He is 14 and hears voices. He's been hospitalized more than 20 times. Stephanie Escamilla is tired of seeing the country focus on the mentally ill only when there's a national tragedy. So she and her son are telling their story — of a family on the brink.
By Wayne Drash, CNN
Video and photography by Evelio Contreras, CNN
Editor’s note: This story was first published in December 2013. The epilogue has been updated.
San Antonio, Texas (CNN)
The boy wears SpongeBob pajamas and sits up in bed, a blanket draped over his shoulders. In his right hand he holds a rosary.
"Please, please, please help me," he whimpers.
Imaginary voices bark at him. "Go away," he tells them. "Go away! Go away!"
He screams for his mother: "They're making me have these bad thoughts."
Stephanie Escamilla is videotaping her son Daniel. He is 10. Nobody believes her when she says he hears voices. This tape will be her proof.
When the voices come, they tell Daniel to kill his brother, his mother and himself. Sometimes he turns the TV on full blast to drown out their commands. Or sprinkles holy water around his bed.
As the camera rolls, Stephanie calls psychiatric hospitals near her home in San Antonio. Repeatedly she is turned down. Nothing can be done for her son, she is told, unless "he is a danger to himself or others." It is December 2009, and Daniel's hallucinations last more than two hours.
CNN's Dr. Sanjay Gupta describes his experience with Stephanie Escamilla and her son, who is mentally ill.
Daniel is 14 now, and his mother no longer needs to convince doctors that he is mentally ill. He suffers from bipolar disorder with psychosis. In the past four years, he has been hospitalized more than 20 times.
But a diagnosis merely marks a beginning. Raising a child with mental illness is "a roller-coaster ride through hell," Stephanie says. She is engaged in an epic battle on multiple fronts.
What if Daniel has an outburst in public and is misunderstood? What if he succumbs to the voices? How can she help Daniel find joy?
And what about the rest of her family? They need her, too.
With broad shoulders and a thick frame, Stephanie looks the part of a worthy combatant and strong advocate. It wasn't always this way. She was a single mother with self-doubt, quick to blame herself for Daniel's plight.
Imagine what it's like for a mother to watch her son suffer – the little boy who sang and danced to Michael Jackson tunes, who tossed the baseball out back, who she dreamed would become a doctor.
Think how painful it is to hear him say nearly every day that he wants to kill himself.
Stephanie's fight is literally one of life and death – a desperate attempt to win back her son from the mental illness trying to consume him.
She'll do whatever it takes to save Daniel.
The Navy Yard.
The only time mental illness dominates the national conversation is when something goes tragically wrong. But the dialogue doesn't last. It gets buried under arguments about gun control, video game violence and unheeded signs of trouble -- until there's yet another mass shooting.
When Daniel feels he might have an episode of psychosis, he goes outside to ease his anxiety and to make sure he is not around his siblings.
"What we always say is we had the tragedies in Arizona, Colorado, Connecticut and Virginia," says Mike Fitzpatrick, executive director of the National Alliance on Mental Illness, "but there are smaller tragedies that happen every day in this country because people are untreated for mental illness. And they end up in jails, in homeless shelters – and families are torn apart."
Those small, quiet tragedies don't usually make headlines. The 75 million American families touched by mental illness, like Stephanie Escamilla's, largely deal with it in private. Every day.
It frays bonds, breaks up marriages. It steals hope.
People don't ask how to help boys like Daniel.
It takes a James Holmes to grab the nation's attention. A Jared Loughner. An Adam Lanza.
Something has to be done about America's mentally ill.
That refrain emerged stronger than ever last December after the mass shooting at Sandy Hook Elementary in Newtown, Connecticut. Never mind that no one knew whether it was mental illness that drove Lanza. He killed 26 people, including 20 children. Wasn't that the definition of madness?
I covered the tragedy in Newtown the week after the massacre and returned there a few times in the months that followed. A shuttered mental hospital overlooks the idyllic New England town; just down the hill sits a high-security prison housing the criminally insane. Standing there, I wondered about the state of our mental health system.
I later learned the scope of the problem: More than 60 million adults and about 15 million children in America suffer some form of mental disorder. That's one in every four adults, one in five children. Far fewer live with a serious mental illness, such as schizophrenia, bipolar disorder or severe depression, but the numbers are still large: 13.6 million adults and about 2 million children.
The mass shootings that shine a spotlight on mental illness actually stigmatize those who suffer with it. The vast majority, advocates point out, are far more likely to be the victims of violence – they often get beat up or bullied -- than to commit a violent act.
What if the issue could be seen through the prism of an average American family – not just through the lens of a national tragedy? What could be learned from people who deal with the day-to-day reality of mental illness?
I asked the largest nonprofit mental health advocacy group, the National Alliance on Mental Illness, to spread the word of my interest in telling that story. I recognized the hurdles. A family would open itself to scrutiny and, possibly, judgment – on top of everything else it faces.
"It is a risk factor for a marriage, for a family, to have a seriously ill child," says Ken Duckworth, medical director for the National Alliance on Mental Illness.
Even for families who have resources and do everything right, it can take years to find the proper care, he says. But people who get that help can stabilize – and function in the world.
Duckworth cautions against drawing conclusions about the paths of children or teens with mental illness. "One person who loves you," he says, "can make all the difference."
Stephanie Escamilla believes that. She also believes complete strangers could make a difference if only they understood. That motivates her to try to teach people about what it's like to walk in her son's shoes. A board member of the San Antonio chapter of the National Alliance on Mental Illness, she welcomed CNN into her home beginning in June. In the months that followed, I witnessed her resolve to change the path of a 14-year-old boy oscillating between the trials of adolescence and the anguish of mental illness.
It's not just her fight, or Daniel's. It touches the entire family. Stephanie, 37, and her fiancé, Jose Farias, 33, are raising three other children, ranging in age from 7 to 10, in their merged household. Also living with the family is Stephanie's mother, who has brain cancer.
Stephanie and Jose asked that CNN refer to their oldest son as Daniel; that is not his real name, and his last name is different from theirs. They also asked that CNN photograph him in a way that keeps his face hidden. Many in his hometown know Daniel has a mental illness, but the family didn't want that label to extend to the Internet, where it could dog him when he seeks a job or applies to college.
If his illness has taught them anything, it's that people judge.
But Stephanie and Jose – and, indeed, Daniel – are willing to take that risk. By telling their story, they hope to help others raising a mentally ill child and shed light on mental illness for those who remain clueless.
Stephanie included Daniel in the decision to lay their lives bare.
"I'm going through a lot of stress and a lot of things that no kid should see, no kid should hear – and things you shouldn't do," he told me. "I just don't want anybody else to go through that."
If it's true that one person who loves you can change your outlook, that force in Daniel's life is his mother. Stephanie hasn't sold out her son's dreams. She believes he can accomplish whatever he sets out to do.
Yet she worries for his future: Will people accept him? Will he adapt to the world around him? Will he someday live under a bridge?
The lights go dim. Stephanie stands at the podium and shows a photograph of Daniel looking dapper with deep brown eyes, trimmed brown hair and a broad smile. It's a recent picture. The next one shows him at 6 months, dressed in a Dallas Cowboys bib and winter cap.
"You would never know that he was going to have a mental illness," she tells the crowd. "I mean, does he look like he has one there?"
Seventeen cadets being trained to work in the Bexar County jail system sit in the audience and shake their heads. Several blurt out: "No."
"He was a baby," she says. "He was awesome. He was always happy."
On the day Daniel was born -- January 29, 1999 -- Stephanie eyed his tiny frame, all 5 pounds and 15 ounces, and marveled at how delicate he was. She felt a bond that touched her soul. She dreamed he would become a doctor, or join the military to explore the world. She was 23 and single.
Raising a child alone, she knew, would not be easy. She promised her son one thing: I will always take care of you, no matter how hard it gets.
The PowerPoint presentation moves to the next slide. This one, titled "Many Hospitalizations Thereafter," is jarring. It shows the dates of Daniel's hospitalizations:
-- 04/29/10 ...
On and on, the list goes: 17 in all. She tells the cadets the slide isn't up to date – the hospitalizations now number about 20.
"It is a roller-coaster ride," Stephanie says. "I don't know if any of you guys have anybody in the family that have mental illness or have dealt with anybody with mental illness, but it is a ride that no one wants to take."
Stephanie moved from the rural town of Uvalde, Texas, to San Antonio to gain better access to mental health treatment. She took an overnight job at a hospital so she could be around during the day for her son. She works in a tuberculosis ward and once was a 911 dispatcher.
Those experiences gave her another view of the mentally ill – from medical and law enforcement perspectives. She realized she could help her son by educating others.
Two years ago, she did her first session for the Bexar County Sheriff's Office, which puts its personnel through mandatory crisis intervention training aimed at teaching the best ways to deal with the mentally ill.
The goal is to "de-escalate a situation and get people the help they need before going hands on and taking them to jail," says Cpl. Shannon Lunski, who helps lead the program. For these cadets, Stephanie puts a face on the struggle.
She tells them about her long and frustrating journey: Daniel was diagnosed with ADHD at age 6, his first manic meltdown came at 10, hospitals kept refusing to admit him "because he had not hurt himself and he had not hurt anybody, and he didn't have a plan" to act – the legal threshold required for hospital admittance.
She plays a video of Daniel enduring an episode of psychosis from May 1 of this year. His legs and arms shake while he sits on a picnic table in the backyard. He places his head between his knees. Then, he stands and paces. He swats the air. His head darts back and forth, as if trying to shake the demons he sees and hears.
"This doesn't happen all the time," she says. "It happens when he has something really stressful going on at school or he has a cycle. Sometimes, the cycle comes every two months; sometimes they're more frequent. I'm happy when they're gone for five months, but that hasn't happened for a while."
Stephanie's voice trembles. Some of the cadets cry. "You guys are my psychotherapists," she tells them. "Not a lot of people want to sit and hear you talk about mental illness."
She admits there were days when she wished she could just give her son away. She's ashamed of that thought now, but realizes she's only human.
She turned her sorrow into action when she finally accepted Daniel's illness. It took time, and came only after she realized his condition was getting worse.
She had an epiphany.
"I thought I hated my son," she says. "But then I realized it wasn't him that I hated. It was his bipolar disorder."
Stephanie Escamilla became an advocate for those with mental illness after her son's condition worsened.
She implores the cadets to show compassion when they arrive at a scene involving a disruptive child.
"You're going to be walking up, and what's going to be your first reaction?" she asks.
"It's a kid acting bad," one cadet says.
"You're going to be judgmental, right? Is that actually how you should approach that?"
The cadet shakes his head.
Think of families like hers, she tells them. "Put yourselves in their shoes. You have officers come into your house, would you want them to judge you?
"I tell you this because you're going to come across homeless people like that, who are schizophrenic, who have not been on meds and are hearing voices," she says. "Calm them down, talk to them. Tell them: 'It's just a voice. The voice isn't going to hurt you.'"
That's what she hopes someone would do for her son.
The boy just needs a good spanking.
Daniel needs a proper male role model.
You're a bad mother.
Stephanie has heard it all. Her mother, three sisters and brother abandoned her when Daniel was first diagnosed. They didn't believe Stephanie. There had to be another reason for his behavior.
Friends told her, please, don't talk about mental illness around the children. But word leaked out. Kids taunted Daniel.
Hey, stupid! You're mental!
Once, Daniel was beaten by an acquaintance while a friend shot video that was later posted on YouTube. It showed Daniel getting punched in the face, then falling to the ground and being kicked.
Some friends shunned Daniel and his mom. The phrase "mental illness" was met with fear, disbelief, prejudice, ignorance.
Stephanie herself had not understood the early signs. At age 6, Daniel complained he heard voices. She downplayed it. She told herself the walls were paper thin, that he was hearing conversations throughout the home.
Then, everything changed.
On a fishing trip one weekend in March 2009, Stephanie watched as Daniel pushed their lunch supplies, one by one, off the top of a picnic table. Chips, cups, napkins. When she scolded him, he apologized: I'm sorry. I'm just clumsy.
He kept the real reason to himself: Voices urged him to shove his 3-year-old brother into the lake so he would drown. Daniel pushed stuff off the table instead; it was his way of deflecting the voices, of keeping his brother safe.
At school the following Monday, Daniel's hallucinations intensified. He stabbed himself in the head with a pencil because he was having more thoughts about hurting his brother. Finally, he confided in his teacher. Only then did his mother learn the truth.
Mom, I have been having thoughts of wanting to hurt my brother, he told her, but don't worry, I don't want to harm him.
Stephanie shifted into overdrive. She stayed home to monitor Daniel's behavior. She began trying to get him admitted to a hospital for evaluation. It took five days but she succeeded. On March 25, 2009, she went with him to Southwest Mental Health Center.
"I had never seen anything like I did that night," Stephanie recalls.
Daniel's mood changed every second. He was happy, sitting next to his mother. Then, suddenly, he was under a table, clinging to a leg and crying. He ran around the room, announced he could fly. Then he stopped and looked at his mother: Mom, did you know I can see through doors?
To Daniel, all of it was real.
"Patient reports he started hearing voices within the last week that he describes as multiple voices, mainly telling him to hurt his brother and specifically to stab him with a sharp object," the hospital evaluation said. "Also telling him to hurt self. Prevents acting on these commands by hurting self or doing things with other objects."
Daniel was hospitalized for two weeks. His diagnosis: type 1 bipolar disorder, compounded by episodes of psychosis.
Stephanie went to Barnes & Noble and bought nearly every book they had on bipolar disorder. She learned to understand what she had witnessed. Daniel's impulsive urges, his sudden bursts of energy fit the description of mania; his extreme lows matched the depression that accompanies bipolar disorder. The voices and visions her son described met the definition for psychosis.
Stephanie also grappled with something the hospital report hinted at: Guilt that her recent divorce from Daniel's stepfather had scarred a boy who'd never known his own father.
Daniel suffered from a lack of self-esteem, and he was "likely to feel he lacks control and things happen to him," the report said. "This could be influenced by the early 'loss' of his biological father and more recently the reported relational loss with his stepfather."
Stephanie renewed the pledge she'd made to her son on the day he was born. "Daniel will never know how heartbreaking it was to watch him spiral up and down in a matter of seconds," she wrote in her journal, "but he will know that no matter how hard it gets, I will always be there to pick him up."
Her son understood for the first time that he suffered from mental illness. "I can tell you how I felt," Daniel says. "I was really, really scared."
That year, Stephanie took the summer off to spend time with her boys. She bonded with them over fishing. "I was the only mom out there," she says. The other boys all had their fathers in tow. Stephanie brags: "We caught more fish than anyone else."
But by year's end, Daniel was in the hospital again. His episodes changed with every medication regimen. Drug combinations that were meant to control his state of mind seemed only to make his condition worse.
The frequency of hospitalizations soon picked up.
The year 2010 was marked by four, and in 2011 there were five, including a 90-day court-ordered commitment.
That was one of the toughest for Stephanie. The doctor suggested that route because outpatient therapy wasn't working.
Agreeing to a court commitment meant a loss of control. He'd be away for three months minimum.
In a way, she felt relief. Her son was where he needed to be, getting professional care, and she had time to breathe. She recalibrated and devised a long-term plan for Daniel. She taught a class for medical assistants at a local trade school and continued working full-time.
But she couldn't help but wonder: Am I doing the right thing?
She visited Daniel every day for the first two weeks. She fretted the staff would deem her a bad mother if she didn't show up.
But the visits were awful. Daniel hurled insults at her, said he hated her. Once, he threw a chair at her during a family session. He accused her of wanting to get rid of him. Every time, she left the hospital more miserable than when she entered. "I dreaded going there instead of being happy to see him."
She dubbed the stroll from the hospital to her car in the parking lot "the walk of shame."
It didn't help that her siblings weren't supporting her. They thought she exaggerated Daniel's problems. Initially, so did Jose.They met at the trade school, where Jose was teaching, too. Stephanie told him up front about her son's illness.
If you want to run, she said, go right ahead.
They've been together two years now.
When a child suffers from an "invisible" illness, Jose says, "You just have a hard time accepting that there's something wrong."
"Once I understood better," he says, "that's when it got easier."
But he adds, "I don't think everyone can do it."
Jose runs his own air conditioning business and can rush home when needed. He has filled a void in Daniel's life. The first hospitalization occurred exactly one year after Daniel's stepfather left. And every year since, that anniversary has triggered an episode resulting in hospitalization.
It's taken time to build trust, but Daniel now calls Jose "Dad."
Not only has Jose not turned and run, but he embraces the messy life of raising a teenager, one who happens to be mentally ill. Many people, he says, don't view those with mental illness as human; they're freaks, crazies, even monsters. Other people, Jose says, have this Hollywood vision of mental illness: It's difficult but then -- ta-da -- everything is fine.
"The reality is people have to live with it for a lifetime," he says. "The illness doesn't end when the credits roll. If you don't have the resolve or the stamina to handle it, you're in a lot of trouble."
In real life, the script gets ripped up.
On a day in late June, Uncle Joe's custom-made barbecue pit, complete with a bottle opener the shape of Texas, covers Stephanie's front lawn. Three massive smokers house a Texas-sized feast: 80 pounds of brisket, platters of sausage links, nine dozen ears of corn, and heaps of barbecued cabbage.
More than 100 relatives mingle in and around Stephanie's house to celebrate the 63rd birthday of her mother, Rosa. It's as much a goodbye party as it is a birthday celebration. Rosa's cancer is progressing.
Daniel’s family attends a Catholic healing mass for his grandmother, Rosa, who is battling brain cancer.
The family lives in a modest four-bedroom ranch in a working-class neighborhood in suburban San Antonio. Stephanie's living room has four framed photographs on the wall, including one of the children with this motto:
"Family: Other things may change us, but we begin and end as a family."
Outside, the children play on an inflatable water slide. Relatives scarf up the food at tables covered with floral prints. When supper is done, everyone's attention turns to a television set on the patio. Images of a vibrant Rosa with her daughters and son flash across the screen. Rosa sits nearby but is too weak to say much. She waves to everyone and thanks them for their love.
Laughter fills the backyard. Tears roll down faces, too.
Among those captivated by the display is Daniel.
He almost left the family nine months earlier. That's when he tried to kill himself. He'd gotten into an argument with his mother about breaking curfew. She said he could no longer be trusted. His response: Gulping down every pill he could get his hands on.
Stephanie and Jose rushed him to the hospital. It took 10 men in the emergency room to hold Daniel down. Let me die! he screamed.
The suicide attempt turned the tide for Stephanie's family.
Her mother and sisters could no longer ignore the severity of his illness. At the hospital, everyone wept except for one person: Stephanie. "I didn't want him to see me break, because if I broke down it would make his situation a lot worse."
On this night, after guests leave, Stephanie's sisters talk about their guilt for abandoning her and their ignorance of mental illness.
Lamar Enriquez is the oldest sister and knows the pain of a loved one going untreated. Her husband of 13 years shot himself in the head last year. "That's what scares me about Daniel," she cries, "because he's only 14. I wouldn't want my sister to go through what I went through."
Mari De La Cerda had an awakening after Daniel twice went into psychosis while she was babysitting. "When it happened, it was scary. Very scary, because I didn't know what was going through his mind.
"I don't know how my sister handles it," she says. "But we're here for her. Now, we totally understand."
Adds Chel Ruiz, Stephanie's youngest sister: "You have to reach that point and realize and accept that he does have a problem. That's the hardest part."
The most striking story comes from a family friend. His 11-year-old son told Daniel he planned to hang himself because his mother left home.
Don't do it. You've got people who love you, Daniel told him. I love you and your daddy loves you.
The father fights back tears. "I thank God for him being my son's friend," he says. "The way I look at it, Daniel is an angel."
Above Daniel's bed hang a crucifix, a drawing of him swinging a baseball bat and a postcard from New York City. A hand-written banner for his favorite television show scrawls across the room. "The Walking Dead," it says.
Clothes overflow drawers. Five baseball mitts sit in a carton on top of books and accumulated junk. Neatness isn't Daniel's strong suit.
In that way – and others -- he's like most teens. His passions are music, dancing, basketball, video games. Martial arts is one of his favorite activities – it helps channel his thoughts in a positive fashion. He hopes to become a UFC fighter one day.
Daniel also knows he's different from most other teens -- in a big way.
"I've seen like bodies on the floor when they're not even there," he says. "If I look up in the sky and I'm outside, it's like everything's just dark, like the sky is red and I see demons flying everywhere.
"When I hear voices, it's hard to like deal with it because you're going crazy, because you don't know what to do."
His mental illness is a terrible thing, he says, not just for him but his whole family. "I hate when it happens. Like I hate it. I hate it," he says. "I don't like having a mental illness because it hurts my mom, it hurts my brother and it hurts my dad. It's just, I don't like it."
He's afraid he will have to deal with the hallucinations for the rest of his life, because "I should be growing out of it by now."
He doesn't want to harm people. He averts his anxiety by running around the neighborhood, pacing in the backyard and cutting his arm, which brings relief. He punches walls and kicks the fence out back so as not to carry out the voices' commands.
Daniel dislikes going to the hospital, "but I have to get stable," he says.
"It's better than hurting someone."
Daniel and his youngest brother play together in the family SUV. Daniel doesn’t like having his siblings see his episodes. “I hate it,” he says.
Five medications attempt to regulate his mood swings, control his anxiety, tamp down the episodes of psychosis.
The family takes safety precautions. Guns are no longer kept in the house. Sharp knives are out of reach. Stephanie sent her youngest son to live with his father for a year while she got Daniel treatment. Now, with four children in the home, Daniel is not left alone with the others. That requires extensive planning and coordination.
Daniel's psychiatrist, Corey Hough, works with him to pinpoint what exactly causes his anxiety and triggers his episodes.
"One of our big goals is to get him to identify when he's heading that direction, rather than wait until he's already there and already feeling like he wants to hurt himself," says Hough, a psychiatrist at the Clarity Child Guidance Center, the facility where Daniel has been hospitalized the most.
Daniel's suicide attempt was a cry for help, he says. "When you have individuals with bipolar and they have an elevated mood and they're manic, they're very impulsive and reckless," he says. "Something doesn't go their way, and they'll go and drink a bottle of pills. They don't really put any thought into it – and that's a very risky situation and that's something Daniel has done."
School acts as his biggest stressor. Daniel worries about fitting in. He struggles to concentrate.
The start of the school year might bring anxiety to any kid, Hough says, but for Daniel it means he worries about it constantly. "It takes over a significant part of his day, just thinking about what's going to happen," Hough says.
He describes Daniel as a "very sweet kid" who is outgoing, friendly and personable. Most people with mental illness deny they have a problem. The fact Daniel not only recognizes his wild mood swings, but is also "very willing to discuss what's going on," signifies a major step toward getting better.
"To have to deal with some of the things he has to deal with – the hallucinations, the thoughts of hurting himself, the anxiety – none of those are pleasant feelings. And he's done a very good job of articulating how he's feeling and communicating to myself and his mom and to his family of what's going on."
What about his thoughts of harming siblings?
Hough explains it is "more of a control thing."
"Fantasizing in his head of hurting people that piss him off helps make him feel better. It's not that he wants to do it; he doesn't. It's his way of sort of coping with it and coping with the moment."
What pushes a person across that edge, to act on the voices' commands, remains the great unknown in psychiatry. "I don't have a crystal ball," Hough says. "I can't say for sure what happens when a patient leaves my office."
The protocol is to err on the side of caution. A family must take measures around the home, and the psychiatrist must recognize when hospitalization is needed.
Hough remains optimistic for Daniel. If Hough can help him better identify the triggers and minimize his medication, there will be success.
"I want to get him through high school," he says. "I'd like for him to go on and do what he'd like to do."
But that will take time.
Stephanie is resting in bed ahead of her overnight shift on a Friday night in August when Daniel walks in.
Two of his siblings have been teasing him. A rage is building inside, he says. Stephanie tells Daniel to take some melatonin to take the edge off his anxiety.
He leaves the room, takes the medicine but soon returns.
This time is different. A dead serious look spreads across his face, and his pupils are dilated. Stephanie has never seen her boy like this.
I'm going to hurt them, Mom, he says.
Stephanie springs from bed.
Well, baby, let's go to the hospital.
She gathers her stuff and calls the Laurel Ridge Treatment Center, the closest hospital to the family's home. Bring him as soon as possible, she's told. She hops into the family SUV. Daniel gets in the passenger seat.
It's only the second time she's driven him to the hospital by herself during an episode. She keeps an eye on the road and one eye on her boy. He sits quietly in the front seat, but it's clear he's still agitated.
She finally engages.
You had thoughts of hurting the kids. Do you still have those feelings?
Actually I still do, he says.
The drive becomes a blur.
Four days later, Stephanie returns to the hospital for a family session with Daniel and his counselor. But first she meets with the counselor alone. She speaks of her stress – caring for her dying mother, trying to help her son, making ends meet.
The counselor reassures her that's enough pressure to make anyone implode.
"That's a lot to go through," the counselor says. "You're not getting a break at all. You're go, go, go. You have to be on 24/7. And it's like to the point of, 'Who is taking care of you?'"
Stephanie utters: "Uh-huh."
"That has to be frustrating. I know it is," the counselor says.
Stephanie bursts into tears.
The counselor stresses the positive – that Daniel is keenly aware of the things going on with him and that he seeks his mother's help when he can't handle his thoughts. Not too many children, especially those with mental illness, have that type of relationship with a parent.
"You know, if you find any encouragement in the fact you're doing a great job with Daniel, he's a great kid."
Daniel enters the room and first explains what happened with the most recent episode.
"I guess I was mad that the kids were home because of the way they treat me."
How do they treat you?
"Well, they treat me like I'm stupid and then they just do every little thing to bother me. They bring me into their arguments, when I don't want to be in their arguments."
As he speaks, Stephanie cries.
"Are you OK?" he asks his mom.
"Yeah," she says.
Stephanie tells the counselor that she and Jose have spoken with the children about the need to go easy on Daniel – that normal sibling spats can easily get overblown. The family will need to address it further.
"We can try it," Daniel says, "but honestly I don't think it will work."
Mother and son then have a heart-to-heart. She begins with the news she's received while he's been in the hospital.
"First of all, you passed into the eighth grade," she says.
"Aww, I did. Yes!"
"I'm just worried about you starting a new grade," she continues, "and getting frustrated so easily with the work and it being stressful at home. So we need to figure out how you're going to be able to have a normal school life."
"I know I've said this before," Daniel says, "but I know I didn't try last year. But I'm kind of tired of that, too. Honestly, it's like since I came here, I've realized a lot of things. I've gotten mad over stupid crap.
"I want it to stop."
"It only stops when it comes from you," his mother says. "You are the one that has to initiate stopping it."
"Yeah, that's what I'm going to do," Daniel says. "I'm going to try to stop, and I'm going to try to work harder, like the hardest I've ever done before, which is nothing actually."
The counselor advises him to draw up an action plan, and Daniel agrees. Stephanie bids farewell to her son.
Leaving Daniel behind in the hospital is no longer a walk of shame. It's become part of the healing process.
The day Daniel comes home, Stephanie and Jose call a family meeting. First they talk with Daniel at the table before calling the other three children into the room.
It's a tricky conversation. Jose and Stephanie try to shield Daniel's siblings from the severity of their brother's illness. They don't want them to know everything because then they will be afraid of him.
"We have to figure out ways to discourage behavior" that sets Daniel off, Stephanie told me the day before, "without saying, 'You drive Daniel crazy.'"
Stephanie sits at the head of the table with Daniel at the far end, Jose next to him. The other three children take up their seats. Then, Jose begins.
"The certain comments you make, the certain things you say," Jose says. "You guys can't do it anymore."
They've had this conversation before and it must end now, Jose says.
"When he says, 'Don't touch me,' don't touch him," Stephanie says. "When he tells you, 'Get out of my room,' you need to just get out of his room. OK?
"He's not trying to be mean to you. He's not trying to be rude. It's just sometimes he doesn't feel well. OK? It's not your fault. It's no one's fault. Sometimes, he just has a bad day and he's not in the mood to be picked on."
Jose: "The thing is you take it to a point where you don't realize how upsetting that is, especially to Daniel. You may get upset, but it's not as bad as Daniel gets."
"There's a difference," Stephanie says.
Jose: "And it has to do a lot with the way Daniel thinks. You doing that to another person – it's still not right, but it has far less of an effect on that person than it does Daniel."
The three siblings remain quiet.
Earlier, Daniel told his parents the other children hate him. "That's how he feels. He really feels you guys don't like him," Stephanie says.
"We can't have that anymore," adds Jose. "Do you guys get it? Are we going to have this conversation again?'"
One of his brothers interjects. "But Daniel has told me he hated me."
"No, I haven't," snaps Daniel.
"Yes, you have."
"I'm not going to get in an argument," Daniel responds. "I'm not going to even argue."
He tosses his hands in the air and then puts them down. Daniel doesn't like having an episode in front of his siblings. He looks for ways to divert his thoughts, and it's clear he's trying to contain his agitation.
Stephanie works to calm him. "If that's the case, then I think you guys all should apologize to each other."
Daniel stands up and walks into the kitchen.
"And let bygones be bygones and start fresh," Stephanie continues.
Daniel heads toward the front door.
"Daniel!" Stephanie screams.
The door slams. Daniel is gone.
"You have to understand that you're not better than anybody else," Jose tells the kids. "That's the biggest thing: We always try to take very good care of you guys. Don't make anybody feel bad. Don't make anybody feel that they're not as good as you."
The meeting is already over when Daniel returns 10 minutes later. But worry will occupy Stephanie the rest of the night.
"If we're asleep and he does something, you know, that's just one of my fears," she says.
"I've never had that fear as bad as I have it now because he's getting older, bigger, stronger."
Ten minutes to go, then it's sangria and flamenco dancing.
The white Chevy Suburban eases to a halt at a stoplight. It's been a long day – a Catholic healing Mass for Stephanie's mother followed by dinner with cousins at a Mexican restaurant. Stephanie and Jose are nearing a long-awaited night on the town.
School starts in two days and already stress is building in the household. "I need to get out," Stephanie said at the start of the evening.
Daniel paces the backyard during an episode of psychosis in August. His mother tries to distract him from the voices he hears. She knows if the episode isn’t brought under control within about 20 minutes, it can last hours – perhaps even days.
The couple has deposited Jose's two children with grandparents. Stephanie's other son is with his biological father. A sitter is lined up for Daniel. All they have to do is drop him off at home.
The SUV lurches forward.
From the back seat, Daniel calls for his mother. "I think I need my pills," he says.
Stephanie perks up. They're almost home, she says, and he can take his medicine as soon as he walks through the door. The family outing took hours longer than expected. Stephanie didn't bring his nighttime dose.
Daniel's tone turns almost shrill. "I need them now."
Jose floors it. The Suburban hurtles down the highway – 65 mph, 70, 75.
The couple have been through this drill before. They know it's key to distract Daniel from the voices he hears. Jose asks him about the priest's sermon on the strength needed to reach heaven.
"How do you get there?" Stephanie asks.
"You get there ... " Daniel places his hands on his head. "I don't know."
"My stomach hurts and my head hurts," he says. "I'm dizzy and everything's blurry."
"You've been in the car a little too long," Stephanie says.
"We're almost home," Jose says. "My head hurts, too. Less than 10 minutes away."
Stephanie: "What are you hearing?"
"Just some weird voice," Daniel says. "It just sounds weird. It doesn't sound like what I used to hear. It's just really, really different."
"Just remember who is in control, right?" Stephanie says.
"Yeah, I know, but it's just like I've never heard this before," Daniel says, his voice rising. "It's creepy. It's different. I can't get it out of my head. The VOICE!"
Jose whips in and out of traffic. He glances from the road to the rearview mirror.
Daniel grimaces and begins talking in a strained tone. The demons are showing him something. "It's a picture of an arm with cuts on it."
"Just take a deep breath," Stephanie says. "Just remember, you're the one in control."
The boy moans.
"Are you all right?" Stephanie says.
"I don't know," Daniel whines.
"We've gone through too many of these things," Stephanie says, "and every time you're all right. Right?"
"Yeah," he says.
Silence consumes the vehicle for 20 seconds. Then, Daniel screams.
"I'm seeing things." His voice is hesitant, almost hushed with worry.
"OK," his mom says. "What are you seeing?"
"I looked out the window, and I saw a face pop up."
Daniel curls into a fetal ball.
Moments later, Jose cuts the SUV down a side street, hooks a left and pulls up to the house. The truck comes to a halt in the family's front yard. The three jump out as if the vehicle is on fire.
They have about 20 minutes to calm him, or the episode will last a couple of hours, perhaps even days.
Stephanie ushers Daniel through the front door, into the living room, and onto the patio. Daniel sits in a rocking chair. He sways back and forth, his legs and arms fidgety. "There's things all around," he says.
Stephanie tries to soothe him, gives him his medication. "What do you think triggered it?"
"I don't know," he says.
"Do you want to walk around for a little bit?"
He rushes from the chair and paces in the backyard. "I'm just trying to make it go away," he says. "It's weird. It's like a conversation's going on."
He plops down at a picnic table. A neighbor's dog barks from behind a wooden fence. Daniel douses his head with a bottle of water. Stephanie and Jose ask him about a summer reading book, "Moby Dick," to get him to think about something else – anything else.
"What do you remember?" Stephanie says.
"What they have is an old man who wanted revenge," Daniel says. "All he had was hate."
"OK," Jose says.
"Who'd he have hate towards?" Stephanie asks.
"Moby Dick, just because he took his leg off."
"Who's Moby Dick?" Stephanie says.
It's a little past 10 p.m., and the temperature hangs in the 90s, the Texas heat adding to the intensity of the moment. A few minutes pass, the medication kicks in and Daniel's mood eases. He heads inside to bed.
Stephanie and Jose sigh. They've conquered this episode just in time, right around the 20-minute mark. But they're exhausted, exasperated. Stephanie's word is traumatized.
"It takes a lot out of you," Jose says.
Jose: "Even when it's simple like that."
Just as Ahab's quest for the great white whale seemed futile at times, so does the family's quest for normalcy.
There will be no sangria or flamenco dancing tonight.
Daniel began eighth grade two days later, on Monday, August 26, 2013. By the end of that week, anxiety overwhelmed him. He went back into the hospital for a six-day stay.
But Daniel didn't give up on school. He returned to class, with renewed dedication.
Success came by year's end. His grades rose from Cs and Ds to As and Bs. His therapy sessions went from twice a week to once a week. It's been nearly a year since his last hospitalization.
All of this -- and Daniel's resolve to do better -- buoys his mother. "We still have to get through the teenage years," she says, "but he's in a good place."
Stephanie Escamilla agreed to let CNN into her home to document what it is like to raise a child with a serious mental illness. Her 14-year-old son, whose real name is not used in the story and whose face is obscured in the video and photographs, also agreed to participate. In June 2013, reporter Wayne Drash made the first of many visits to their home in San Antonio, Texas. Video producer Evelio Contreras also spent weeks with the family.
The dialogue and direct quotes in the story were heard by Drash or drawn from documents, videos or audio recordings. Italics are used in the instances where the dialogue was recalled by a participant and not witnessed by the reporter.
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