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Sons, Daughters, and Sidewalk Psychotics: Mental Illness and Homelessness in Los Angeles
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 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.
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 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.
382 pages, Kindle Edition
Published March 29, 2024
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Displaying 1 - 8 of 8 reviews
January 10, 2026
4.5 stars
Thoughtful, well-written, smart sociology book about disparities in treatment for the severely mentally ill, with a focus on those living in Los Angeles in the U.S. Neil Gong does an excellent job of writing about the disparities and differing experiences of poor and working class folks with mental illness and wealthy folks suffering from similar afflictions. One thing I deeply appreciated was how he critiqued and added nuance to the idea of "freedom" (e.g., if freedom entails granting someone individual liberty though their actual choices are still materially constrained and/or downright awful, what are the limitations of freedom?) I liked how Gong interacted with and provided in-depth specific anecdotes from people actually suffering from severe mental illness as well as different treatment providers.
This book was both academically rigorous and accessible; I didn't find it too dense or jargony. Gong poses thoughtful implications at the end of the book, a challenging task given how multifaceted issues are related to mental illness (e.g., how it involves systems-level factors interacting with individual psychology, personality, biology, etc.)
Thoughtful, well-written, smart sociology book about disparities in treatment for the severely mentally ill, with a focus on those living in Los Angeles in the U.S. Neil Gong does an excellent job of writing about the disparities and differing experiences of poor and working class folks with mental illness and wealthy folks suffering from similar afflictions. One thing I deeply appreciated was how he critiqued and added nuance to the idea of "freedom" (e.g., if freedom entails granting someone individual liberty though their actual choices are still materially constrained and/or downright awful, what are the limitations of freedom?) I liked how Gong interacted with and provided in-depth specific anecdotes from people actually suffering from severe mental illness as well as different treatment providers.
This book was both academically rigorous and accessible; I didn't find it too dense or jargony. Gong poses thoughtful implications at the end of the book, a challenging task given how multifaceted issues are related to mental illness (e.g., how it involves systems-level factors interacting with individual psychology, personality, biology, etc.)
September 13, 2024
A really useful and thoughtful comparative account of mental health services in Los Angeles for the rich and poor. Gong coins and/or develops a number of analytical categories like "social diagnosis", "concerted constraint" versus "tolerant containment", and "the institutional circuit," all of which are very useful for breaking down service relationships in dynamic ways.
My small critique would be that the brief historical sections on deinstitutionalization and juridical change are underdeveloped and sometimes a bit rigid. This wouldn't be a huge deal (no book can do it all!) except that Gong relies on these histories and points to them numerous times to explain how various practices came to be how they are and I found them incomplete. At the same time, I found his economic analysis (in the few points it came up) cogent and clear. Therefore, I highly recommend this as a window into comparative service dynamics along class lines, but one should add a lot more history books to the docket before attempting to answer the question of "why is it like this?"
My small critique would be that the brief historical sections on deinstitutionalization and juridical change are underdeveloped and sometimes a bit rigid. This wouldn't be a huge deal (no book can do it all!) except that Gong relies on these histories and points to them numerous times to explain how various practices came to be how they are and I found them incomplete. At the same time, I found his economic analysis (in the few points it came up) cogent and clear. Therefore, I highly recommend this as a window into comparative service dynamics along class lines, but one should add a lot more history books to the docket before attempting to answer the question of "why is it like this?"
October 26, 2025
Dust Jacket Hardcover
Brilliantly written
It covers the de-institutionalization of America's mental health programs in an attempt to curb what it saw as the excessive power the staff had with punitive treatments, like electroshock therapy, used to keep patients in line.
Nowadays, with the Department of Mental Health and upscale mental health centers, the only people who get their mental health problems treated are the homeless and the wealthy.
The homeless are seen as the undeserving poor and many people canvassing the homeless somewhat infantilizing them. There is a common view that the homeless legally refuse help because they choose to be homeless, whereas in reality, it is because they found a stable community, probably had previous bad run-ins with government or social workers, and moving shelters is one of the most stressful activities that humans do in the developed world. Plus, when they move into housing, there are often complaints that they wreck the place, disrupt other people's lives or bring tons of conflict into the housing units, which gets them progressively bumped down the ladder of housing quality. The social workers do their best to keep the homeless in the housing units, since it's the least bad option, given that housing can be a form of therapy and the homeless abuse less substances when they have a roof over their heads.
The middle class psychotics get no help and are more or less trapped in the middle. Sometimes having a bit of money with no system in place to curb excessive behavior could lead to legal drug addictions. This is due to a mix of having private insurance and lenient doctors who will prescribe anything patients ask of them. Ironically, the government programs that curb these excesses and do regular checkups were more effective than letting the free-market attempt to solve middle-class psychosis. Sometimes the families go heavily into debt trying to get their adult children into the upper-class bespoke mental health firms as patients.
The upper class psychotics are seen as huge disappointments for their families since the expectations from those families tend to be sky high. Since they come from different worlds from the therapists, some therapists have a hard time connecting and difficulty understanding their clients' goals, despite it seeming unrealistic to the therapists (like getting married to someone super successful, starting a family, and landing a terrific job). At the same time, class differences play a huge role and inform how people should perceive goals, so the therapists by default try to act supportive. At the same time, money can act as an insulating agent. It can grant the psychotics everything pleasure they want in life like multiple massages and unlimited classes. However, it does not buy true friendships nor does it buy freedom. They are under regimented schedules that make them feel like kids and are surrounded by pseudo friends that are paid to be around them.
There is no silver bullet to this issue, since it's not just one singular issue. It is a confluence of mental health provider availability, erosion of the middle class, constraint of state budgets, lack of affordable housing, among many other problems.
Brilliantly written
It covers the de-institutionalization of America's mental health programs in an attempt to curb what it saw as the excessive power the staff had with punitive treatments, like electroshock therapy, used to keep patients in line.
Nowadays, with the Department of Mental Health and upscale mental health centers, the only people who get their mental health problems treated are the homeless and the wealthy.
The homeless are seen as the undeserving poor and many people canvassing the homeless somewhat infantilizing them. There is a common view that the homeless legally refuse help because they choose to be homeless, whereas in reality, it is because they found a stable community, probably had previous bad run-ins with government or social workers, and moving shelters is one of the most stressful activities that humans do in the developed world. Plus, when they move into housing, there are often complaints that they wreck the place, disrupt other people's lives or bring tons of conflict into the housing units, which gets them progressively bumped down the ladder of housing quality. The social workers do their best to keep the homeless in the housing units, since it's the least bad option, given that housing can be a form of therapy and the homeless abuse less substances when they have a roof over their heads.
The middle class psychotics get no help and are more or less trapped in the middle. Sometimes having a bit of money with no system in place to curb excessive behavior could lead to legal drug addictions. This is due to a mix of having private insurance and lenient doctors who will prescribe anything patients ask of them. Ironically, the government programs that curb these excesses and do regular checkups were more effective than letting the free-market attempt to solve middle-class psychosis. Sometimes the families go heavily into debt trying to get their adult children into the upper-class bespoke mental health firms as patients.
The upper class psychotics are seen as huge disappointments for their families since the expectations from those families tend to be sky high. Since they come from different worlds from the therapists, some therapists have a hard time connecting and difficulty understanding their clients' goals, despite it seeming unrealistic to the therapists (like getting married to someone super successful, starting a family, and landing a terrific job). At the same time, class differences play a huge role and inform how people should perceive goals, so the therapists by default try to act supportive. At the same time, money can act as an insulating agent. It can grant the psychotics everything pleasure they want in life like multiple massages and unlimited classes. However, it does not buy true friendships nor does it buy freedom. They are under regimented schedules that make them feel like kids and are surrounded by pseudo friends that are paid to be around them.
There is no silver bullet to this issue, since it's not just one singular issue. It is a confluence of mental health provider availability, erosion of the middle class, constraint of state budgets, lack of affordable housing, among many other problems.
October 10, 2024
Dr. Gong tells a compelling story that reflects his scholarship and is accessible to the lay reader. It is a problem most of us seen around us so often the homeless almost disappear into the urban scenery; his story-telling excels in touching the reader with the human stories that put faces on those people we see on street corners and encamped on roadsides. Dr. Gong clearly lays out the dichotomies and challenges that suggest that solutions will be nuanced and may involve compromise -- easy solutions are blunt instruments. However, the power of the evidence, and the humanity he brings to it, make irresistible his call to address the needs of the sons and daughters struggling on our streets.
October 4, 2024
The homeless and mental health problems are often discussed in the media and print, but never in the detail and compassion that is presented in this book. The Author has been able to connect with people buy going both to the street and inside institutions. His incite is from real people and experience that explain the problem in detail. Highly recommended even for the lay person!
October 5, 2024
Interesting but a little repetitive
November 17, 2025
Seminal peice of work in modern-day sociology of the unhoused,
November 29, 2025
Surprising conclusions about the vast inequalities in U.S. mental health care.
Displaying 1 - 8 of 8 reviews