The pervasiveness of untreated mental illness on the streets of blue cities – about 20 percent of the homeless population in the United States is severely mentally ill – is a glaring feature of the urban landscape. So we invited sociologist Neil Gong, the author of an eye-opening book, Sons, Daughters and Sidewalk Psychotics: Mental Illness and Homelessness in Los Angeles, to join us on this latest BCB episode to talk about his observations of how class dynamics drive radically different social expectations of how to address this problem.

Gong spent years observing public outreach and treatment efforts directed at the mentally ill in Los Angeles, first with the homeless on the gritty streets of Skid Row, and then in the city's tony private pay clinics where wealthy families sent their mentally ill relatives. His book insightfully unpacks the complicated – and often counterintuitive – ways that social inequality shapes not only how we address, but also how we think about, mental illness in urban America. 

We dig in with Gong on the “two different worlds” that exist in LA for handling mental illness. The public system for the homeless focuses on what Gong terms “tolerant containment.” This is the effort, born of civil libertarian ideas about the personal autonomy of the mentally ill combined with a woeful lack of public resources, to accept the problematic behaviors of the mentally ill so long as they remain out of public view in subsidized apartments or flophouses. But Neil contrasts that with the “concerted constraint” work of private clinics that, driven by the concerns of the patients’ families and loved ones, limit the freedoms of their clients as they intensively work to make them as high functioning as possible. 

In the latter part of the conversation we talk about what we should be doing to improve our response to mental illness in American cities. Gong argues we don't need new approaches, but rather greater investment in a more balanced system that combines a variety of approaches, from sober housing to intensive residential programs to in patient hospitalization capacity that compliments the existing, clearly inadequate, post-deinstitutionalization community care system.

Our editor is Quinn Waller. 

Outside sources:

Neil Gong, Sons, Daughters, and Sidewalk Psychotics: Mental Illness and Homelessness in Los Angeles (University of Chicago Press, 2024).

About Blue City Blues: 

Over the last two decades, rural places have gotten redder and urban areas much bluer. America’s bluest cities developed their own distinctive culture, politics and governance. They became the leading edge of a cultural transformation that reshaped progressivism, redefined urbanism and remade the Democratic Party.
But as blue cities went their own way, as they thrived as economically and culturally vibrant trend-setters, these urban islands also developed their own distinctive set of problems. Inequality soared, and affordability tanked. And the conversation about those problems stagnated, as rising tribalism and growing polarization constrained discourse and reinforced cosmopolitan progressive groupthink among educated urban elites. Blue City Blues aims get beyond that conventional wisdom in offering a national perspective on the present and the future of urban America. We will consider blue cities as a collective whole. What unites them? What troubles them? What defines them? Through conversations with a diverse array of smart thinkers and expert guests, we're committed to expanding the horizons of dialogue about the challenges blue cities face. 

Please send your feedback, guest and show ideas to [email protected]

Please send your feedback, guest and show ideas to [email protected]