When Chris Marciano was 4 years old, he would have a blistering tantrum whenever music came on the radio. By the second grade, his teacher described him as "not with us." At age 11, he was kicked out of school.
"The pediatrician said he was just obnoxious, which wasn't very helpful," said his mother, Mary Gabel, about the first assessment of her then-preschooler. "I knew something wasn't right."
Some 20 years later, Marciano has accumulated a long list of other adjectives in medical evaluations - excitable, fearful, grandiose, hostile, suicidal - and his mother hasn't stopped searching for the right kind of help.
Diagnosed with paranoid schizophrenia, Marciano bounced from emergency room to jail to the streets. When he believes he is Jesus Christ or Tupac Shakur or tells his mother she needs to "watch her back," Gabel said, she double-checks the locks on her house in Chicago's Mount Greenwood neighborhood and alerts her neighbors that her son might come home. She estimates he has been hospitalized 45 times.
Americans have longed for better ways to prevent and treat mental illness in children for years, and the desire is especially amplified after school shootings such as Columbine High School in Colorado in 1999 or Sandy Hook Elementary School in Newtown, Conn., in December. The questions hauntingly and stubbornly remain the same: Are parents clueless? In denial? Why don't they just do something about their troubled children?
Gabel has tried so hard for so long that she is emotionally and financially drained, she said. Her quest illuminates the challenges of navigating a mental health care system that many say is broken, leaving too many children and young adults with psychosis and nowhere to turn.
Marciano's mother and siblings say they feel betrayed by a gutted, piecemeal mental health system. Gabel gave the Chicago Tribune access to her son's records to show the barriers to getting treatment.
Of the 15 million U.S. youth with bipolar disorder, schizophrenia and other mental illnesses, less than half will get medical attention, according to the American Academy of Child and Adolescent Psychiatrists.
There are treatments that work, "but frequently you cannot get them to the people in crisis," said Susan Resko, president of the Balanced Mind Foundation, a national children's mental health advocacy group, based in Northfield.
The hurdles are especially high in Illinois, which slashed more than $100 million in mental health services between 2009 to 2011 and perennially dwells at the bottom of state rankings, according to the National Alliance on Mental Illness. During Gov. Pat Quinn's budget address in March, he emphasized mental illness should be a "top priority" and proposed an additional $25 million investment to improve care.
Gabel, an administrative assistant and mother of three, fears her 24-year-old middle child is now too ill to respond to medical interventions, not unlike a cancer patient who ignored early symptoms and is left with a body studded with tumors.
"He's just so far gone now," she said sadly.
Long before the threats and prison tattoos, Gabel remembers a sweet-faced, compassionate boy who liked Batman and Ninja Turtles.
But by age 8, Marciano was often agitated and couldn't sleep, concerned that "bad people" were breaking into the house on 114th Street. He had his first psychiatric hospitalization at Hartgrove, on the city's West Side, where he was diagnosed with anxiety and depression. Three days later, he was discharged, records show.
At home, Marciano's behavior became a source of conflict for his parents, who clashed over how to handle his moods and the use of medications, family members said. They divorced in 1998, when Marciano was 10.
Marciano's father did not respond to requests for comment.
As Marciano got older, his conduct became harder to control. He was asked to leave St. Christina Catholic School and transferred to Mt. Greenwood Elementary, where he was placed in a special education classroom for seventh and eighth grade, medical records show.
At his new school, Marciano still struggled to fit in. But the one place he excelled was wrestling, winning matches week in and week out. "It was the best time of my life," said Gabel.
The triumphs, though, never lasted. One day, the boy brought a knife to practice and was kicked off the team, Gabel said. She couldn't get her son reinstated.
By ninth grade, he entered Beacon Therapeutic School, reserved for CPS's most impaired students. He was defiant, and when he didn't want to attend, he'd refuse to get off the bus or would climb out the classroom window, his mother said.
As the meltdowns increased, so did the hospitalizations and diagnoses, which now included bipolar and conduct and narcissistic personality disorders, medical records show. Gabel would often tear out of her downtown office to meet an ambulance at the ER. He was often admitted but rarely stayed longer than five days - the hospitalization covered by most insurers.
Dr. Alan Ravitz, a child and adolescent psychiatrist, advised more comprehensive care when he saw Marciano as a 15-year-old at the University of Chicago.
In a 2003 evaluation, Ravitz recapped a list of anti-social and aggressive actions - including verbal threats, slashing clothing of others with a knife, stealing, fire-setting and talk of suicide.
"The only appropriate ... placement for him given his severe mental illness and his significantly dangerous behaviors is a 24-hour residential facility," Ravitz concluded. "Any educational intervention less intensive will result in a continuing downward spiral and the likelihood that Chris will act out in some type of dangerous fashion, endangering his life or those of the people around him."
But few families have the resources for such around-the-clock placements, which can run more than $10,000 a month. His mother applied for financial assistance through the Individual Care Grant, a program offered by the state for its most severely ill youth. Despite her son's voluminous medical history, the application was denied. Gabel appealed and again was turned down. In 2012, only 7.5 percent of applications were accepted, according to the program's annual report.
As director of child and adolescent services for the Illinois Department of Mental Health from 1994 to 2006, Dr. Peter Nierman was charged with reviewing Individual Care Grant applications.
"The decision to yay or nay was made with the knowledge that you had to dole out a highly controlled and scarce resource," said Nierman, now medical director at Chicago Lakeshore Hospital, speaking in general terms and not about Marciano's case in particular.
"We tried very hard as bureaucrats to be responsible advocates for children and at the same time protect this scarce resource. I think given the job, we did about as good as we could."
Some 80 percent of youngsters with mental illness do not get care and the average delay between the onset of symptoms and intervention is eight to 10 years, according to the National Institute of Mental Health.
"When he was getting good help ... he was making progress," Gabel explained. "But without it, we were all walking on eggshells."
For a 10-month period starting in 2004, Gabel could actually see how the right intervention could change the trajectory of her son's life. Following a domestic incident where Marciano broke a chair and grabbed his mother, a juvenile court judge sent the 15-year-old to Lad Lake, a home for emotionally disturbed youth in Dousman, Wis., medical records show.
The structured environment and close supervision provided the support Marciano needed to function. He attended class and was gradually weaned off the drugs that helped regulate his moods, his mother said.
He had made such strides that the court said he no longer needed a residential facility, even though Lad Lake recommended he stay. Gabel went to CPS to see if the district would pick up the annual $116,800 tuition, room and board to keep Marciano at Lad Lake under federal law governing special education. After a five-day hearing, placement was denied. Beacon Therapeutic School could sufficiently meet his needs, said officials. Marciano dropped out of Beacon a short time later, just weeks into his sophomore year.
Meanwhile, the unraveling continued. Marciano's use of crack cocaine to self-medicate increased after he left Lad Lake, his mother said. He was racking up criminal cases by the time he was 17, starting with criminal trespassing and retail theft charges and arrests for theft, battery and drug possession, according to the Cook County sheriff's office and county court records.
Marciano's family eventually became terrified every time he was released from a hospital or jail, worrying he would come home in the middle of the night in a rage, his sister, Stephanie Marciano said.
"We're all scared," said the 22-year-old hairdresser. "You have that conflict where you have to call the police on your own brother, which you never want to do, but he can harm himself and everybody else."
In 2007, Chris Marciano was sentenced to three years in prison after pleading guilty to burglary. In 2010, when Marciano was 21, he got into even bigger trouble.
On May 25, 2010, Marciano went to the Cook County Domestic Violence Courthouse downtown to be fitted for a GPS monitor. He walked into the building and began dancing and singing to himself, according to the sheriff's office. Deputies escorted him to the probation office and told employees to let them know if they became concerned about his behavior.
After the deputies left, Marciano allegedly approached a 3-year-old girl who was with her family, grabbed her buttocks and kissed her, according to the sheriff's office.
The girl's family pulled Marciano away, while the deputies hurried back and arrested him.
"This should have been a red flag," said Suzanne Andriukaitis, executive director of the National Alliance on Mental Illness of Greater Chicago. "Who acts like this in a courthouse? If the behavior doesn't make any sense at all, this person might be psychiatrically ill."
Marciano pleaded guilty to aggravated criminal sexual abuse and was sentenced to another three years in prison. Gabel left the courtroom in tears after her son entered his plea, convinced he didn't understand what he was doing by pleading guilty but powerless to stop him. Now, along with his record, Marciano is on Illinois' sex offender registry.
He ended up at Dixon Correctional Center, about 100 miles west of Chicago. There, because of his outbursts, he spent much time isolated from other inmates, now sporting tattoos on his face, crudely etched with cigarette ashes and staples pried loose from magazines, his mother said.
Mark Heyrman, a professor of law at the University of Chicago, said prison has become the nation's de facto mental health system, but it is naive to think it can address complex psychiatric disorders.
"It is difficult if not impossible to get help in the correctional setting. Many of the dedicated people working there are saints, but the environment isn't designed for treatment, it's designed to punish people ... and it doesn't work," said Heyrman, who chairs the state's mental health task force.
Would the journey have been different if Marciano had been wrapped in intensive services from a young age? While there are no guarantees, mental illness is no different from any other disease, experts say: Early action leads to better outcomes, especially when it comes to thwarting secondary conditions - such as addictions.
"The clock is ticking ... and to get treatment, you have to be sophisticated, you have to be relentless ... and even then many will fail," Heyrman said. "If you're independently wealthy and not dependent on state-funded services, it is possible to get appropriate help. But the number of people who fall into this category are exceedingly small."
When Marciano was released from Dixon on Nov. 30, 2012, he was homeless and even more untethered from reality, said his mother. He would be hospitalized three more times over the next two months, records show. Each time, he'd leave with a fistful of prescriptions for medications, which were found shoved in his pocket, said his mom.
Finally, Marciano got into an altercation with a passer-by near 95th Street and the Dan Ryan, and police were called. Officers trained to deal with mental illness gave him a choice: jail or Madden Mental Health Center in Maywood, according to Andriukaitis. After 90 days at Madden, he was transferred to Chicago Read Mental Health Center on the Northwest Side, the only long-term, state-operated psychiatric facility in the city. Taxpayers are covering the cost of his care at roughly $250,000 per year.
To an outsider walking through the halls at Read, the brown linoleum and institutional green walls might seem dreary, but Gabel pronounced it "beautiful."
On a recent visit, Marciano emerged from his room, his eyes vacant. In a rambling conversation, he told Gabel that their Mount Greenwood home was purchased for him by Tupac Shakur, that Mariah Carey was his mother, and that Gabel deserved the death penalty.
Gabel didn't flinch or show emotion.
"Good to see you, babes," she said gently, sitting on a chair next to him.
"You're not my mom," her son replied in a monotone voice.
"Oh, you know I'm your mom," she said.
A few moments later, Marciano abruptly stood up, said, "This meeting's over," and then walked out. The visit lasted less than seven minutes.
Only after he left did Gabel's eyes well with tears and her shoulders sag under the weight of it all. But at least, she said gamely, no one is talking about discharging him from the facility.
"My mom has fought long and hard for that boy," Stephanie Marciano said. "She's talked to anybody and everybody that she possibly could, and he's just fallen through the cracks every time."
Specific events in Marciano's life - such as the state's inability to provide him with an Individual Care Grant and his incarcerations - stand out as turning points in what his 26-year-old brother calls "a slow, gradual spiral downward."
"He should have been one of the ones accepted, and he got shunned," Tim Marciano said. "In the meantime, he was just rotting in prison, when he should have been getting help in a mental health facility somewhere. Look at where it's gotten him."