Five Questions with Neil Gong, author of “Sons, Daughters, and Sidewalk Psychotics: Mental Illness and Homelessness in Los Angeles”

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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.

book cover

Gong’s findings raise uncomfortable questions about urban policy, family dynamics, and what it means to respect individual freedom. Sons, Daughters, and Sidewalk Psychotics helps us imagine a fundamentally different psychiatric system—one that will meet the needs of patients, families, and society at large. 

In this post, we chat with Neil about his research and his ideas for how we might mitigate the homelessness crisis in Los Angeles and beyond. 

In Sons, Daughters, and Sidewalk Psychotics, you look at the overlapping crises of mental health, addiction, and homelessness—particularly how they have manifested in Los Angeles. What makes California different from other states battling these issues?

A lot of people see California cities and ask, reasonably enough, “what the heck is going on?” There are visible encampments, public drug use, and people in obvious psychiatric distress. Other expensive areas with inadequate housing supply, like New York City, also have significant homelessness. But NYC has a gigantic shelter system that keeps unhoused people relatively out of sight, whereas places like LA have far more unsheltered homelessness. This means people are highly visible, and then if they do have a mental health crisis, it is more likely to be in public. In other states with abundant housing stock and cheap cost of living, people still suffer from addiction and mental illness—they just typically do so indoors.

California has also developed an idiosyncratic approach to managing low-level street disorder that I call “tolerant containment”: accepting social problems if they can be made relatively unobtrusive. Part of this stems from important progressive civil liberties victories. The state has recognized that policing and prisons don’t fix complex issues like addiction or mental illness. Unfortunately, it hasn’t actually created the public infrastructure and services to fix things, either. So rather than criminalization or “root cause” solutions, there’s often simple neglect. For instance, CA turned meth and heroin possession into a misdemeanor and planned a big expansion of addiction services. Unfortunately, the state really only accomplished the first half. This is similar to what California did with psychiatric deinstitutionalization in the 1960s-1980s: letting patients out of the state hospitals, but not creating a community care system. The result is abandonment wrapped in the language of freedom.

To research this book, you spent time with people living in Los Angeles’s Skid Row, shadowed social workers, and met with patients and caregivers at elite treatment centers. How did you first become interested in this topic, and why did you decide to pursue it?

For a long time, I’d thought I wanted to become a clinical psychologist. My first job after college was on a mental health treatment team, helping homeless people diagnosed with serious psychiatric disabilities move into independent apartments. And as I watched folks cycle in and out of jail, the hospital, and back to the streets, I became interested in fixing the broken treatment system. I’d also begun working with some patient activist groups, who fought against abuses in psychiatric care. All of this pointed me away from psychology and toward sociology, where I could think more in terms of systems, power, and history.

Then when I went to graduate school at UCLA, I saw that Los Angeles’s Skid Row was a good place to study public safety net and non-profit care providers. I began fieldwork on mental health and homeless outreach, volunteering with the county. And I, alongside providers, would sometimes ask questions about a hypothetical other system: what if there was more staff? What if the patients hadn’t been homeless for years? Would money fix things? I thought I might have to go to another country like Sweden to see an alternative system. But it turned out I could just go across town! Soon I encountered a whole other world of elite private care, with its own set of institutions, facilities, and approaches to treatment. That’s how I got started on my comparative ethnography. 

While you were researching and writing Sons, Daughters, and Sidewalk Psychotics, what did you learn that surprised you the most?

What surprised me the most was that I observed a kind of “freedom” for poor patients and constraint upon privileged ones. Numerous social theorists, working in the vein of Michel Foucault, predict that the local state will discipline and micro-manage impoverished social deviants, or perhaps arrest them. And common sense tells us that the poor get controlled while the rich get to do what they want.

But in fact, I found that safety net providers lack the resources to control or surveil patients. Instead, they use that “tolerant containment” I mentioned before. I watched staff get people into subsidized housing, and then let them do as they please, so long as they stay out of the way. There simply isn’t the capacity for consistent surveillance and behavioral correction. And as noted, police often ignore low-level offenses now. Sometimes it looked like “client choice” but sometimes it looked like neglect.  

On the flip side, I found discipline and surveillance in care for the rich. Here, wealthy families had expectations of a more upper-class recovery, and the resources to pay for more monitoring. It turns out effective social control is a luxury good. Providers aim to normalize people and help them return to college, go back to work, or at least be respectable. This can lead to quite inspiring care. But I also met clients who felt oppressed by all of this intensive treatment and micro management. Care and control went hand in hand, for good and for bad. Although it makes sense to me now after writing the book, it was surprising at the time.   

What do you most hope readers will take away from your book?

A lot of the text is devoted to concrete policy ideas and practical ways to improve care delivery, and so I of course hope voters, politicians, and practitioners engage with these. But I also want readers to come away with an appreciation for the humanity of folks they might otherwise dismiss. That people derided as “sidewalk psychotics” are human beings is both an obvious, almost banal point, and something that our social arrangements actively encourage us to forget.

Many of us have two contrasting experiences around serious mental illness. First, we might encounter people we pity or fear as a kind of embodied social problem. Yet many of us also have a second experience of serious mental illness—of a loved one, a friend, or ourselves during a crisis. For these situations, we may have an entirely different set of ideas, goals, and policies in mind. To bring my takeaways together, I’d say that morally serious policy will require both technical solutions and a recognition of peoples’ humanity. The solutions imagine for “those people” are rarely things we would want for our loved ones or ourselves, and policy must take this into account. 

Where will your research and writing take you next?

Lately, I’ve become interested in the way the so-called “migrant crisis” and “homelessness crisis” are becoming linked. For instance, here in Southern California near the border, many asylum seekers are being dropped off into areas already experiencing a housing crisis. There’s a practical issue of where people with zero resources will go when there’s not enough shelter or housing. But it’s also a political issue posing serious problems for Democrats. For instance, after Texas. Gov Abbott began shipping migrants to New York City, Mayor Eric Adams has claimed that the shelter system is getting overwhelmed and called on the federal government to get stricter at the border. I’m hoping to begin fieldwork on this soon.

author photo of Neil Gong
Photo by Reggie Hui

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.

Sons, Daughters, and Sidewalk Psychotics is available now from our website or your favorite bookseller.

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