Stuff

by Gail Steketee

  Saint Anthony, Saint Anthony please come around

  Something's lost that can't be found.

  They chanted in unison faster and faster as they searched. Although they never found the article, the chanting seemed to ease her father's distress.

  Besides the emotional costs of growing up in a hoarded home, children of hoarders bear the responsibility of figuring out what to do with an aging parent who is living in such unsafe and unhealthy conditions. Most children are frustrated and angry after years of unsuccessful attempts to get their parents to do something about the problem. At the same time, they love their parents and are worried about them. Conflicting feelings of love and resentment put the children in an impossible position, and understanding a parent's problem does not change the condition of the home. One woman on the COH Web site wrote about how her mother died in squalor, leaving her scarred by shame, guilt, embarrassment, and anger. She advised, "I don't care what the cost for the rest of you whose parent is still alive and living this way, WHATEVER IT TAKES, have an intervention."

  Some interventions involve clandestinely removing things from the parent's home. But forced cleanouts can be long, acrimonious, and, in the end, ineffective. Wholesale cleanouts may temporarily resolve the health or safety crisis, but they do little to change the problem behavior or the causes of hoarding, and the problem often resurfaces (see Ralph in chapter 7 and Daniel in chapter 9). From a mental health perspective, we strongly recommend that the hoarder be included in the de-cluttering process when the cleanout is legally mandated. Even when the person is mentally incapacitated by conditions such as dementia or psychosis, some involvement in the intervention is likely to reduce the trauma. A hoarder's attachment to his or her things and decisions about acquiring and saving will not change if he or she does not participate in the disposition of the stuff. Of course, when the situation is at a crisis level or the person's life is in danger, immediate action to ensure the person's safety is essential. But whenever the process can include the hoarder, even if this slows things down considerably, the quality of the family relationships (and the relationships with legal authorities) will be improved.

  When children, siblings, and parents intervene by discarding items against the wishes of the hoarder, things generally turn out badly. Usually the family fractures, with the hoarder feeling angry, resentful, abused, and sometimes suicidal, and the family members feeling frustrated and angry. At this point, the family members often abandon the hoarder, concluding that there is nothing they can do. The hoarder becomes more isolated and suspicious of others.

  The key is for families to evaluate the pros and cons of different courses of action and to figure out where the leverage lies. Dr. C. Alec Pollard and his colleagues in St. Louis have developed a telephone consultation program to help family members decide how to engage a loved one with a hoarding or other OCD problem in seeking help. The starting point for any family member is to understand what his or her loved one experiences when dealing with possessions.

  Therapists face an additional burden when severe hoarding cases appear for treatment. Every state in the United States now mandates that mental health clinicians report suspected cases of child or elder abuse and neglect. Severe hoarding qualifies as neglect, and as a result, someone with a serious hoarding problem who comes in for treatment may find himself or herself dealing with child or adult protective services. Once a therapist, by legal and ethical obligation, reports a suspected case of abuse or neglect, the chances that the client will return for treatment are almost nil. Protective agencies typically—and sometimes unfairly—have a bad reputation. Although agency employees who are familiar with hoarding as a disorder and educated about dealing with it may be useful resources, when workers aren't familiar with hoarding, the outcomes can be traumatic for everyone involved. The unfortunate consequence of the mandated reporting law is that it reduces the likelihood of the hoarder voluntarily engaging in treatment. As the case unfolds, treatment may be mandated by the court, but the therapist will have to overcome a mountain of resentment before therapy can begin.

  With Ashley's help, Madeline found a therapist familiar with hoarding and began treatment. When I last spoke with her, she happily told me that she had made progress in clearing out her apartment. She had removed more than ninety boxes of stuff, although most had gone into storage. Although the apartment was getting better, Madeline's room at her mother's house was getting worse. There were narrow pathways in the room, and getting to the window required climbing over the bed. Despite this setback, Madeline was hopeful. Ashley, after years of watching her mother's previous attempts, was understandably pessimistic.

  Marrying into a Mess

  Research on hoarding clearly shows that people with this problem are less likely to marry, and when they do, they are more likely to get divorced. Among the participants in our first study in 1993, only 42 percent of the hoarding group was married, compared to 80 percent of the non-hoarding group. In our 2001 study of elderly hoarders in Boston, 55 percent had never been married, compared to only 5 percent of the general population over age sixty-five. So the marriage rate alone makes hoarders a very atypical group, even compared to people with conditions such as anxiety disorders or depression, whose marriage rates are much higher. Something about this syndrome keeps people isolated. As long ago as 1947, Erich Fromm suggested that people with a "hoarding orientation" tended to be isolated figures who distanced themselves from others.

  Clinical lore has followed this trend. The stereotype of a hoarder among clinicians is of someone who is withdrawn and difficult to get along with. But our experience indicates that people who hoard vary widely in their interpersonal skills, just like the rest of the population. * At one end is Irene (see chapter 1), a delightful conversationalist, and at the other end is Daniel (see chapter 9), extremely isolated and detached.

  There's a prosaic explanation for why so many hoarders live without spouses: no one wants to live with all that stuff. The chaos created by hoarding reduces the chances that the hoarder can find and sustain intimate relationships. Most people who hoard are intensely ashamed of their failure to control the clutter and try to hide the conditions of their homes from others. Since the problem has usually escalated enough to create significant clutter by the time they reach their mid-twenties, hoarders enter adulthood with a reluctance to let anyone into their homes—which makes dating (or even friendships) next to impossible.

  The shame surrounding hoarding may also contribute to the development of social anxiety. Nearly a quarter of people with hoarding problems have social anxiety severe enough to warrant a mental health diagnosis of social phobia. This kind of anxiety—which can come across as shyness or even rudeness—can cripple the development of intimate relationships, as it leads sufferers to avoid parties, dining out, and dating.

  For some, the intimacy struggle is more complex. One woman who hoarded animals told me that she was desperate to find someone to love. Nearly fifty, she had never had a serious relationship. She attended social events and even took evening classes at a local university in order to meet men. But getting serious with a man would be difficult if he visited her home. Although she did not have piles of clutter, she did have dozens of cats—so many that the humane society had taken some away and put her on notice. Unless she kept her cat collection to a minimum and submitted to periodic inspections, they would remove all her animals. Her home smelled so strongly of cat urine that my two-hour interview with her left me with a splitting headache. She insisted that her cats were "keeping my love alive" until she found a boyfriend. Once she found someone, she believed, she would be able to get rid of most of her animals.

  More tragic for this woman was the fact that after the animal control officers raided her home and removed most of her cats, her New Hampshire town held a town meeting (a tradition in New England) to discuss the threat she posed to public health. This socially anxious woman sat in the front row while her fellow citizens admonished her for her behavior. Th
is public humiliation drove her deeper into isolation.

  Sharing space with another person proves difficult for many hoarders, except perhaps when both partners have hoarding tendencies. These folie à deux couples may live together contentedly until lack of space provokes conflict or the authorities invade their territory and insist on a change. In our experience, a different problem arises when one partner recognizes the hoarding problem and wants to change but the other does not. It's hardly surprising that we've had limited success in breaking the hoarding cycle in such families.

  Not surprisingly, most hoarders' marriages follow a rocky course. Frustrated spouses criticize their hoarding partners until the marriage breaks up or an icy standoff occurs. Irene's marriage was typical. Her hoarding got progressively worse as her efforts to control the clutter failed. Her husband responded by criticizing her for these and other shortcomings. As his criticism escalated, so did her depression, which further reduced her ability to control the problem. Finally, he left. By the time she regained control of the clutter, it was too late to save her marriage. In other cases we've known, non-hoarding partners disengage from the marriage, relieving their frustration by avoiding the partner and the home and arranging their social lives with others on the outside.

  In a different and probably less common scenario, one spouse acquiesces to the other's hoarding behavior and simply learns to live with it. Bella and her husband, Ray, had been married for several years when her hoarding began. Twenty years later, much of their house was unlivable. Through it all, Ray never complained or pressured Bella to change. Over the next ten years, Bella, with the help of a therapist, learned to control her hoarding, and the couple regained much of their living space. Although Ray didn't hoard, he wasn't bothered by the clutter and was happy to follow Bella's lead, both in collecting and in cleaning up.

  At War over Hoarding

  Some couples make an uneasy truce in which the non-hoarding spouse controls the living areas of the home, restricting the clutter to the basement, attic, garage, or storage units. The success of this arrangement depends on how well the afflicted partner can resist cluttering the living areas. If the urge to clutter is controlled and the collecting behavior doesn't cause financial or other problems, the marriage often survives and may be quite happy. But when keeping clutter out of the living space is an ongoing battle, the truce is fragile.

  Such was the case for Helen and Paul. Half a generation apart in age, Helen was in her mid-fifties and Paul nearing seventy when I met them. According to Helen, Paul's hoarding started some ten years after they were married. Before the hoarding began, they lived in a small and very neat apartment without any clutter. But according to Paul, he had been collecting seriously since his mid-twenties. He had concealed it from Helen by keeping his stuff in storage sheds, at work, and spread among his friends. Paul collected objects from behind department stores and machine shops—junk by most people's standards.

  He told me that he felt bad when he went out and didn't return with something. Before long, his collecting expanded to buying, mostly surplus items from shops and stores. When Paul and Helen married, years before Helen knew the extent of his problem, Paul said that he was "buying like a drunken person." Helen knew he liked to pick things up and save them, but to her it seemed a harmless eccentricity. It wasn't until they moved to France and bought a house that the extent of the hoarding became apparent. Paul's stuff quickly filled the yard and both porches of their new home, and soon it began to creep into the house. From that moment on, battles over clutter defined their marriage.

  When I first spoke with Helen, their home and marriage sounded like a war zone. She controlled the kitchen, dining room, and parlor. He controlled the bedroom, living room, and laundry room. The porches and yard were disputed territory—the frontlines. Rules of engagement evolved. If any of his hoard found its way into her territory, she could move it and scold him, but she dared not throw anything away. If she got rid of something, he became unreasonable, sometimes even violent.

  Paul gained some territory when he retired and had more time to scavenge. She reconquered it when she got the health department to take him to court over the condition of the property. His charm and vigor swayed the judge, however, who gave him an overly generous amount of time to clean it up, at least in Helen's view. Paul convinced the judge that he needed the extra time to sort, clean, and store his possessions. He cleaned, or attempted to clean, everything that came into the house. He then tied things into neat bundles and stored them, usually never to look at them again. His interpretation of the problem was that he simply didn't have enough time to clean and put away what he had collected, and with new things coming in daily, he had little time for anything but sorting, cleaning, and storing his things.

  Paul was dedicated to the proposition that if a thing exists and is free or cheap, it must be had. He foraged throughout the neighborhood behind paint stores, grocery stores, and Laundromats. Anything with a "castoff" appearance, obviously not of use to the proprietors, was his treasure. Before long, he won the battle for the yard and porches.

  The kitchen formed part of Helen's territory, but in Paul's forages, he frequently acquired discarded vegetables and produce from grocery stores. Some of the produce rotted in the yard and prompted a lawsuit from their neighbors. Some of it he brought into the kitchen. Retrieved at the point of spoilage, the rotting food sickened Helen but didn't seem to bother Paul. For some reason, Helen didn't feel that she could throw it out. Somehow it transcended their rules of engagement.

  Another battle was waged over sex. The bedroom was his domain. To sleep there, she had to move part of the hoard off the bed. She took the offensive and refused to have sex with him until he cleared the hoard from the bedroom. He refused. They had reached a stalemate. Her use of sex as a weapon in the war had failed. He argued that she was ruining the family and forcing him to seek the comfort of prostitutes.

  Helen stayed in the battle, refusing to surrender or to quit the marriage. Finally, after many years, something changed. Paul declared that he was through collecting and that he was going to get rid of much of what he had accumulated. Helen described the turnaround as nothing short of amazing. In the months preceding this change, Helen had taken to reading articles about hoarding to Paul. He enjoyed being read to and was attentive, providing critiques of the research. After she read portions of a draft of our treatment manual to him, he stopped collecting. When I met him a few years later, he told me why. His rationale had always been that someday he would need and use the things he collected. But it finally dawned on him that at his age, this was terribly unlikely. As another of our clients on her way to overcoming hoarding once remarked, "You can't hook up a U-Haul to a hearse." Helen attributed Paul's sudden change to pressure from the city and his friends, as well as her threat to leave him at the end of the year if nothing changed.

  When I last spoke with them, the situation was much improved, but their perceptions of the extent of the remaining problem differed substantially. Helen's account of the condition of their home indicated that using the refrigerator, eating at the table, finding important papers, and sleeping in their bed were still difficult because of the hoarding. Paul thought that none of these things was a problem. Helen also described parts of their home as extreme fire hazards and very unsanitary. Paul considered their home safe and clean. His perceptions of the value of objects also differed substantially from Helen's and from most people's. One day a visitor asked him why he washed and hung out to dry so many rags and why he never used them. The questions enraged him. He couldn't understand how someone could describe his used clothes and bits of cloth as "rags." In his mind, he would never have picked up or kept something that was just a rag.

  Helen and Paul came to a fragile truce in their marital war. Skirmishes still occurred on a regular basis, and whether they would be able to keep the peace remained to be seen.

  12. BUT IT'S MINE! Hoarding in Children

  If she ever owned it, it's her
s; if she wished she owned it, it's hers; if in the future she might own it, it's hers; if it belongs to anyone she loves and who loves her, it's hers.

  —Amy's mother

  Many people who see hoarding cases—psychologists, psychiatrists, social workers, housing and health department officials—insist that it is a disorder of older people. Most people who get in trouble with the health or fire departments because of their hoarding are middle-aged or older. A survey of the existing research might lead to the same conclusion. The participants in our studies, for example, have ranged from ages eighteen to ninety, with an average age of just over fifty. But our studies of people who suffer from hoarding problems indicate that hoarding begins early in life. Although few published case studies of hoarding in children exist, some of our colleagues have described the symptoms in their child clients. Aureen Wagner, a clinical child psychologist at the University of Rochester and author of Up and Down the Worry Hill: A Children's Book about Obsessive-Compulsive Disorder and Its Treatment, told me about an unusual case: a six-year-old girl who collected nearly everything she found—crumbs from a restaurant, pencil shavings at school, empty juice cartons, whatever came her way. When her parents were remodeling their home and workers removed the drywall from her room, she threw a fit. On another occasion, she was with her parents at Wal-Mart when some mud dropped off her shoe. An alert store clerk happened by and scooped it up. The little girl fell apart in the store, demanding to get her mud back. "But it's mine!" was the only explanation she could give.