LUIGI MANGIONE: How A Chronic Pain Survivor & Murderer Tapped Into A Zeitgeist Of Rage Against Health Insurance Companies

Yesterday, I shared on Facebook my thoughts about Luigi Mangione, the corrupt health insurance industry, the dismissal by many in health care of trauma-informed, mind-body medicine treatments, how even murderer parts are just that- parts, and how even though hurt people hurt people because of trauma, we must still hold them to account for their criminal actions because vigilante justice is not really just.

What I wrote stirred up a lot in people, including the many who did not appreciate my choice of imagery based on this article I read The Meme Glorification Of Luigi Mangione, which featured a meme casting the murderer as the patron saint of health care justice, complete with halo. In spite of the bad taste and lack of empathy these memes show towards the murdered victim, I chose these images to represent how much this situation has tapped into the zeitgeist of people’s learned helplessness and rage around health insurance injustices, not because I agree in any way that a murderer is a saint, but because I get why sick people are sick and tired of having their claims denied and their needs unmet. Here’s the meme I shared, in case you’re curious.

The many comments people shared on Facebook are worth reading here, if you’re curious. I’ll share the rest of what I wrote, and I’d love to hear what it brings up in you all. But first, I’ll share a nicer image, taken during today’s winter storm in coastal California.

As a physician who left the hospital in 2007 because I could no longer cooperate with a system that gives lip service to patient wellbeing while being ultimately at the mercy of the financial bottom line, and as an expert in mind body medicine and traumatology who teaches physicians, therapists, and patients about the strong link between psychological trauma and medical disease, I’ve been observing the whole Luigi Mangione story with a kind of morbid curiosity as he gets glorified as the patron saint of health care justice and valorized as some sort of folk hero by people who are fed up with the corruption of the American health care system and the for profit insurance companies that are destroying it.

While there is never any excuse for violence and my heart goes out to the family of United Health Care CEO Brian Thompson, among those of us who have had to deal with a very broken health care system, who hasn’t fantasized about getting revenge on the greedy corporate middlemen, who are not doctors but somehow think they have any business interfering with the sacred doctor-patient relationship or deciding who they’re going to reimburse for necessary medical care? What patient who has had their health care claims denied or their life and pain-saving medical treatments refused hasn’t felt murderous rage when they find out these fat cats are making $10 million/year? Who hasn’t thought about offing someone when they’re in severe pain and can’t get empathy from anyone in the corporatized American health care system?

When you’re an insider in the corporate health care structure, like my partner Jeffrey Rediger was, as medical director of Harvard’s McLean Hospital, it’s maddening to discover that it’s a known business strategy for insurance companies to create obstructions for doctors and patients to get treatment or reimbursement for medical care. Most doctors I know are very empathic human beings who are trying to do right by their patients, but I have yet to meet a corporate middleman who gives a shit about how much a patient is suffering or how hard a doctor is trying to help them. Have I felt enraged at these people and wanted them to be held accountable (in an ethical way, of course), by all means, Hell Yeah.

Now, I’m not endorsing murder as a solution to what ails the American health care system. Nor am I making excuses for someone who I hope is held accountable for his crimes, so the family of the victim can get some justice and peace. And I’m in no way saying anyone should go mow down some health care fat cats.

But I am curious about this guy’s murderer parts.

In Denver in 2019, at the Internal Family Systems (IFS) conference where I co-taught an IFS As Medical Treatment daylong workshop with IFS founder Dick Schwartz, I watched a video shown by “the Oprah of China” Hailan Guo, who is a medical doctor and IFS practitioner/ psychotherapist who teaches “Inner Peace Coaching” to lay people in China. One of her clients was the District Attorney of a small village in China, where a 14 year old boy had murdered two 15 year old boys and had been mute ever since.

After his arrest, the DA gathered the village around the boy, including the parents of the victims and his own parents, and in front of everyone, she acknowledged that the boy had a murderer part, but that it was only a part, not the whole boy. And that he had a mute part, but that also wasn’t the entirety of his being. She asked if the mute part would step aside so she could talk to his murderer part (a “firefighter” protector part, we can assume, using IFS lingo.)

She then proceeded to do a whole IFS session with him, getting to know and extend compassion to his murderer part, understanding his mute part, and “unburdening” the severely wounded part those parts were protecting. The whole village was apparently in tears, and the parents of the victims were moved by their compassion. The parents of the boy were so touched that they decided to sell their home and give the money to the parents of the victims, and the whole village went through its own restorative justice healing because of it.

I don’t know what happened to him after that. I assume he still went to court and jail. But there was healing, in addition to justice.

When I hear about Luigi Mangione’s history of growing up in an extremely privileged family and suffering from debilitating back pain, and when I just found out from a colleague that he was a fan of David Hanscom’s Do You Really Need Spine Surgery?, John E. Sarno’s Healing Back Pain: The Mind-Body Connection, and Gabor Mate’s The Myth of Normal, my spidey senses perked up.

I don’t know anything about Luigi Mangione’s family, and I’m sure they’re suffering enough, so I don’t want to cast any aspersions upon them. But in my experience working with trauma survivors, coming from an extremely privileged family is often code for “suffered from narcissistic abuse,” since if you’re that rich, there’s usually a narcissist or two in the family causing holy hell for those who are “one down” to someone else’s “one up.” Show me one powerful person at the top of the power and privilege chain who doesn’t have at least one person in the family abusing their power on their own children. The poor little rich kid isn’t a cliche for nothing.

And the fact that Luigi Mangione had chronic back pain that he must have suspected had mind-body origins if he was drawn to David Hansom, John Sarno, and Gabor Mate pushes all my “This guy is somaticizing his trauma” buttons. John Sarno believed that a lot of non-organic back pain results from suppressed rage, so maybe we shouldn’t be surprised that it blew out into a full blown murderer part.

Now don’t get me wrong. Lots of people have back pain or narcissistic parents and they don’t go kill people. But we need to talk about how hurt people hurt people, and how sociopaths in the family can raise budding sociopaths. We also need to talk about medical trauma, and how we’re not helping people when we ignore relational trauma and go straight to surgical fixes or drugs.

I can’t help wondering what would have happened if Luigi Mangione could have been a client of Howard Schubiner’s. At the same IFS conference where I saw the IFS video about the DA and the teen’s murderer part, I met Howard Schubiner, MD, a student of John Sarno’s and author of Unlearn Your Pain, who specializes in treating chronic pain not caused by structural damage with psychological treatment methods. I invited Howard to teach physicians at the Whole Health Medicine Institute. One of the students had debilitating facial pain that had failed to respond to other medical interventions. During the course of his treatment, her pain dropped to zero and months later, when I followed up, had not returned.

In a recent study published in the Journal of Pain by Howard Schubiner, 222 patients with spine pain were studied, and although 98% had at least 1 spinal anomaly on imaging, a careful diagnostic evaluation found that 88% of patients had primary (also called neuroplastic) pain, meaning that the pain was generated directly by the brain, rather than resulting from structural damage. Neuroplastic pain results from traumatic stress, painful emotions, and other life challenges and has been proven to be treatable with “pain relief psychology,” like the kind practiced by John Sarno and passed on to Howard Schubiner and others like him. In this Boulder study, pain scores in people with an average duration of pain of 10 years dropped from 4 out of 10 to 1 out of 10 in one month and remained there for a year of follow-up.

But since photos of his spine with metal in it suggests that Luigi Mangione must have gone for the back surgery, which is famously known to make many people worse and fail to resolve symptoms, since if pain is neurogenic in origin, fixing hardware isn’t going to help.

A part of me is reluctant to write more articles about a murderer who has captured the public imagination, become a sort of folk hero for people who are outraged at the health care system, attracted the lust of women and men alike who think he’s hot, and proven, once again, that being a cis, white, hetero, socioeconomically privileged, hot, young male means you can murder someone in cold blood and you’ll still make it to the top of the news feed in ways that are anything other than derogatory.

But with that disclaimer, I couldn’t help chiming in about our need for health care reform, how sad and angry it makes me that mind-body medicine and treating trauma as part of any medical treatment isn’t completely mainstream by now, and why even murderer parts are protector parts, trying to protect us from overwhelming feelings from young wounded parts that were very often harmed by the parents who were supposed to have loved us.

Again, I hope justice is served and this guy doesn’t get off scot free just because he’s at the top of the privilege hierarchy. But if his goal was to start a nationwide conversation about how f*cked our health care system and was willing to go to jail for it, well…I dare say he succeeded.

What does all this bring up in you? I’d love to hear what’s roiling around in the rest of you.

*Schubiner H, Lowry WJ, Heule M, et al (2023). Application of a Clinical Approach to Diagnosing Primary Pain: Prevalence and Correlates of Primary Back and Neck Pain in a Community Physiatry Clinic. Journal of Pain