Description

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Sociologist Neil Gong explains why mental health treatment in Los Angeles rarely succeeds, for the rich, the poor, and everyone in between.
 
In 2022, Los Angeles became the US county with the largest population of unhoused people, drawing a stark contrast with the wealth on display in its opulent neighborhoods. In Sons, Daughters, and Sidewalk Psychotics, sociologist Neil Gong traces the divide between the haves and have-nots in the psychiatric treatment systems that shape the life trajectories of people living with serious mental illness. In the decades since the United States closed its mental hospitals in favor of non-institutional treatment, two drastically different forms of community psychiatric services have developed: public safety-net clinics focused on keeping patients housed and out of jail, and elite private care trying to push clients toward respectable futures.

In Downtown Los Angeles, many people in psychiatric crisis only receive help after experiencing homelessness or arrests. Public providers engage in guerrilla social work to secure them housing and safety, but these programs are rarely able to deliver true rehabilitation for psychological distress and addiction. Patients are free to refuse treatment or use illegal drugs—so long as they do so away from public view.

Across town in West LA or Malibu, wealthy people diagnosed with serious mental illness attend luxurious treatment centers. Programs may offer yoga and organic meals alongside personalized therapeutic treatments, but patients can feel trapped, as their families pay exorbitantly to surveil and “fix” them. Meanwhile, middle-class families—stymied by private insurers, unable to afford elite providers, and yet not poor enough to qualify for social services—struggle to find care at all.

Gong’s findings raise uncomfortable questions about urban policy, family dynamics, and what it means to respect individual freedom. His comparative approach reminds us that every “sidewalk psychotic” is also a beloved relative and that the kinds of policies we support likely depend on whether we see those with mental illness as a public social problem or as somebody’s kin. At a time when many voters merely want streets cleared of “problem people,” Gong’s book helps us imagine a fundamentally different psychiatric system—one that will meet the needs of patients, families, and society at large. 

About the Author

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Neil Gong is assistant professor of sociology at the University of California, San Diego. He is coeditor, with Corey Abramson, of Beyond the Case: The Logics and Practices of Comparative Ethnography. His writing has appeared in the Washington Post, the Atlantic, and Los Angeles Review of Books.

Praise For…

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"In this nuanced study, UC San Diego sociologist Gong compares and contrasts two mental health 'treatment approaches' in Los Angeles. . . . Gong persuasively recommends establishing a more structured outpatient system of public mental health care (while cautioning against a return to the asylum’s prison-like potential for abuse). Mental health professionals and advocates will find much to learn."
— Publishers Weekly

“Sons, Daughters, and Sidewalk Psychotics is a heartbreaking book. Gong carefully details the way we have created a system in which the right to freedom has far outstripped the right to health care and housing—because that choice saves time and effort for the rest of us. The deep insight of the book is how differently these freedoms unfold for those with money and those without. This is a thoughtful and well-researched book that could help us to make better choices.”
— Tanya Luhrmann, author of "Of Two Minds"

“Combining rich storytelling, sharp analysis, and brave scrutiny of unpopular ideas, Gong reveals America’s mental health crisis to be as much about class inequality and cultural hypocrisy as it is about brain chemistry and medical diagnoses. Comparative sociology at its finest, from one of the most promising ethnographers working today.”
— Forrest Stuart, author of "Down, Out, and Under Arrest" and "Ballad of the Bullet"

“This book is smart, heartbreaking, and ethnographically rich and glitters with surprising insights. It’s much more than a book about mental illness: it’s about how we define and nurture freedom, personhood, and human dignity—and how we deny them.”
— Colin Jerolmack, author of "Up to Heaven and Down to Hell"

“The United States is a world leader in psychiatric science but routinely fails its vulnerable people with severe mental illness. Gong’s study provides critical information for understanding systemic challenges faced by patients, families, clinicians, and public authorities. The novel findings illuminate the half century of failure in community treatment and offer a rich and detailed study for those who aim to advance care and quality of life for the mentally ill.”
— William T. Carpenter, editor emeritus of "Schizophrenia Bulletin"

“Set in Los Angeles, epicenter of homelessness, Sons, Daughters, and Sidewalk Psychotics weaves an eloquent tale of the contradictions involved in mental health care for the wealthy versus the indigent. The comparison itself is innovative, as is the idea that freedom, something often prized without question, can mean neglect. It is an engaging read that poses innovative questions about how our understanding of mental health care reflects and perpetuates systems of inequality.”
— Michele Wakin, author of "Homelessness in America"

“Sons, Daughters and Sidewalk Psychotics provides an up close, on-the-ground journey into the treatment options and experiences of two strikingly disparate socioeconomic populations: the mentally ill homeless on the streets of Los Angeles and their similarly impaired but economically advantaged counterparts who reside in the upper middle class and upper class neighborhoods of western LA. Given the concerns about homelessness and mental illness across the country, this is a most timely and insightful contribution to understanding of the intersection of these two pressing issues.”
— David A. Snow, author (with Leon Anderson) of "Down on Their Luck"