No one knows what went through the mind of Sydney shopping mall killer Joel Cauchi, but psychiatrists believe one underlying cause of his rampage was schizophrenia, which he stopped taking and dropped out of treatment for.
Since the knife assault at Bondi Junction on April 13, which killed five women and a male security officer and injured another twelve, including a nine-month-old girl, many have been looking for an explanation.
Cauchi’s parents have stated that their son was diagnosed with schizophrenia at the age of 17 and treated effectively for around 18 years.
Schizophrenia is a dangerous mental condition that can produce hallucinations, delusions, and disturbed behaviour. It requires lifetime treatment.
Karen Webb, the New South Wales police commissioner, said it was “obvious” to her and officers that the 40-year-old Cauchi targeted women while avoiding men, igniting a media debate over misogyny in Australia.
Prime Minister Anthony Albanese condemned the gender distribution among the victims as “concerning” and promised to do more to combat violence against women, citing a weekly toll of one woman killed at the hands of a man they knew.
“But we will never know what was in the mind of the perpetrator of these acts,” said professor Ian Hickie, co-director of health and policy at the University of Sydney’s Brain and Mind Centre.
“Ordinary people are trying to impose a rational explanation,” he told AFP. “The most obvious one is the irrational mind of the perpetrator.”
Recurrence of the mental illness cannot by itself necessarily explain the violence against other people, which is “extremely rare” in such cases, Hickie said.
“Often these things are complicated by other factors; drug use, disconnection, social isolation, homelessness.”
Hickie explained that no two psychotic people have the same thoughts, which are shaped by each person’s unique, irrational interpretations of the universe.
Cauchi may have attacked women because men were better able to protect themselves—for example, Frenchman Damien Guerot was acclaimed a hero for fending off the assailant with a metal post, he added.
‘Acutely psychotic’
“The wider issue of domestic violence and the number of women who are harmed or killed by men who do not have any mental illness in our country is a national problem. I don’t think this is a manifestation of that problem,” Hickie said.
“The social factors that matter here are homelessness and isolation, and the stigmatisation of treatments for mental illness.”
Cauchi’s parents say he progressively tapered off his medicine over the course of several years after consulting with a doctor and feeling good. He moved from his family’s home in Toowoomba, Queensland, to Brisbane, the state capital, and then to Sydney recently.
Since leaving home, he had been living in a vehicle and hostels, only communicating with his family on occasion via text messages.
According to Patrick McGorry, professor of youth mental health at the University of Melbourne, he appeared to be unaware that he was developing ill and “became homeless, completely disconnected from any sources of support, and ended up in this very acutely psychotic state”.
McGorry, a former president of the Schizophrenia International Research Society, described his behaviour as “completely disorganised or delusional.”
Cauchi’s actions were “completely off point” when attributed to misogyny.
“It’s purely a case of untreated or poorly treated mental illness,” he told reporters.
It stated that Australia’s mental health system was “completely inadequate” to ensure that people like Cauchi received ongoing care.
“It is true that he wanted to move cities but in that case the healthcare should have been set up for him at his destination,” McGorry said.
If patients with schizophrenia stop medication, there is an 80 percent-plus chance of the disease returning, he told AFP.
“And when it comes back, it is likely that the person will not recognise that it’s returning and won’t seek help.”
Nowhere to go
Carolyn Nikoloski, chief executive of Australia’s peak advocacy group Mental Health Australia, said there was a gap in support for people with complex care needs.
People were often turned away from hospital emergency departments because their illness was not judged to be serious enough at the time, she told AFP.
“That’s a common experience, and there is nowhere else for them to go,” Nikoloski said.
“We know that overall mental health expenditure does not meet the burden of disease, and it has declined over time.”
The health system was unable to catch people who fell between the cracks, said professor Anthony Harris, head of psychiatry at the Sydney Medical School with a special interest in psychosis.
“The real issue here is that this man is diagnosed with schizophrenia — that is one of the most severe mental illnesses you can have — but he just drops out of care and drops out of community,” he said.
“If you had cancer, if you had a severe physical illness, there’s this whole system of follow-up care,” Harris said. But with a severe mental illness, “nobody seems to blink an eye”.