Sociologist Neil Gong explains why psychiatric treatment in Los Angeles rarely succeeds, for the rich, the poor, and everyone in between…

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 patients are only caught in the safety net after homelessness or arrests. Public providers engage in guerilla 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 opulent 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 care, and yet not poor enough to qualify for social services—struggle to find treatment at all…

Advanced Praise 

Tanya Luhrmann, author of Of Two Minds: “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.”

Forrest Stuart, author of Down, Out, and Under Arrest and Ballad of the Bullet: 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.  

William T. Carpenter, MD, editor-in-chief of Schizophrenia Bulletin: The United States is a world leader in psychiatric science, but routinely fails its vulnerable people with severe mental illness. Gong's study of clinical care for the poor versus the privileged 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.

Colin Jerolmack, author of Up to Heaven and Down to Hell: “This book is smart, heart-breaking, 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.”

David A. Snow, author of Down on Their Luck: “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.”

Michelle Wakin, author of Homelessness in America: “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.”