Luigi Mangione’s ‘Baffling’ Journey

I’m no William of Ockham, but the simplest explanation—a young man in the throes of mental illness—may prove the best.

Luigi Mangione, 26, a suspect in the killing of UnitedHealthcare CEO Brian Thompson, arrives for an extradition hearing at Blair County Courthouse in Hollidaysburg, Pa., Dec. 10, 2024. (Reuters/Matthew Hatcher)

By Michael Judge

Like most people I know with a loved one who’s suffered from a serious mental illness, I’ve been shocked by the media descriptions of Luigi Mangione—the 26-year-old private school valedictorian and Ivy League graduate apprehended by police Monday and facing murder charges for the shooting death of UnitedHealthcare CEO Brian Thompson—as “strangely normal” or a young man “on a baffling journey from star student to murder suspect.”

What’s baffling to me—and probably millions of other Americans who’ve seen a friend or family member suddenly commit bizarre, terrifying, and yes, sometimes violent acts in the midst of a psychotic break or paranoid delusion—is how willfully ignorant many in the media seem to be.

It may not be politically correct or ethically sound to speak about a defendant’s mental state until an official diagnosis. But often it seems to this old-school journalist that a story is somehow sexier and will attract more eyeballs if the perp is not simply a young man from a good family suffering from undiagnosed schizophrenia, bipolar disorder, or borderline personality disorder, but rather a radicalized Ivy Leaguer in the growing anti-corporate army who was willing to kill for the greater good.

Nowhere was this more sickeningly on display than in a TikTok post by a professor at the University of Pennsylvania, Mangione’s alma mater, enthusiastically smiling and gesticulating while playing the song “Do You Hear the People Sing?” from the Broadway musical “Les Misérables” under a banner that read: “Have never been prouder to be a professor at the University of P3nnsylvania.”

One wonders if that professor would be proud if Mangione had murdered Brian Thompson’s wife and two children as well? Or if he had happened to kill a security guard or police officer—a valuable member of the proletariat—along with the healthcare CEO? And will that professor still be proud if it turns out that it wasn’t his “social conscience” but rather God or Jesus or Satan himself who told Mangione to murder a 50-year-old father of two sons who grew up, according to The New York Times, “in a working-class family in Jewell, Iowa,” where “his mother was a beautician … and his father worked at a facility to store grain.”

Jewell, Iowa, is just about an hour’s drive from Mason City, Iowa, where I grew up. Like Thompson, my friends and I made money during the sweltering Iowa summers “walking beans,” a euphemism for whacking thousands of weeds and pulling up “volunteer corn” in acre after endless acre of soybeans. Thompson and his wife, Paulette, both graduated from my alma mater, the University of Iowa, and raised their kids in Maple Grove, Minn., near the town of Coon Rapids where my twin nieces attended high school.

Tragically, my nieces never knew their dad because when they were toddlers he took his own life. Like Mangione, my brother John was “strangely normal” before he suffered a psychotic break after a head injury and was eventually diagnosed with schizophrenia. Again, like Mangione, he was charming, handsome, and a great athlete—a star football player with a full-ride scholarship to the University of Iowa who most people thought would go on to great things.

But, also like Mangione, he suddenly dropped off his friends’ radar, appearing months later in the local news after committing a violent act: In John’s case, taking his own life at the age of 21 with a .22 caliber rifle he’d owned and cherished since boyhood. One can imagine a news story, after his death over Labor Day weekend in 1982, saying John had been “on a baffling journey from star football player to suicide victim.”

What the readers of such a story would not know was the journey mental illness had taken him on before he dropped out of sight and eventually took his own life—the crippling paranoia, the fear that people were out to hurt him and his twin girls. Most of all, the belief that he might hurt someone else—that he might take someone’s life because the voices in his head said he must.

In the throes of mania and paranoia, he was taken into police custody several times, miraculously not hurting law enforcement or any bystanders. Once he was picked up by state troopers after running the length of two marathons south on I-35, his shoes worn through, his feet swollen and bloody. He was simply “running toward God” he said when the officers took him into custody, delivering him to the nearest hospital.

John didn’t write a manifesto like Mangione did, but he did leave behind written clues as to his state of mind before his death: “Thank you God, mother and father, sister and brother, Lord be with my girls” was one. “The good returns. The bad stays gone. Forever someday the world will be all brother and sister” was another. But there were also darker messages: “Treat him like a fool. Lie to his face. He’s not as stupid as you think.”

That doesn’t sound too dissimilar from Mangione’s manic words, shouted as if his life depended on them, as he stepped out of a police car and was escorted—shackled at the waist and ankles—into a Pennsylvania courthouse Tuesday: “It’s completely out of touch and an insult to the intelligence of the American people and their lived experience!” he screamed, his eyes wild with fury and purpose.

I can hear readers saying, “How dare you make such a comparison. Mangione told the court himself on Tuesday that he had no drug or mental-health history that they should be aware of.” But, as is nearly always the case, a prominent feature of delusional thinking is not believing your thinking is delusional.

“How dare you call my manifesto the product of a delusional mind,” Mangione might tell the world sometime soon. “How dare you say my admiration and praise for the Unabomber’s murderous manifesto is a sign that I too share Ted Kaczynski’s diagnosis of schizophrenia!”

Of course, one can have radical political views—even views condoning violence for political ends—and not be mentally ill. As Mangione reportedly wrote about Kaczynski’s bombing campaign that killed three people and injured 23 others: “He was a violent individual—rightfully imprisoned—who maimed innocent people. While these actions tend to be characterized as those of a crazy luddite, however, they are more accurately seen as those of an extreme political revolutionary.”

Nevertheless, Kaczynski had a diagnosis of schizophrenia, as do nearly three million people in the U.S. today. According to the Treatment Advocacy Center (TAC), a nonprofit dedicated to eliminating the barriers to timely and effective treatment of severe mental illness, in 2020 schizophrenia was estimated to affect 1.1% of the U.S. population, or approximately 2.8 million adults. Tragically, an estimated 40% of individuals with the condition are untreated in any given year.

Importantly, psychotic disorders like schizophrenia “nearly always emerge in late adolescence or early adulthood, with onset peaking between the ages of 18 and 25,” says Dr. E. Fuller Torrey, a psychiatrist, founder of TAC, and the author of the bestselling book Surviving Schizophrenia, now in its seventh edition. The reasons for its appearance in this age-range have not been fully identified, says Dr. Torrey. “But some consensus has emerged around the concept that psychotic breaks are not, as they may seem, abrupt but rather are the climax of a long buildup. In this model, they are rooted in molecular changes in the brain that begin as much as a decade before symptoms occur and progress to an end-stage psychosis in which reality surrenders to delusion, paranoia, hallucinations, or other forms of disordered thinking.”

Other stressors like fevers, infections, or chronic pain—many reports say Mangione suffers from severe back pain—may also contribute to an eventual psychotic break and delusional thinking. However the delusional thinking is brought on, it often goes undiagnosed and untreated for too long. As Dr. Torrey explained in our March 2022 TFP conversation, “Many of [those suffering from schizophrenia and other serious mental illnesses] don’t ask for help because they don’t know they’re sick. They have a brain disease that does not allow them to think clearly about what they need.”

Could it be that Luigi Mangione, a 26-year-old who showed all the promise in the world until a Ted Kaczynski-like voice inside him told him to kill a healthcare CEO and father of two who was loved by his family and community, was suffering from a serious mental illness like schizophrenia—a brain disease that Dr. Torrey says “does not allow” those afflicted with it to “think clearly about what they need”?

And might that possibly—just possibly—be why an otherwise accomplished, sensitive, and “strangely normal” young man might lose touch with his loved ones and embark “on a baffling journey from star student to murder suspect”? I’m no William of Ockham, but in this case the simplest explanation may prove the best.