How Louis Ziskind Helped Deinstitutionalize Mental Healthcare

Alex Sayf Cummings

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Perched among the lumpy hills and modest cottages of Los Angeles’s Echo Park, a hospital sits. You would not expect to run across this curious facility only six blocks from the trendy bars and coffee shops of Sunset Boulevard, but there it is. Behind a big sign with very 1960s-style lettering is Gateways Hospital and Mental Health Center, a pioneering institution in the field of community mental health.

In the 1950s, thirty years before Prozac became a household word, Americans with psychological problems encountered great stigma. “The common concept at that time was that if you had mental illness, your bloodline was tainted and you opened it up to the community,” Louis Ziskind, a social worker who had worked for decades with Jewish social welfare organizations in L.A., recalled in 1997. “Who wanted to marry into a family that had mental illness in it?”^[1]

Many people in a mental health crisis also faced confinement in a state hospital, where they might spend five, ten, thirty years. “Most of the mentally ill who could not pay for private care were treated at large state hospitals, often ordered there by the court system,” journalist Jocelyn Y. Stewart has noted. “Patients sometimes remained in the facilities longer than necessary because they or their families lacked the resources and support services to return them to the community.”^[2]

In the 1930s and 1940s, Louis Ziskind recognized that the mentally ill frequently fell through gaps in the social safety net. Without other options, and with fearful families, they would end up in California’s state hospitals for years and all too often lose touch with the outside world. “Ziskind envisioned mentally ill patients being treated in their own communities at ‘community mental health care’ centers,” the Los Angeles Times observed on his passing in 2007. “Patients would be hospitalized for a short time, their illnesses treated with new drug therapies and short-term psychotherapy.”^[3] Ziskind believed this would be a better way.

Ziskind’s vision was realized in Gateways. The hospital stood at the forefront of the mid-twentieth-century movement for deinstitutionalization in mental health. Founded in 1953, the facility aimed to tackle episodes of acute mental illness, with the goal of returning patients home and helping them remain integrated in their communities as soon as possible.

From Eastern Europe to Echo Park

Ziskind’s views on mental health care and treatment were informed by his family and upbringing. His parents had been childhood sweethearts in Lithuania, where vicious discrimination and pogroms promised a bleak future for Jews. Other family members had already fled to the United States, sending back “stories of freedom… [that] fired the imagination of my parents,” Ziskind recalled in his 2005 memoir. “To them it was like heaven on earth.”^[4]

The Ziskinds brought their radical views across the Atlantic. “My folks were very die-hard socialists,” Ziskind recalled. “They believed in the underdog.”^[5] (They also abhorred their son reading “trash” like Horatio Alger’s rags-to-riches stories, though he loved them.) The Ziskinds landed in Baltimore, where Louis was born in 1908, but the child was in ill health, and doctors soon urged the family to move to a better climate.^[6] As for so many searching for milder climes, Los Angeles was the place to be.

The Ziskinds grew into an exceptional family. Louis’s older brother Eugene became a successful physician and served as head of psychiatry at USC Medical Center; his wife, Esther Somerfeld-Ziskind, was perhaps even more prominent as a specialist in neurology and psychiatry.^[7] Louis’s other brother, David Ziskind, was a labor lawyer who crusaded against workplace discrimination and housing segregation, writing about police brutality, strikes by public employees, and human rights over a long career.^[8]

Louis initially aimed to follow Eugene into the medical field, but he found his way into social work – which was, until then, an overwhelmingly female profession. “I want to tell you something,” a hiring manager told Louis in the 1930s. “I know your brothers, you come from a nice family, what the hell are you doing applying for a job in social work? This is a woman’s business.”^[9]

Despite bad job prospects amidst the Great Depression, Louis found work in California’s State Relief Agency in 1934, and then the Jewish Big Brothers organization three years later. He subsequently joined the Jewish Committee for Personal Service (JCPS), serving as its executive director for decades.^[10] Louis became a savvy negotiator among groups that distributed charitable funds, such as JCPS and the United Way.^[11] But he soon saw the difficulties of providing critical support for the mentally ill, who often ended up isolated and severed from their communities, due in large part to the shame attached to such maladies in the mid-twentieth century

Gateways, then, grew from frustration with the shortcomings of the state mental healthcare system in California, particularly the long-term detention of patients in state facilities. Louis Ziskind saw that people with serious mental illness were well served by neither the public safety net nor the private charities he worked for. In 1941, he began floating the idea of a facility that would treat mental health crises with a short in-patient stay, and then coordinate with local agencies and patients’ families to get them back into the community as fast as possible. “We could see the patients instead of at General Hospital or in addition to General Hospital or before General Hospital saw them and determine if they are suitable for rapid treatment,” he said. “Then we wouldn’t send them over to the state hospital. We have a way station that would give the rapid treatment.”^[12]

This approach meant ongoing mental health support, with help from faith institutions, assistance with job-seeking, and so on. For several years, the Jewish philanthropic leadership in L.A. was initially skeptical. “I had colleagues come to me when I dreamt up the thing about Gateways, [and say] you’ll never make it,” Louis remembered in 1993. “Why even try it, the [Jewish] Federation doesn’t want you to, they don’t need another area of service to raise money for.”^[13]

But, working with his wife Edith, along with Eugene, Esther, and David, Louis was able to marshal the necessary resources to found Gateways in 1953. It moved to its current Effie Street location in Echo Park in 1961, where, on a sweaty afternoon, hundreds gathered to see Eleanor Roosevelt bless the groundbreaking.^[14] The new facility was sustained from its inception by support from innumerable individuals and groups in L.A.’s Jewish community.

Of course, the Ziskinds were not the only ones to see the problem. As historian Gerald Grob has shown, many experts grew increasingly worried about the state of public mental healthcare in the 1940s and 1950s.^[15] State hospitals were often underfunded, overcrowded, and prone to coercive tactics for difficult patients, holding seemingly little hope that people could be successfully treated, only contained. Louis Ziskind mapped out what a new approach might look like, but he was not alone in contemplating change.

Gateways was among the first institutions that promoted deinstitutionalization: the idea that ill people should be treated, as much as possible, outside long-term care in large institutions. One could call it a nimbler approach to care, but also a more optimistic one. People might suffer from episodes of serious mental illness, but they could have their most acute symptoms addressed and remain part of their communities. Gateways called their approach, “Recovery first, then a ‘cure’.”

The Bigger Picture

Today, many see deinstitutionalization as part and parcel with the cruelties of the Reagan era of the 1980s, when cuts to social welfare programs basically dumped vulnerable people on the streets. Some critics cite deinstitutionalization as a significant cause of today’s crisis of homelessness in U.S. cities.^[16] And recently, states such as California and Oregon have considered more coercive measures to force the unwell, and particularly unhoused individuals, into treatment – raising the ironic specter of a return to the heavy-handed approach of the mid-twentieth century.^[17]

No honest person in 2024 could argue that mental illness and homelessness are handled well in the U.S. And the community healthcare paradigm has its inherent shortcomings. Louis Ziskind envisioned partnerships that would coordinate local agencies to nurture an individual back to healthy participation in society, yet such resources are often too fragmented and under-supported to achieve that goal.

At times, too, public fears play a part. California’s conditional release program, better known as CONREP, tries to determine whether people accused of crimes, who have been committed to treatment in places like Gateways, are ready to reenter society. Some former patients argue that psychologists employed by the state are reluctant to let people out of care for fear they will reoffend. What were well-intended reforms could result in individuals feeling trapped in the system – again, risking remaking the older state hospitals that community mental healthcare was meant to replace.^[18]

But it is crucial to remember that Louis Ziskind’s vision and Ronald Reagan’s were far from the same. In the 1950s, the goal of steering people who need treatment away from long-term detainment in decrepit state hospitals was a noble one. Gateways came about in the 1950s when some commitment to a robust social safety net remained in the United States, which would be bolstered by Lyndon Johnson’s Great Society programs in the 1960s, and then substantially undermined by the rise of the New Right in the 1970s and 1980s. When mental hospitals in the 1980s started offloading people under Reagan, they were operating in a very different cultural and political environment, where the impetus to maintain community connections and support people in need was greatly diminished.

Gateways Hospital was early in showing what an alternative could be. It’s just that, in the over 70 years since the hospital was founded, we have – for the most part – not figured out how to put the pieces together to make community care for the most vulnerable work (though states such as Massachusetts have explored better options for coordinated treatment in recent years). It doesn’t mean that what the Ziskinds imagined in the 1940s was wrong, or impossible. All too often, what seems impossible or intractable is just difficult or inconvenient.

Notes

1. “Louis Ziskind, Interviewed by Ed Humel at his Brother’s Home” May 14, 1997, https://digitallibrary.usc.edu/Share/5uxd4846mj3274b73hhkl3rpi7vbt00x, p. 70. ↑
2. Jocelyn Y. Stewart, “Louis Ziskind, 98; Started Hospital to Treat Mental Illness,” Los Angeles Times, March 24, 2007, https://www.latimes.com/archives/la-xpm-2007-mar-24-me-ziskind24-story.html. ↑
3. Stewart, “Louis Ziskind, 98.” ↑
4. Louis Ziskind, A History of the Jewish Committee for Personal Service & Gateways Hospital and Community Mental Health Center: A Memoir of My Life in Social Work, 1939-1985 (2005), p. 4. ↑
5. “Louis Ziskind, Interviewed by Ed Humel,” p. 2. ↑
6. Ziskind, A History of the Jewish Committee for Personal Service, p. 4-5. ↑
7. Elaine Woo, “Dr. Esther Somerfeld-Ziskind, 101; Pioneering Physician,” Los Angeles Times, November 22, 2002, https://www.latimes.com/archives/la-xpm-2002-nov-22-me-somerfeld22-story.html. ↑
8. Myrna Oliver, “David Ziskind; Helped Desegregate L.A. Fire Department,” Los Angeles Times, July 13, 2001, https://www.latimes.com/archives/la-xpm-2001-jul-13-me-21849-story.html. See also David Ziskind, “A Sociological Study of Public Opinion Concerning Certain Police Practices in Los Angeles,” M.A. thesis, University of Southern California, 1933; David Ziskind, One Thousand Strikes of Government Employees (New York: Columbia University Press, 1940); David Ziskind, Peace through the United Nations (Los Angeles: Litlaw Foundation, 1994). ↑
9. “Louis Ziskind, Interviewed by Ed Humel,” p. 68. ↑
10. Ziskind, A History of the Jewish Committee for Personal Service, front flap, p. 12, 17. ↑
11. “Louis Ziskind, Interviewed by Ed Humel,” 71-75. ↑
12. “Louis Ziskind, Interviewed by Ed Humel,” p. 92. ↑
13. “Louis Ziskind Interview by Marj Schwarz,” August 11, 1993, https://digitallibrary.usc.edu/asset-management/2A3BF11SLSLS, p. 26. ↑
14. Louis Ziskind, A History of the Jewish Committee for Personal Service, p. 109, back flap. ↑
15. Gerald N. Grob, From Asylum to Community: Mental Health Policy in Modern America (Princeton: Princeton University Press, 1991). https://press.princeton.edu/books/hardcover/9780691631264/from-asylum-to-community ↑
16. Divya Kakaiya, “Here’s How Reagan’s Decision to Close Mental Institutions Led to the Homelessness Crisis,” San Diego Union Tribune, April 24, 2023, https://www.sandiegouniontribune.com/opinion/commentary/story/2023-04-24/opinion-impact-of-deinstitutionalization-on-homelessness-reagan-mental-health-hospitals-san-diego. For a contrary view, see Jim Shields, “Who Closed Mental Health Hospitals in California? Three Guesses, It Wasn’t Reagan,” Ukiah Daily Journal, August 19, 2023, https://www.ukiahdailyjournal.com/2023/08/19/the-observer-who-closed-mental-health-hospitals-in-california-three-guesses-it-wasnt-reagan/. ↑
17. April Dembosky, Amelia Templeton, and Carrie Feibel, “When Homelessness and Mental Illness Overlap, Is Forced Treatment Compassionate?” LAist, March 21, 2023, https://laist.com/news/health/when-homelessness-and-mental-illness-overlap-is-compulsory-treatment-compassionate; Scott Wilson, “California Shifts to an Experiment in Coercion to Treat the Homeless,” Washington Post, April 27, 2023, https://www.washingtonpost.com/nation/2023/04/27/california-homeless-mental-illness-newsom/; ↑
18. Christie Thompson, “No Driving, No Working or Dating: This Program Controls People Leaving Psych Hospitals,” Los Angeles Times, September 24, 2021, https://www.latimes.com/california/story/2021-09-24/california-conrep-program-criminal-justice-not-guilty-by-reason-of-insanity. ↑

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Featured image caption: Gateways Hospital in Echo Park in 2024. (Photo by author)