Neil Gong's "Sons, Daughters, and Sidewalk Psychotics"

Neil M. Gong is an assistant professor of sociology at UC San Diego, where he researches psychiatric services, homelessness, and how communities seek to maintain social order.

His book, Sons, Daughters, and Sidewalk Psychotics: Mental Illness and Homelessness in Los Angeles, compares public safety net and elite private psychiatric programs to better understand inequality in mental health care.

Gong applied the “Page 99 Test” to Sons, Daughters, and Sidewalk Psychotics and reported the following:

Page 99 reveals some of the core themes of my book: how material resources, class culture, and visions of the future shape the treatment of serious mental illness. In this section I’m interviewing an owner of a psychiatric group home, who is explaining why there are lots of flophouses but almost no high-quality long-term residences in Los Angeles—even for the rich. Some of the difficulty in making elite care homes stems from zoning restrictions, neighborhood opposition, and less immediate profit in comparison with intensive, short-term programs. But some of it is also about consumer expectations and dreams. Wealthy families might be willing to spend $30k a month on a short-term program by the beach that promises to “fix” their loved one. But they don’t want to hear that their adult child will have to live in a care home forever. As I put it on page 99, “[Families] envisioned the creation of a respectable, middle- or upper-class life for the patient, not a life of safety and basic management.” In other words, elite treatment providers are selling the (sometimes unrealistic) dream of a full recovery.

In the rest of Sons, Daughters, and Sidewalk Psychotics, readers will learn about care for the poor and formerly homeless client. There is no such promise of rehabilitation--much less the promise of a future middle class life-- in the flophouse or the subsidized apartment unit. On the contrary, it is expected that people will continue to be symptomatic, use drugs, and otherwise behave bizarrely. One could call these patients “free,” or call them abandoned. Without enough staff and therapeutic resources for such rehabilitation, most poor patients are left to their own devices.

In sharp contrast to the neglect of the poor, the privileged may feel hemmed in and dominated by expensive care and parents who have unrealistic expectations. Poor and rich patients are both harmed, then, but often in different ways. Part of the book discusses what this means for social theory (e.g., it contradicts theories predicting the local state will “discipline” the poor social deviant) and the rest addresses workable policy solutions to create a better psychiatric system for everyone.

Visit Neil Gong's website.

--Marshal Zeringue