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 after that assessment, 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 haunting questions 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 Tribune access to her son's records to show the barriers to getting treatment.
Of the 15 million U.S. youths with bipolar disorder, schizophrenia and other mental illnesses, less than half will get medical attention, according to the American Academy of Child and Adolescent Psychiatry.
There are treatments that work, "but frequently you cannot get them to the people in crisis," said Susan Resko, executive director of the Balanced Mind Foundation, a national children's mental health advocacy group based in Chicago.
The hurdles are especially high in Illinois, which slashed more than $100 million in mental health services from 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 intervention, not unlike a cancer patient who ignored early symptoms and is left with a body riddled with tumors.
"He's just so far gone now," she said.
Symptoms by age 8
Long before the threats and prison tattoos, Gabel remembers a sweet-faced, compassionate boy who liked Batman and the Teenage Mutant 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 Hospital, 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 Mount 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," Gabel said.
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.