Stuff
Page 10
The findings on trauma and attachment, together with the soothing effects possessions seem to have for people who hoard, suggest that part of this problem relates to feelings of vulnerability generated by difficult life circumstances. Hoarding affords many of its sufferers the illusion of control and replaces fear with a feeling of safety. For those for whom safety and control are a driving force, treatment necessarily requires exploration of a painful history. Resolution requires them to observe themselves closely so that they can fully grasp the causes of their hoarding. They must also shift their misguided thinking and beliefs along with their acquiring and hoarding behaviors. Put another way, they must "put their money where their mouth is," so that core values, such as Bernadette's commitment to her children and her religious beliefs, can translate to appropriate buying and saving behavior. Of course, as Bernadette's situation illustrates, this is easier said than done.
Bernadette's treatment progressed in fits and starts. Sometimes she could work on her clutter and clear space, and sometimes she couldn't. Her therapist noticed that whenever she encountered something reminding her of the rape, such as a picture of her room at the time or a fabric resembling the curtains, she shut down emotionally and couldn't go on. A similar thing happened whenever they got close to the point of sorting stuff from the bedroom where the rape had occurred. She had, in effect, walled off the still frightening bedroom, and indeed the entire third floor. Her therapist mentioned one day that she'd done an effective job of making sure no rapist could ever get into that bedroom again. She thought about this carefully. "I never realized what I was doing," she said.
To break this cycle, the therapist suggested that she and Bernadette spend time working only on the rape to help her come to terms with it. As they talked about the trauma and her reactions to it, it became clear that Bernadette had interpreted the rape in a self-damning way. Unable to face her guilt and vulnerability, she had blocked the rape out. In the same way avoidance forms part of the cycle of hoarding, not thinking about traumatic or emotional events forms part of the cycle of anxiety, depression, and posttraumatic stress.
Bernadette's acquiring, saving, and clutter served a purpose. Buying clothes provided temporary relief from her depression; saving things made her feel safe; and the clutter, especially in the bedroom, shielded her from memories of being raped and feelings of vulnerability. Gaining control over her acquiring, saving, and clutter required that she face those memories and feelings. After spending a few sessions talking about the rape, Bernadette's need to hang on to objects to feel safe began to wane, and she was ready to return to treatment for hoarding.
The main focus of that treatment was the powerful beliefs she had about her possessions and their value. We discussed these beliefs during therapist-assisted sorting sessions. Bernadette sorted possessions into categories—items to save, give away, recycle, or discard. The therapist asked Bernadette to describe her thoughts as she evaluated each item. In one case, she said, "Oh, I should save that sock; we'll probably find the other one. I know it's too small for him now, but maybe someone could use it." In another case, she explained, "I loved those shoes [pink patent leather with black smudges on them]. They don't fit now, but I want to remember [how I felt] when I wore them." After she became good at recognizing the patterns of her thoughts and emotions, she was ready to evaluate and challenge them. One method that worked especially well for her was considering her real need for an item versus her simple desire or want. For example, after considering this question, she concluded that keeping clothes that no longer fit either of her children was a fantasy wish, not a real need. Further consideration of the advantages and disadvantages of keeping things she had no real need for (e.g., the outgrown clothes) led her to conclude that the disadvantages of saving them (taking up a whole dresser that the kids needed for their current clothes) far outweighed the advantages (nice memories, but she had pictures for that). Although these considerations seem rather simple, beliefs such as Bernadette's are usually rigid and strongly held. Our goal was to loosen the grip of these beliefs and get her to start thinking from a different perspective. When she had mastered these strategies (evaluating need versus want and advantages versus disadvantages), her therapist asked her to take the perspective of another person—that of a trusted woman friend from her church community—when trying to make decisions about specific items. When considering each decision in light of what her friend would choose, Bernadette nearly always discarded the item, recognizing her friend's "wisdom" in simplifying her life.
During the early stages of Bernadette's treatment, we didn't emphasize getting rid of things. Instead, we focused on changing the way she thought about her possessions. Once she had some success in challenging or testing her thinking, we put more emphasis on discarding. For most of our clients, this involves a slow and time-consuming process in which they spend many months sorting through the things in their homes. Midway through treatment, if a client has been able to challenge his or her hoarding beliefs and tolerate other people touching his or her things, we recommend a more intense approach.
Bernadette was such a client. She had succeeded in loosening her attachment to the clothes she purchased for her children. Because of the huge volume of clutter in her home and her success in challenging her thinking about the clothing, Bernadette's therapist suggested a "team cleanout." This is a highly structured session in the client's home with a team of therapists and assistants. Gail and five staff members showed up in two shifts at Bernadette's home. Bernadette and her therapist had already decided on and written out the rules for the day. Clothes that were too small for her children could be bagged and taken away for donation without Bernadette's approval. So could duplicate clothing if the team kept the two or three nicest items. Bernadette had already put the children's current shoes in the closet, so all shoes found lying around could be donated. The team agreed to organize papers and other household objects by type and put these in bins for later sorting by Bernadette and her therapist.
Bernadette and her therapist sat in the bedroom on the second floor as team members paraded by with items that fell outside the rules. Bernadette's job was to make decisions on these items. Her therapist's role was to keep up her spirits and ask challenging questions, such as "When will you use it?"; "Where will you put it?"; and "Do you have other things like it?" The process was designed to train hoarders how to make decisions about saving and discarding. Bernadette's typical pattern had been to think only about how great these clothes would look on her or her children. Now she had to consider other issues, such as space and likelihood of use. Her therapist was careful not to put any pressure on her to get rid of things. Bernadette made the decisions. If she decided to keep something after reflecting on the therapist's questions, that was considered a successful decision.
One of the worst experiences for someone with a hoarding problem occurs when another person or crew arrives to clear out the home, usually at the order of the public health department or a frustrated family member. It is easy for an observer to say that the hoarder is overreacting to someone discarding his or her stuff, since the piles seem like worthless trash. But because of the hoarder's difficulties with organization, the piles often contain much more than trash. In many such cases, the crew hired to clean will just scoop up the piles and cart them to the dump. But under the decades-old newspaper may be the title to the person's car or the diamond ring she lost years before. These scenarios almost always leave the hoarder feeling as if his or her most valued possessions have been taken away, which in fact may be the case. Beyond this, most hoarders have a sense of where things are amid the clutter. When someone else moves or discards even a portion of it, this sense of "order" is destroyed. We know of several cases in which hoarders have committed suicide following a forced cleanout.
The time, expense, and trauma of a forced cleanout are not worth the effort if any other alternatives are possible. Although conditions in the home may improve temporarily, the behavior leading to tho
se conditions will not have changed. Moreover, the likelihood of obtaining any future cooperation after such a trauma is slim. One Massachusetts town in our survey of health departments conducted a forced cleanout costing $16,000 (most of the town's health department budget). Just over a year later, the cluttered home was worse than ever.
For Bernadette, who consented to the team cleanout and worked alongside the team to make decisions, the experience, though still very hard, was much more beneficial. She had come to trust her therapist and knew that the team members were operating with her goals and rules in mind. As the day wore on, more and more bags of trash and giveaway items accumulated on the front porch. Bernadette found the process exhausting, but she didn't give up. When her husband and their two children returned from a daylong outing (planned so that Bernadette could concentrate on the cleaning), he was so excited by the mountain of departing stuff on the porch and the now visible hardwood floors in the entryway, living room, and bedroom that he gathered everyone together in a circle in the entryway. Earlier in the day, such a gathering would have meant wading through three feet of clothes, newspapers, and boxes. Then he began to pray, his voice rising high in rhythmic chanting of his praise to God and his blessings for the crew: "Hallelujah! Hallelujah! Hallelujah!" Everyone held hands and swayed to the sound of his voice, basking in the pleasure of the moment.
5. A FRAGMENT OF ME: Identity and Attachment
If I throw too much away, there'll be nothing left of me.
—Irene
Debra began collecting magazines at thirteen. Seventeen, Young Miss, and Life were her favorites. They gave her a window into the world, and, for a precocious and inquisitive young woman, an entry into all the possibilities it had to offer. She wanted to know the world, "to learn everything," "to experience everything." As she got older, her collecting expanded to include travel, cooking, news, and women's magazines. There were always new magazines with more for her to learn. Before long, she was spending more time collecting than reading. As with many people who hoard, she planned to read them when she found time, but she couldn't afford to miss what was coming her way. The magazines and newspapers began piling up in her room as she found less and less time to read. At least, she reasoned, she had them for when she could find time.
Even when it became apparent to her that she would never have time, her intention to read gave way to a more dangerous motive. She stopped caring about reading the magazines and wanted simply to preserve them. She began to see herself as "the keeper of magazines." Keeping and protecting them would, she told me, "preserve the time in which we live." Soon this idea evolved into an identity. "Having, keeping, and preserving are part of who I am," she declared. Each magazine was its own time capsule, similar to those accumulated by Andy Warhol (see chapter 2). They preserved the time in which Debra lived and provided a physical representation of her existence, or at least what was going on when she was alive. She made a few attempts to fight off this motive. In an effort to convince herself that this sort of preservation was better left to the government, she visited the Library of Congress. She wanted to see if the library had all the magazines she did. "They didn't have half of what I had!" she exclaimed. At that point, she said, she wished she had started her work sooner.
Her preservation expanded from magazines to TV shows. At first she taped only entertainment shows. She didn't watch them: seeing them didn't interest her; preserving them did. She began to spend hours studying TV Guide, planning and programming three VCRs to run continuously so that she could tape not only entertainment but news and talk shows as well. Her compulsion to tape these shows was powerful. Shortly before the last time we spoke, Debra had been in a car accident and ended up in the hospital. Her doctors were worried that she might have a serious spinal cord injury, and they put her in a special bed to restrict any movement. Debra could not control her panic at not being able to tape her shows until her husband agreed to go home and program her VCRs.
The Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association is the bible for defining psychiatric disorders. The most recent version lists hoarding as one of eight symptoms of obsessive-compulsive personality disorder (OCPD). There it defines hoarding as "the inability to discard worn-out or worthless objects even when they have no sentimental value."
After speaking with Debra, Irene, and so many others, we found this emphasis on non-sentimental items puzzling. It is a subjective term, after all, and our research indicates that many objects in the homes of hoarders carry intense sentimental value. Sentimentalizing objects—giving them emotional significance because of their association with important people or events—is not unusual. We all do it—ticket stubs from a favorite concert, pieces of a long-ago wedding cake, a scrap of paper with a child's first drawing. In this respect, what happens in hoarding is not out of the ordinary. The difference for Irene and Debra, as for many hoarders, is that intense emotional meaning is attached to so many of their possessions, even otherwise ordinary things, even trash. Their special ability to see uniqueness and value where others don't may stem from inquisitive and creative minds and contribute to this attachment. The desire to "experience everything" may expand the range of attachments hoarders enjoy.
Getting rid of ordinary things upset Irene greatly. As soon as she put her decades-old history book into her sell box, she started to cry. "I just feel like I want to die. This is one of my treasure books. I know I haven't looked at it in thirty years, but it feels like a part of me." Irene's reaction to purging these things was grief, as if she'd lost a loved one. Clearly, strong and wide-ranging sentimental attachments to objects are defining elements of hoarding, contrary to the official description. Hoarded objects become part of the hoarder's identity or personal history. In a sense, they come to define his or her identity.
Most of us keep the things we use regularly and discard the rest. We derive pleasure from using objects and, in this way, determine their value. But Irene kept things she didn't use. It was not their use that she found reinforcing, but the idea of having them. Their potential appealed to her. For instance, she had, by her estimation, more than three hundred cookbooks, and she also saved the cooking section of every newspaper and all the recipes she found in magazines. But she almost never used them. In fact, her stove and kitchen counters were inaccessible due to clutter. The mere possession of the cookbooks and recipes allowed her to enjoy thinking about the image of herself cooking and to imagine a potential identity as a cook. Indeed, much of her hoard allowed her to imagine various identities: a great cook, a well-read and informed person, a responsible citizen. Her things represented dreams, not realities. Getting rid of the things meant losing the dreams.
Debra
Debra was in her late thirties when I first met her at an Obsessive Compulsive Foundation meeting several years ago. She attended our workshop and volunteered to take part in a "non-acquiring trip," as described in chapter 3. Her story reveals much about how possessions and identity can be fused.
Debra and her husband lived with her mother and stepfather in a modest home. Although her husband worked and they could have afforded to live on their own, most of their income went to paying rent on three large storage units and purchasing the magazines and other things that Debra collected.
The main living areas of their home were relatively free of clutter when I first met Debra. She confessed at the time that this was because of the efforts of her mother and husband. They maintained control over those spaces and moved anything Debra left there, despite her grumblings and occasional tantrums. In contrast to these areas, wall-to-wall stuff covered the bedroom she shared with her husband. A fortress of papers, books, magazines, videotapes, and more surrounded the bed and reached nearly to the ceiling. She and her husband had to clamber over piles of stuff to get into bed. Amazingly, though we've seen many a person who had to sweep stuff aside to sleep at night, the bed itself remained clear. At the end of the upstairs hallway, Debra's childhood room
overflowed with the remnants of her youth. Even if she had allowed it, no one could squeeze into that room. In addition to all this, Debra rented three ten-by-forty-foot storage units, all packed to the ceiling.
In the time I knew Debra, conditions in her home got worse. Her mother and husband got worn down by her never-ending pressure to put her stuff in other parts of the house. When we last spoke, her things had spilled out into the upstairs hallway, and the parts of the house normally cleared by her mother and husband had become cluttered. The corners of her mother's bedroom and the living room now contained growing mounds of videotapes. The dining room had been completely taken over by newly acquired magazines, and the porch now resembled her bedroom.
DEBRA'S PARENTS DIVORCED when she was two, and she lived with her mother and grandmother until she was eight. She had limited contact with her father and knew little about him until after his death three years before we met. It was then that she discovered that he also kept storage units filled with pieces of his life. In sorting through his stuff, all of which he left to her, she found that he had taped and transcribed all of his conversations with her and kept copies of every letter he wrote, just as she did. He had accumulated literally tons of magazines, grocery bags, and papers.