Pinpointing the moment that quality of life is impaired enough to consider the behavior a disorder is not always easy to do. To some, an active response to hoarding may seem like a civil liberties violation, in which people's homes are invaded by the "clutter police." But after standing in the living rooms of the people described in this book, we find it hard to agree with that point of view. To illustrate this dilemma, each year the students in my seminar watch segments from the BBC documentary series A Life of Grime. The segments feature Edmund Trebus, who emigrated from Poland to England shortly after World War II. Mr. Trebus settled into life in London, where he married, had five children, and began his life as a collector. He started by filling the upper floors of his four-story Victorian home by theme: vacuum cleaners in one room, cameras in another. By the time his children had grown up and moved out, much of the house was full, and he was spending his days collecting whatever could be had for free. His wife held out as long as there was space for her, but eventually she left, and he filled up her space. He never saw his wife or children again. The documentary follows Mr. Trebus's subsequent battles with the local Haringey Council over the rat-infested hoard in his garden. His defiance of the council led to his arrest on several occasions, and the debris in his garden was forcibly removed three separate times. Each time, the crew was met by a defiant Mr. Trebus telling them to "stick it up your chuffer."
The image of the frail, elderly Trebus confronting the burly cleanup crew over his prized but unused and dilapidated possessions highlights the ethical dilemma faced by anyone responsible for the public's health. He comes across as an unlikely, but likable, hero, one oddball against the implacable force of the government. Mr. Trebus has become something of a cult figure in Britain. Since his death in 2002, Web sites have celebrated his life and battles with the Haringey Council. After showing the segments, I divide the class into "pro" and "con" groups to debate the ethics of forcibly cleaning out the property of someone like Mr. Trebus. The debate ranges widely from property rights to civil liberties to community responsibility and liability, and in the end students often end up agreeing with both sides.
Therapy Outcomes
For Irene (see chapter 1) and many others like her, possessions provide pleasure, opportunity, comfort, safety, and a sense of self and personal history that make up an identity. Detaching from her possessions led her to feel wasteful, guilty, and distressed. Possessions provide similar feelings for all of us, but for Irene and other hoarders, the drive to acquire and possess things is stuck in high gear, and changing it is difficult. At a recent research conference, a widely respected colleague confessed that in her therapy outcome studies of OCD, she excludes people with hoarding problems. "They make my therapy look bad," she said. This comment reflects the clinical lore on hoarding—that it is a very difficult condition to treat and that existing treatments don't work.
This professional frustration is one of the factors that led us to develop a treatment program specifically for hoarders, based on what we have learned from our research and clinical experience. In fact, we have had some success in helping people control their acquiring and become more effective at discarding and de-cluttering their homes. In our recently completed therapy outcome study, the clients in our treatment program were significantly improved after only twelve therapy sessions compared to a control group on a waiting list. By the end of twenty-six treatment sessions, more than two-thirds had responded to treatment according to the therapists' judgments, and nearly 80 percent described themselves as much or very much improved.
Despite this success, many were only partly improved and still had cluttered homes. Further, we don't yet know how well such progress can be maintained. Some of our early success stories have struggled to maintain their homes. Irene, for example, who was able to de-clutter almost every room in her house, maintained her new life reasonably well for a number of years. Then two things happened. First, her son went away to school, leaving her alone in the house. (Our research has consistently shown that hoarders who live alone have significantly more trouble maintaining control over their clutter.) Second, Irene got a new job at the library. As she had been many years before, Irene was again in charge of "weeding" the vertical files, which meant that she was responsible for disposing of all the old newspapers and magazines. Many of them came home with her. Though not as formidable as when we first started working with her, the clutter had taken over several rooms when last I spoke with her.
Controlling one's thinking about possessions may take a lifetime of effort for people with serious hoarding problems. Paula Kotakis, who organized the hoarding tour of Berkeley, California (see chapter 4), has kept her home clutter-free for more than five years. In preparation for writing this book, I asked if I could describe her as a "former hoarder." She said no, she doesn't consider herself a former hoarder because she struggles every day with her attachments to possessions. To illustrate her plight, she sent me the following description of her recent experience in throwing away a yogurt container.
As I tossed it into the bin, the thought crossed my mind: maybe the container would rather be dry inside instead of sitting there for a long time, humid. I resisted "rescuing" it in order to dry it out first. Although it felt very silly to have the thought about the yogurt container, it was not at all easy to resist. I felt anxious about letting the top stay on—I wanted to go back into the bin and take the top off so as to ease my anxiety about making the yogurt container stay humid (and thus, "uncomfortable"). I also had to resist apologizing to the container, even as I was reminding myself that it was not alive and was simply a plastic container.
And yes, this all feels very crazy to me.
I remember feeling bad about not choosing "this" particular container as one that would remain at home with the others, and so I was feeling responsible for rejecting it and placing it into the recycling bin to begin its long journey to eventual destruction. I felt responsible for giving it as "comfortable" a ride as possible, seeing as how I was rejecting it, and the thought of it having to endure a humid, long journey made me very anxious. This was followed quickly by the thought of how silly this thinking was, and that I needed to resist following through on what I wanted to do to make me feel less anxious.
Paula's anthropomorphizing—ascribing feelings to an inanimate object—is not uncommon among hoarders. Clearly, hoarders can gain control over hoarding impulses, but they may have to exert considerable effort over a long period of time to do so. The next efforts in our research must involve finding ways to improve on and maintain the effects of treatment.
Fix-It-Yourself Books
As for many other human problems, there are many self-help books on the market to help people de-clutter. A quick perusal of Amazon.com produced more than ninety books promising solutions, including Clutter's Last Stand; How to De-Junk Your Life; Outwitting Clutter; The Clutter-Busting Handbook; Clutter Control: Putting Your Home on a Diet; Help! I'm Knee-Deep in Clutter; The Clutter Cure; The Complete Clutter Solution; Love It or Lose It: Living Clutter-Free Forever; Good-bye Clutter; and Clutter, Chaos and the Cure. Many of these books were written by professional organizers who have years of experience working with a wide range of people to control their stuff. Certainly, these books are helpful in guiding people to organize their mess and get rid of things they don't and won't use anytime soon. Many provide helpful guidelines for deciding whether or not to hang on to Aunt Maude's wedding gift or clothes that are two sizes too small. The rules are sensible and work well for people who are not inordinately attached to their things. But the powerful attachment and other problems we see among hoarders makes us think that these books will not solve most of their clutter problems.
A few self-help books have been written by mental health professionals, including our own Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding and one by Dr. Fugen Neziroglu and her colleagues, Overcoming Compulsive Hoarding. These books provide more insight into the entrenched nature of hoarding, as
well as strategies to resolve these problems. We are just beginning to test whether these books are effective for changing hoarding behavior. We suspect that some people will benefit, most likely those whose problems are less severe and less entrenched. Unfortunately, many of our patients own bookshelves full of de-clutter books that simply add to their clutter without fixing the problem.
Fix-It-Yourself Groups
Several self-help groups are available for people with hoarding problems. In 1981, Sandra Felton founded Messies Anonymous, the largest of these efforts. Sandra described herself as a hopeless "messie" until she made a commitment to change the way she lived. When she regained control over her own home, she expanded her efforts to help others. Now Messies Anonymous groups are active all over the world and have large followings in the United States. Sandra also operates a Web site, which includes an interactive on-line group, a regular newsletter, and access to her writings.
"Mexico" Mike Nelson, a former "clutterer," founded Clutterless Recovery Groups in 2000 to provide support for people with hoarding problems. Like Sandra, Mike has written several books providing useful tips on how to live a clutter-free life.
Though not associated with any one individual, a third set of groups called Clutterers Anonymous has sprung up in many places in the United States. As of yet, we know nothing about how well any of these groups help people with debilitating hoarding problems.
A more highly focused self-help group is Overcoming Hoarding Together (O-H-T). Paula Kotakis launched the group and has managed it since 1998. About a hundred people belong to the group, with another hundred on the waiting list. Those trying to join must wait more than a year for an opening. Several members who suffer or have suffered from hoarding problems serve as moderators, and the group relies on a few committed psychologists to provide backup support. O-H-T bases its program on our model and treatment methods. Group members have access to educational resources, tips on de-cluttering and organizing, professional referrals, worksheets, cognitive therapy strategies, and a real-time chatroom. Members make a commitment to work on their de-cluttering goals and are required to post their goals, action plans, and progress on the Web site at least once a month. Interaction among the members reduces isolation and loneliness, common problems among people who hoard.
The leaders of O-H-T recently asked us to find out whether membership in the group helped people with hoarding problems. Dr. Jordana Muroff, one of our colleagues, has begun to study this question. After almost a year of data collection, it seems clear that the group is at least somewhat successful. Group members reported modest reductions in their clutter and acquiring and were able to get rid of their accumulated stuff more easily than people still on the waiting list. Still, the overall reduction in clutter was quite modest.
From our observations, Internet-based self-help for hoarding is a novel method that might be a good way to provide help for hoarders who live in locations without adequately trained treatment providers, or a good first step for those reluctant to seek treatment. We recently began experimenting with in-person facilitated self-help groups with some success. Group members enjoy interacting with one another and seem to derive motivation to work on clutter from the experience. It is too early to tell whether this approach will be truly useful.
Our first efforts at treatment began more than a decade ago, and our methods have evolved over time with the help of what we have learned in the laboratory. Nevertheless, we still have a long way to go. When we started studying hoarding, there were no other research groups working on the problem. Now at least a dozen highly sophisticated research teams from around the world are studying all aspects of this behavior, including the neurobiology, neuropsychology, genetics, comorbidity, and treatment of hoarding. Undoubtedly the next decade will produce many more advances in our understanding of this intriguing human condition.
One of the challenges for this research will be to distinguish what is positive in hoarding from what is pathological. We wonder whether the attention to the details of objects indicates a special form of creativity and an appreciation for the aesthetics of everyday things. In the same vein, empathy with the physical world expands life's horizons and can give meaning by connecting us to the world and one another. More than anything, hoarding represents a paradox of opportunity. Hoarders are gifted with the ability to see the opportunities in so many things. They are equally cursed with the inability to let go of any of these possibilities, thereby ensuring that few of the imagined options can ever be realized. Hoarding seems to be a symptom of both positive and negative capacities among those who are so blessed and afflicted. With luck, researchers will be able to sort out this paradox and to help people take advantage of the opportunities and jettison the costs.
There have been dramatic developments in the public arena as well. More than sixty cities throughout the country have formed task forces to deal with hoarding problems. These task forces are made up of officials from fire, health, housing, elder services, and mental health departments, as well as people with hoarding problems. They encounter the most severe hoarding cases and individuals who often don't recognize the threat posed by their behavior. Many members of these groups are veterans of massive and expensive cleanup operations that failed, such as Susan in chapter 9. One of the longest-running and most successful of these efforts is the San Francisco Task Force on Compulsive Hoarding, run by the city's Mental Health Association. This task force recently released a comprehensive report on hoarding in the city. The report not only estimated the financial cost of hoarding to San Francisco service providers and landlords ($6.4 million per year) but also laid out a set of recommendations for more effectively dealing with hoarding cases. Their report was a joint effort by members of the task force, which included not only agency representatives but hoarders as well. The efforts of the task force also led to the establishment of the Institute on Compulsive Hoarding and Cluttering, the first organization of its kind. It provides public education about hoarding, training for service providers, support and therapy groups for hoarders, and advocacy to prevent homelessness due to hoarding. It also consults with other agencies and other communities about how to establish hoarding programs. We hope that this will be the wave of the future in dealing with hoarding problems.
Finding Help
If you or a loved one has a hoarding problem, here are steps you can take to get help.
• Find a therapist with experience treating hoarding problems. Several professional organizations provide help in locating suitable therapists in your area, including the Obsessive Compulsive Foundation, the Association for Behavioral and Cognitive Therapies, and the Anxiety Disorders Association of America. Therapists who are registered with these organizations list their areas of expertise, including the treatment of hoarding. If you are seeking help for a loved one who refuses help, these therapists can help you find ways of interacting with your loved one that increase the likelihood that he or she will seek help on his or her own.
• Find a local hoarding task force. Your community may have developed a hoarding task force. If you or your loved one is in trouble with the health department or other agency due to hoarding issues, a hoarding task force can sometimes help provide resources. These organizations are made up of people who are eager to find compassionate ways of solving hoarding problems, and they are less likely to make the mistake of seeking punishments or cleanouts as a first resort. The agencies involved in task forces are responsible for the health and well-being of all residents. Don't be afraid to ask for their help.
• Find a local hoarding support group. Many task forces have started support groups or serve as clearinghouses of information about local support groups. If no groups exist in your area, consider starting one. To find people with hoarding problems to join the group, place a small ad in a local newspaper or community newsletter. Finding other people in your situation who live in your community may be a good first step on the road to your recovery. Our initial research on self-help support grou
ps indicates that groups that use the protocol in our book Buried in Treasures can have a positive effect on members.
• Read one of the self-help books mentioned in this chapter.
• Read Digging Out by Michael Tompkins and Tamara Hartl. This book outlines a harm-reduction approach for family members of people who hoard and is especially helpful when loved ones do not recognize that they have a problem. The authors describe how to construct a team of helpers to work with a loved one to help him or her recognize and seek/accept help for hoarding.
• Above all, try to maintain a positive and healthy relationship with a loved one who has a hoarding problem. Keep in mind that the person's attachment to objects is something that he or she has little control over.
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REFERENCE LIST
Prologue
Alighieri, D. (1954). The Inferno (J. Ciardi, Trans.). New Brunswick, NJ: Rutgers University Press, pp. 73–74.
Bank and Collyers declare a truce. (August 8, 1942). New York Times.
Black, D. W. (2007). A review of compulsive buying disorder. World Psychiatry, 6, 14–18.
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