SAN DONATO VAL DI COMINO, ITALY — At six o’clock each morning, the alcoholics, addicts and mentally ill residents of this Italian village emerge from their homes and congregate in the cafés around the town’s main square. Some of the hardened alcoholics order an espresso with a shot of liquor, then climb into work trucks and head out to farms and construction sites. The mentally ill order cups of coffee or sit at the patio tables empty-handed, an indication that they have run out of cash for the month.

My father was born in this village, where I’ve observed this early-morning ritual on family vacations for two decades. But this time it struck me in a new way. For the past 18 months, I’ve reported on homelessness, addiction and mental illness in American cities and spent hours with America’s most vulnerable residents, who, on the surface, struggle with the same afflictions as the residents here in San Donato.

In fact, the contrast is profound. In US West Coast cities, tens of thousands of addicts and mentally ill people live outdoors in squalid conditions and survive on a combination of panhandling, prostitution and property crime — which, in turn, creates disorder on urban streets.

In San Donato, addicts and the mentally ill are deeply integrated into the community and maintain a dignified standard of living. Their families and relatives look after them and stay involved in their lives.

When necessary, the municipal government provides employment sweeping the streets, and local businesses sometimes pay mentally disabled residents to walk through the streets with a loudspeaker announcing new products available at the market. The residents play a role in helping the most vulnerable through the values of self-help and community responsibility.

In San Donato, a man found sleeping on the streets would suggest a moral scandal. The village would shame the homeless man’s family into taking him in to provide financial, practical and psychological support. The reason nobody sleeps on the streets here isn’t medical or technical — it’s cultural.

Despite massive economic and social change over the past century, Italians have retained a culture of family and responsibility that strictly limits the expression of pathological behavior and enforces a standard of dignity that encourages addicts and the mentally ill to participate in society despite their condition.

It’s true that a small village like San Donato can’t be compared with an urban environment like San Francisco, but the dislocation and devastation in small-town America is arguably worse than in its cities. The difference is not only a matter of scale. Some might argue that higher taxes and more generous public-welfare programs prevent Italians from falling into homelessness and despair — but America actually spends more per capita on social services than Italy does, with worse outcomes.

The dominant policy prescriptions for addressing addiction and mental illness in America involve professionalization, medicalization and destigmatization. Despite mounting evidence of failure over the past half century, we continue to add social programs, to treat addiction as a disease and to destigmatize everything from heroin consumption to homeless encampments.

Yet America is more addicted, more despairing and more disordered than ever before. In Italy, family and cultural norms are central to solving the addiction and homelessness crises. To American officials and academics, that’s naive or even immoral. But San Donato presents a case that traditional societies have a superior understanding of social problems, with cultural expectations playing a decisive role in curbing the most ­destructive human tendencies.

Many years ago, a friend ­referred to San Donato as an open-air madhouse. He captured the poetic truth that we all fall somewhere on the spectrum of human irrationality, and that a good society integrates the sane and the insane into its common cultural institutions.

Though a traditional shame culture exists in San Donato, residents express compassion toward the addicted and mentally ill — actually living with them and looking after them — while remaining intolerant of the pathological ­behavior accepted by American progressives.

The lesson for Americans: Culture matters — and no doctor, pill or policy can replace a truly compassionate society.

Christopher Rufo is a contributing editor of City Journal, from which this column was adapted.