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Kono’s accused killer believed his mental illness under control

While the events leading up to the tragic shooting of Alan Russell Kono last week remain a mystery to most, a profile of his accused killer released earlier this year by Kitsap Mental Health Services(KMHS) is offering some insights into the battle Wayne Brent Hower waged with mental illness for more than 10 years.

Hower, 44, charged last week with murder for allegedly shooting the 48-year-old Kono in front of his store on June 23, was one of six patients featured in a series of portraits and profiles KMHS created called “Journeys of Recovery.”

For the series, Hower and five other patients agreed to be photographed and interviewed about their struggles with various mental illnesses that KMHS treats.

According to the KMHS’ 2004 Annual Report booklet, the series was created to help “(change) the face of mental illness to mental wellness,” and remove some of the stigma surrounding such diseases as depression, bipolar disorder and schizophrenia.

Bainbridge Island photographer Karyn Carpenter spoke to each of the patients and took their pictures for the series, which was funded in part by the Munson Family Foundation and displayed in various Kitsap Bank branches.

In his profile, Hower revealed that he began hearing voices in his head more than a decade ago at the age of 33.

“It was like someone took over my brain and started putting stuff in it,” he is quoted as saying, explaining that within a couple of months people around him began noticing his personality was changing, but he thought it was others who were changing, not him.

According to the profile, Hower’s parents soon became concerned he might be a danger to himself and had him placed in an in-patient evaluation treatment center. There he was diagnosed with schizoaffective disorder with psychotic tendencies.

A medical doctor familiar with the disease and its treatment, who provided information solely for background and not attribution, gave an overview of Hower’s diagnosis.

He described it as a hybrid, or a merger, of two different conditions — schizophrenia and a mood disorder, such as depression or manic-depressive disorder.

As far as the added phrase “psychotic tendencies,” he described that as redundant because those behaviors are already consistent with a schizoaffective diagnosis, but it can indicate a patient’s particular vulnerability to psychosis, or the inability to separate fantasy from the real world.

He said symptoms of schizophrenia include hallucinations, delusions, social withdrawal, and a marked disorganization of thought processes, while symptoms of mood disorders include a marked and prolonged decrease in regular functions such as sleep, appetite, sexual activity, and a general lack of joy or pleasure in daily life.

Fortunately, the same medications can be used to effectively treat both schizophrenia and mood disorders, so patients with schizoaffective disorder are not necessarily more treatment-resistant, the doctor said.

In about two-thirds of all mental health patients, he said the prescribed medications are effective in reducing symptoms and recurrences of major episodes, affecting a complete or near-complete remission. However, if patients stop taking the medication, the majority will be re-hospitalized within a year.

According to Hower’s profile, after his diagnosis he gradually “regained control of his life through medication, counseling and self-work.”

He explained that at first he was very frustrated with the irrational ideas invading his mind, but “...now, when a thought comes into my head, I’m better able to evaluate it, and when I realize it isn’t mine, I’m able to blow it off.”

But, he continues, it was a constant struggle to separate the rational thoughts from the irrational ones.

“The ‘voices’ haven’t given up trying to convince me of their ideas,” Hower said, “but I was probably more gullible in the beginning of this. (The voices) really threw me for a while.”

Few specific details have been revealed about what might have led Hower to allegedly shoot Kono — who has been described as his friend — that afternoon.

Officials and staff at KMHS declined to speak on the record regarding Hower’s treatment, or his recent mental health.

Although the KMHS profile lists Hower’s occupation as “life coach,” in his first court appearance following Kono’s shooting, prosecutors said their records indicated he was unemployed.

Investigators with the Kitsap County Sheriff’s Office report they have not uncovered a motive for the killing, and a source revealed only that Hower’s family members told the Sheriff’s Office shortly after his arrest he had not been taking his medication.

In a court hearing this week, Dr. Scott Lindquist of the Kitsap County Health District, which oversees the administration of prescription drugs to county jail inmates, revealed that Hower is currently prescribed risperidone, the generic form of Risperdal, an antipsychotic drug used in the treatment of disorganized or psychotic thinking, including aggression or false perceptions.

One of Hower’s defense attorneys, David LaCross, revealed in Kitsap County Superior Court that the defendant’s blood was drawn shortly after his arrest, and that pending test results would reveal how much, if any, of the drug was present in his system.

LaCross also attempted to revoke his client’s consent to have the prescribed drug offered to him by jail staff, claiming that if the tests revealed none of the drug was present in his client’s system, altering his medical condition would adversely affect the quality of the defense he could provide Hower.

Judge Leila Mills denied his request, ruling that the decision to accept or decline any medication remained solely with Hower.

As for Hower’s relationship with Kono, staff and regular customers of P.J.’s Market said Hower was not only a regular customer himself, but a “friend” who was just one of the many recipients of Kono’s much-lauded goodwill.

On Monday, Judge Mills ordered Hower undergo a psychiatric evaluation to determine his competency to stand trial for Kono’s murder.

Q&A about Schizoaffective Disorder

Q. What is schizophrenia?

A. Schizophrenia is a chronic and severe brain disease. Sufferers often have terrifying symptoms such as hearing voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn.

Q. What is schizoaffective disorder?

A. Schizophrenia and related mental disorders can be hard to distinguish, and some people with symptoms of schizophrenia and/or also manic-depressive (or bipolar) disorder whose symptoms cannot be clearly categorized are sometimes diagnosed as having a “schizoaffective disorder.”

Q. How are the disorders treated?

A. Antipsychotic drugs — such as clozapine, risperidone and olanzapine — are the best treatments now available, but they do not “cure” schizophrenia or ensure that there will be no further psychotic episodes. Most people with schizohphrenia continue to suffer some symptoms throughout their lives; it has been estimated that no more than one in five individuals recovers completely.

Q. What are the side effects of the medication?

A. Patients and families sometimes become worried about the side effects of antipsychotic medications, believing they act as a kind of mind control, or a “chemical straitjacket.” While these medications can be sedating, the utility of the drugs is not due to sedation but to their ability to diminish the hallucinations, agitation, confusion, and delusions of a psychotic episode. Other common side effects include lethargy, sedation, sexual dysfunction and weight gain.

Q. Do the disorders make people violent?

A. Studies indicate that except for those persons with a record of criminal violence before becoming ill, and those with substance abuse or alcohol problems, people with schizophrenia are not especially prone to violence. More typically, they are withdrawn and prefer to be left alone. However, substance abuse significantly raises the rate of violence in people with schizophrenia, as it does in people who do not have any mental illness.

People with paranoid and psychotic symptoms, which can become worse if medications are discontinued, may also be at higher risk for violent behavior. When violence does occur, it is most frequently targeted at family members and friends, and more often takes place at home.

Q. Why do patients stop taking their medication?

A. For a variety of reasons: Patients may not believe they are ill and may deny the need for medication, or they may have such disorganized thinking that they cannot remember to take their daily doses; family members or friends may not understand schizophrenia and may inappropriately advise the patient to stop treatment when he or she is feeling better; some patients report that side effects of the medications seem worse than the illness itself, and finally, substance abuse can interfere with the effectiveness of treatment, leading patients to discontinue medications.

Q. What happens when they do stop?

A. Far higher relapse rates of psychotic episodes are seen when medication is discontinued. Because relapse of illness is more likely when antipsychotic medications are discontinued or taken irregularly, it is very important that people with schizophrenia work together with their doctors and family members to adhere to their treatment plan.

Source: The National Institute of Mental Health

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