would-be killer had to acquire a weapon, get information on when and where they could accost their intended target, and map out an escape plan through a big city that may have been unfamiliar to them.

It takes a certain amount of humility for a would-be killer to realize, “If there’s one thing I forget to think of, I’m done; I’m cooked,” Welner said.

Therefore, if Mangione did kill Thompson, overconfidence may have been his undoing, Welner said.

“What goes along with unhealthy narcissism is hubris ... the belief that I’m smart enough to pull this off,” Welner said.

A suspected criminal on the run from an intense search is forced to remain hyper-vigilant, and that “eventually does take its toll,” Welner said.

Being alone, with no one you can trust, and aware that your image is widely publicized creates “a tremendous psychological burden on the fugitive,” he said.

“When that dragnet and the intensity of it escalates, it does not allow for relief ... he comes to believe that every camera is going to catch his image,” which produces a lot of stress, Welner said.

Many would-be criminals fail to fully consider those ramifications as they plot their misdeeds, Welner said.

Message for Those Who Identify With Suspect

Welner disagrees with people who think it was “stupid” for Mangione to be dining at a McDonald’s in Altoona, Pennsylvania, where he was arrested five days after Thompson was killed.

“You can be a dispossessed person at McDonald’s, and you’ll fit right in ... where else are you going to go to eat without attracting attention?” Welner said. Wearing a surgical mask on his face—a vestige of the COVID-19 pandemic—might have aroused more scrutiny, Welner said.

“COVID panic is out of place in 2024 Altoona,” he said

During his 30 years in forensic psychiatry, Welner has seen everyday people on the lookout as law enforcement’s most important asset. Police cannot rely solely on forensic technology; they need people to come forward and say, “Hey, I saw somebody who looks like the person you’re looking for,” Welner said.

Mangione’s arrest reinforces the notion that “investigative and forensic resources will be marshaled in spectacle crimes such that you’re not going to get away with it,” Welner said.

“That’s an important message of a case like this to those who identify with Mangione,” he said.

“Do you want to be imprisoned? Because that’s how the story ends.”

Suspect Luigi Mangione is taken into the Blair County Courthouse in Hollidaysburg, Pa., on Dec. 10, 2024. Janet Klingbeil via AP

Impact in Iowa

Meanwhile, the effects of Thompson’s death have reverberated deeply, especially in places where Thompson lived and worked.

In Thompson’s Iowa hometown, his death hit hard, especially among people who knew him and his family, said Todd Coy. Now principal of Thompson’s alma mater, South Hamilton High School, Coy had been Thompson’s health and physical education teacher.

“Even after 30 years, he still stands out as one of those students that made a difference,” Coy said.

He said it bothers people to know “someone born and raised in the Jewell area and a South Hamilton graduate that is part of such a senseless, tragic loss like this.”

In response to negative comments about Thompson—apparently from people who didn’t know him but resent his line of work and “corporate America”—Coy dismissed them.

“That’s a dumping zone anytime you get into social media,” he said. “It’s easy to reflect on things that you’re not held accountable for.”

Coy considers Thompson to be a “small-town Iowa success story.”

Signs of his potential emerged early, the former teacher recalled: “He was determined and was going to excel at whatever he chose to do.”

Coy remembered Thompson as a model student who inspired his peers and the larger community. He served as homecoming king and class president, while also being a standout trombone player and athlete.

Yet the young man showed no sign of conceit; he seemed to be liked by all, Coy said.

Thompson and his brother, Mark, grew up in a rural middle-class family that had deep roots in Jewell.

Dennis Thompson, their father, was a South Hamilton grad who married his high school sweetheart, the former Pat Hunter, in 1968, his 2023 obituary says. The patriarch spent 43 years working in Jewell-area grain elevators; even after retirement, he continued helping local farmers at harvest time.

After graduating from high school, Brian Thompson also graduated at the top of his college class at the University of Iowa.

He earned a bachelor’s degree in business administration and an accounting major in May 1997, “with special honors and with highest distinction, meaning his GPA was 3.95 or above,” the university said in an email to The Epoch Times. Thompson then was employed at PricewaterhouseCoopers as an audit manager before being hired at UnitedHealth Group in 2004.

He was named the CEO of UnitedHealthcare in 2021, a position that draws a multimillion-dollar salary.

Thompson’s eventual success didn’t change him, his former teacher said. When Coy saw Thompson at his father’s funeral in 2023, his demeanor betrayed no clue that he was the big cheese at UHC.

“He was as humble and down-to-earth as he was when he graduated in 1993,” Coy said.

Minnesota Mourns, Too

In greater Minneapolis, home of UnitedHealthcare’s headquarters, Thompson was remembered as a person who did good deeds.

He was instrumental in securing Minneapolis as the site for the 2026 Special Olympic Games.

Tim Shriver, an advocate for the organization, paid tribute to Thompson with this statement: “Brian Thompson was a friend, an ally, and a believer in the power and importance of the athletes of Special Olympics. His sudden and horrifying death has left all of us in Special Olympics in shock and heartbreak. We will hold his spirit as we run our races for justice and joy and pray for his rest.”

David Frey, mayor of Minneapolis, said in a social media post: “This is a shocking and devastating loss for our whole community. Brian was a great man and my thoughts are with his family and friends at this time.”

Under that post, a person using the name “Anonymous Account” retorted: “Nobody thinks he was a great man,” along with a chart purporting to show UnitedHealthcare’s insurance-claim-denial rates.

In the wake of Thompson’s death, the company said “inaccurate and grossly misleading information” has been circulating about it. “UnitedHealthcare approves and pays about 90 percent of medical claims upon submission,” a Dec. 13 news release said.

Flags at the corporate offices flew at half-staff following the death of Thompson, who lived with his wife and sons in a Minneapolis suburb.

Flags fly at half mast outside the United Healthcare corporate headquarters in Minnetonka, Minn., on Dec. 4, 2024. Stephen Maturen/Getty Images

On Dec. 11, a day after Thompson was buried and colleagues gathered to celebrate his life, UnitedHealth Group CEO Andrew Witty sent a companywide email about the impact of Thompson’s death—and his life.

“It was a life lived to the absolute fullest. And a life that helped make a profoundly positive impact on the lives of so many people. People he never saw. People he never met. People who never knew him. But people Brian cared so deeply about,” Witty wrote in the message, which the company provided to The Epoch Times.

“Brian was one of the good guys. He was certainly one of the smartest guys. I think he was one of the best guys. I’m going to miss him. And I am incredibly proud to call him my friend.”

Witty suggested that the best way to honor Thompson’s life would be to “carry on his legacy—continuing to do right by the people who’ve entrusted us with their care and those who are counting on us to take care of their loved ones.”

“We owe it to Brian to make good on our promise to make health care work better for everybody, in every way,” he concluded.