Can't Just Stop

by Sharon Begley

  • Hoarders tend to be perfectionists, which hobbles their decision-making even further: absent confidence that they can make perfect decisions about what to keep and what to toss, hoarders make no decisions. They procrastinate and have difficulty organizing or completing tasks because “they’re worried about making mistakes,” Frost said. “One woman couldn’t bring herself to clean her home because she was afraid she couldn’t get it perfect.”

  • Hoarders often display an intense emotional attachment to every object that comes into their lives. By avoiding discarding, the hoarder avoids the emotional pain of parting with something that has great sentimental value and the anxiety and grief that would return every time he thought of the now-absent object. Far from keeping worthless things, as the 1994 DSM-IV described, hoarders keep the same sort of things the rest of us do. Just more. Lots more.

  • Hoarders see utility where the rest of us see trash, and a universe of possibilities in every object, which makes discarding anything feel like wasting. Hoarders have such a deep abhorrence of wasting, Frost and his Boston University colleague Gail Steketee found, that even the possibility of discarding something they might use one day feels as sickening as if they had violated a religious prohibition. Many people whose behavior falls short of a DSM diagnosis also abhor wasting, of course (doggie bag, anyone?), and many of us know people—or are people—who feel a tinge of angst when they see “perfectly good” furniture at the curb waiting for the garbage truck. And many people who don’t meet DSM criteria nevertheless engage in a little just-in-case keeping: you never know when you’ll want to watch that DVD or read that old magazine. The difference is that hoarders keep it all. Just in case.

  Hoarders do not have to use something to value it. Merely knowing it exists suffices. A scrap of paper with a mysterious phone number might represent a wonderful opportunity, as one hoarder told Frost; of course she can’t throw it out. But neither does she call the number, instead keeping it as pure potential, an eternal possibility unsullied by mundane reality, let alone disappointment. Bonnie, after all, never took the vacations advertised in the brochures she hoarded, nor did she plunge into even a tiny home improvement project to make her house look a little like the beautiful ones in the magazines she hoarded. Reality disappoints; unrealized dreams do not.

  Bob Hartzell exemplifies hoarders’ off-the-charts ability to see potential. Take the sleeves from Starbucks coffee cups . . . as Bob did, so many over the years that he could form holiday wreaths with them, fitting one inside the other and bending them into shape. Or take the cardboard boxes that printer paper comes in. At his last job, at a pharmaceutical distribution company, employees were allowed to take them home, and Bob did . . . a few at first, then a couple dozen, until he had at least two hundred in his apartment in Ohio. He planned to store screws, tools, and odds and ends in them, but over time the boxes accumulated in piles that rose from floor to ceiling. “I’m afraid to throw any away because I might need them,” he told me. “There’s this fear that it’s a nice useful box and I would be stupid to get rid of it.”

  Bob has a particular affinity for containers. Pill bottles fill one large dresser drawer. The kitchen table is covered with plastic storage containers, plastic jars, bottles, pieces of tinfoil, pots, pans, and plastic bag after plastic bag after plastic bag. As the containers built up, he felt a stronger and stronger “anxiety of avoidance,” as he called it, meaning that if he thought about culling his hoard, as his rational mind told him he should, anxiety seemed to flood his every pore. “My big breakthrough was having only one kind of thing, like bottles, in a box, instead of having it filled with unlike things,” he said.

  The medicine bottles in their very own boxes, however, soon posed a different problem. One day he vowed to throw them out, but then a suffocating anxiety gripped him: I might need them one day, he thought. It’s such a waste. It took all the strength he could summon to throw the bottles into the garbage. Not setting them aside for recycling was a major victory, an admission that, You know, some things really are trash. It made him sick to his stomach, and a wave of anxiety that felt like his very veins were constricting spread over him, but he saw it through, and on garbage pickup day the bottles left forever. Unfortunately, Bob’s eyes immediately landed on the now-empty box, labeled BOTTLES, at the top of a tall pile. It seemed so forlorn, so wasted, as bereft as a mother whose children had been wrested from her. He started saving bottles again. “It just sneaks up on you,” he said wearily.

  As we spoke, Bob walked through the home he shares with his wife, peering at labels, reaching up to peek inside boxes, bending down to read the labels on those at the bottom of a pile: “These are filled with papers and magazines and old newspapers . . . oh my god! These boxes here must be ten years old, and they’re not labeled. I don’t know what’s in them.” There were piles of old furniture, window shades, wooden shutters, cardboard boxes, broken chairs, computer boxes, a plastic hose, tennis racket, popcorn tin, throw rug, cat litter box, shelving, flowerpots. Bob is befuddled that things got to this point, and feels as if he is stuck in some bizarre chess nightmare: “It’s like pieces are coming onto the board constantly, and I’m powerless to stop them or get rid of them.”

  A tendency to sentimentalize objects? Anxiety about discarding something that might be useful? Trouble making decisions? Yes, yes, and yes; Bob has the key psychological traits that compel hoarding. When I asked how he got this way, Bob fumbled a bit before zeroing in on his childhood in the 1950s and 1960s, when boys were discouraged from showing their feelings. Sadness, disappointment, frustration, and loneliness were to be kept under wraps. “If you said you felt bad, adults would say, don’t feel that way,” he recalled. “Or they’d ridicule you. I learned to keep my feelings to myself. It became a habit; just answer, ‘I’m doing fine.’ I think that’s why I became attached to things instead of people: they don’t judge you, and they don’t ask anything of you.”

  Lest you think that hoarding has ruined Bob’s life, think again. He has a well-paying job and his wife is a pianist and staff member at a prestigious university. Although he’d just as soon be able to let go of objects, retaining them is less painful, even therapeutic.

  * * *

  Whether the ultimate explanation for hoarding is difficulty in making decisions, imbuing countless objects with sentimental meaning, not wanting to be wasteful, or some combination, in each case the proximate motivation for hoarding is avoiding the anxiety the hoarder would suffer if he discarded things. It is hardly uncommon to act as one does because acting otherwise is too painful. For people with social anxiety disorder, interacting with other human beings is torture, so they keep to themselves. Hoarders cannot part with their stuff because the mere thought of doing so causes an anxiety as deep and sharp and excruciating as cutting off a limb.

  Apart from this trio of traits, hoarders come in every human variety under the sun. Some are social, some are socially isolated. (If the latter, it is often a consequence and not a cause of hoarding.) Some can’t hold a job, some are professionally successful. Some build walls of stuff between themselves and others in order to keep the world out, while for others hoarding becomes a way to fill the holes that life has left and to find a sense of permanence in the permanence of their never-to-depart possessions. It becomes a way to slay the existential angst that comes with the knowledge that nothing lasts, everything goes.

  What hoarding seldom brings is joy or pride, two feelings that distinguish hoarding from collecting. Hoarders may see every item as a treasure but they do not display their haul. At most, all the hoarder feels is secure that her stuff is still there.

  Michele felt that. One evening at the International OCD Foundation’s meeting in Atlanta, she told me that her hoarding began after she joined a quilting club in the 1970s and started making fiber art. At first the supplies fit on a table, but eventually they sprawled onto the floor. Then it was rubber stamps, and fabric. “I’m an artistic person,” she said. “So the biggest bed
room in the house”—an 1,100-square-foot, three-bedroom bungalow that she and her husband bought in 1970—“is filled with my stuff. I have so many projects,” she said with a sigh. “I have a fabric room and a crafts room, and a room with rubber-stamp-art supplies. I do know that my ‘creative interests’ are at the bottom of my compulsion. I enjoy sewing, did some knitting, crocheting, fabric painting, dyeing, batik, photography, calligraphy, and more. I was an art major, and appreciate beautiful things.”

  Her projects rarely reach fruition, however. Michele often hits the Salvation Army store for blue jeans just for the pockets, for instance; “I think blue-jeans pockets are so cute,” she told me. “I can make things out of them.” She paused. “But then I didn’t have room to put my sewing machine out, so I couldn’t make anything.” What was in the way? I asked her. “Books! I love books,” she said, her face lighting up. “In the living room I have magazines in boxes, and books in boxes, and articles I cut out but didn’t get to yet. But it’s a neat clutter,” she assured me. “There are big pathways going through it all. It isn’t narrow goat paths at all.” Although two living room chairs are covered with stuff, “there is a wide area to walk in,” she said.

  All three bedroom closets are filled with her clothes. “I collect T-shirts from places,” she explained. She also rents three storage units, all filled. Although Michele does not have a strong sentimental attachment to her stuff, as many hoarders do, she is clearly hostage to the “I might need it one day” syndrome and paralyzed by what seems like a Sisyphean task. “I started going through some stuff once,” she said. “I put labels on all the boxes. But it took so much time. It was just overwhelming to even start. And so many catalogues come in, you know? I have to go through them before throwing them out but I just don’t have time. But maybe I could start with the kitchen, then the living room . . . then I could bring stuff in from the garage and sort it . . .” Her voice trailed off.

  Out with It

  She at least has the right idea. Hoarders understand what it would take to change their situation. The trouble is, they typically want absolutely no part of it. They know intuitively why they hoard and the purposes it serves; remember, the feelings that underlie a compulsion to hoard are not ego-dystonic, or alien to a person’s true thoughts and core being, as is the case with OCD thoughts. They essentially define the person. As a result, “most hoarders don’t even seek treatment unless a spouse threatens to leave, a family member issues an ultimatum, or a landlord threatens eviction,” Terrence Shulman, a therapist who founded the Shulman Center for Compulsive Theft, Spending, and Hoarding in Michigan, said of the hoarders who find their way to him. “It’s not about the stuff per se. It’s about the emotions underneath. The struggle to get to whether you can address that is so overwhelming it can be paralyzing, but if there were a flood or a fire and they lost everything, they’d feel an enormous sense of relief.”

  Although there is no therapeutic recipe for overcoming hoarding, a form of cognitive-behavior therapy has been shown effective, at least partially and for some hoarders, in numerous studies. The cognitive part involves teaching a client or patient about hoarding, with lessons in setting goals—modest at first, like getting rid of a single item before the next session, or passing up a potential acquisition—as well as training in organizing and decision-making. The approach has been codified in a program called Buried in Treasures, named for the eponymous 2007 book by Randy Frost and Gail Steketee. Over thirteen weekly, two-hour sessions, participants led by a trained facilitator (not necessarily a professional; the manual is available free online) ponder why they keep a particular piece of clutter (which they bring in), and discuss what prevents them from tossing out clutter. The hoarder practices sorting, usually starting small, such as with a kitchen counter. (It helps to get a feeling of accomplishment, and nothing says progress like being able to use your kitchen again.)

  This approach has been tested since about 2007, with results sufficiently encouraging that researchers have now run proper trials. In a 2013 study led by Frost and Steketee, for instance, forty-six people with hoarding disorder were randomly assigned to either this cognitive-behavioral therapy or wait-listedII for it. The intervention consisted of twenty-five or more one-hour sessions plus home visits, spread over nine to twelve months. Through a hybrid of cognitive and behavioral therapy, psychologists first help the hoarder understand her motivations; many have poor if any insight into why they hoard. The therapist also tries to teach the hoarder different, healthier ways of thinking about objects, about herself, and about her memories, questioning whether parting with useless items would really be an abomination, whether donating a deceased husband’s clothes would really negate their love, and the like. After three months, 43 percent of those receiving treatment were “much” or “very much” improved, according to evaluations of their homes by clinicians, whereas none in the wait-listed group were. (Hoarding rarely resolves on its own.) After another twenty-six weeks of treatment, 71 percent of the hoarders had improved, the researchers reported in the journal Depression and Anxiety, and most held onto their gains: a year later, 62 percent were much or very much improved.

  Nathan Blech tried this sort of cognitive-behavior therapy, or at least an informal version of it, on his Meetup group as well as himself. When he invited me to see his Brooklyn apartment, the photographs he showed me beforehand made me wonder how I would even fit through the door. But that was “before.” It was a time when Nathan kept hundreds of pounds of papers, including his grandfather’s Holocaust memoir, written in pencil, for a family history project he felt compelled to take on (or else his family, many of whom had been killed by the Nazis, would be eliminated once again), and which spawned thousands of additional pages of notes, translations, and related family projects. It was a time when he kept six or twelve or sixty of nearly everything, from T-shirts to toothbrushes, so he would never run out. This was “after.” Nathan had co-launched a Meetup group for hoarders, gathering twice a week in a Manhattan skyscraper, preaching what he practiced: over the course of several months he had weaned himself from accumulating (though it nearly killed him to say no to the deli worker’s offer of six free hummus trays) and, item by item, culled his clutter.

  Since much of it was paper, Nathan vowed to rid his apartment of more than a decade’s worth of tax documents (not just the returns; the records, too) by buying a shredder. For days it sat in his apartment like a demon threatening to devour his identity. Everyone who has overcome hoarding has his own epiphanic insight, and Nathan’s was this: if he could shred just one page of one return, the collection would be imperfect, like a “complete” Shakespeare without Hamlet. “Now the whole thing was incomplete,” Nathan explained, “and that made it easier for me to shred the next page of the return, and then the supporting documents, and once I did 1997 it became easier to do 1993, and on and on.” As he showed me around the kitchen, bedroom, and living room, Nathan was embarrassed that he still had multiple paper and plastic bags, dozens of folders of historical papers and research (neatly arranged on shelves in an enormous wall unit), and dozens of T-shirts (stored in built-in drawers). But when I pointed out that he had essentially eliminated the clutter shown in the photographs, and that the stuff he had left was nothing unusual, he beamed.

  The Roots of Hoarding

  The trigger for compulsive hoarding can be something chronic, such as Bonnie’s deep melancholy over how her dreams had turned to yellowing newspaper articles. Or it can be an acute trauma, such as when losing a spouse or child causes survivors to keep everything that comes into their possession so that they, unlike the cruel universe, are not guilty of throwing away something precious. Indeed, one study done for the DSM-5 found that many hoarders report their problem began when their spouse died or their children left home. People get snatched from us; damned if we let our stuff be taken, too.

  Frost finds that about half of hoarders recall a stressful event around the time they began accumulating and keeping. These are pe
ople like Patty, who answered an ad I posted on Craigslist seeking hoarders. When she moved out of her parents’ home after graduating from college, she told me, she piled her stuff into the old used car she had bought: the usual clothing, books, and electronics but also photocopies of virtually every letter she had written (many to her parents when she was away at college) in order to have a record of her life. One night the car was stolen; she never saw her stuff again. A few years later, she forgot to pay the monthly bill on a storage unit she had rented, and the contents—more clothes, records, furniture, tchotchkes, clocks, papers, lamps—were sold off. After that, Patty said, “I began to like to keep stuff, and to surround myself with stuff.” It gave her a sense of security; if she could see it, she could be sure it wasn’t going anywhere.

  For people whose hoarding is sparked by a sudden loss of people or things, the behavior generally begins later than for people who do not recall such a trauma. In contrast, in people whose compulsion to hoard develops slowly over time, its origins often trace back to childhood. There’s something in human nature—atavistic memories of scarcity? an innate drive to possess?—that leads most children to collect something, from dead beetles to expensive dolls or action figures. By age six, nearly 70 percent do so. Even if a child’s urge to collect threatened to turn into full-blown hoarding, it would be tough to reach the extremes of goat paths: children are neither free agents nor armed with credit cards. Parents generally limit any tendency to collect, let alone hoard, through the age-old demand to clean up your room—and to get in there with garbage bags if necessary. Moms rifle through children’s book bags in search of “forgotten” homework assignments and, while they’re at it, toss old papers and junk, perhaps not suspecting their child regards them as treasures. (Mom, where’s my dead moth?!)