Learning from the Tee Vee August 1, 2011

I’m facebook friends with Geralin Thomas, one of the organizers from Hoarders, and this morning she asked her followers what we’ve learned from watching Hoarders on TV. It seemed like a good opportunity to come up with a top ten list, so here you go:

1) There is a HUGE difference between hoarding and being cluttered/disorganized. Most of us have times in our lives when our stuff gets out of control, and it’s really just a matter of straightening up and figuring things out. We may call in professional help, but we call organizers, not therapists. Hoarders need organizers, but they also need therapists. There are larger issues at play. It’s not just about sentimentality, time management, or changing life circumstances. What they do on Hoarders is definitely not the same as what they do on Clean House, by any stretch.

2) Not everyone who is on Hoarders wants to be on Hoarders. I’ve seen quite a few episodes where it’s pretty clear that the person is only on TV to get help due to legal issues or citations, and if they had their way they would make no effort towards changing their lives. As a side note, Hoarders has given me a lot to think about regarding when we should intervene – at what point should the government or protective services get involved, and how much should we “live and let live?” in extreme cases the need for intervention is obvious, and clearly the milder cases will become extreme if left alone, but at what point is criminal or civil intervention appropriate?

3) Hoarding affects entire families, even when they don’t live together. The anguish and concern, especially of children of hoarders, is heartbreaking.

4) The anguish of children who live with hoarding parents, however, is far worse and far more dangerous. There have been some episodes where the show has called in child services, and quite a few where I’ve wondered why they haven’t. These kids have a tough road. Most of the time, they know that something is not right and their house is not supposed to look like that. Their environments are full of physical hazards and often toxic air. They live without utilities, without proper bedrooms, without private space, and without room to play. In some cases, they grow up without knowing any better and show signs of hoarding behavior themselves – they lack the frame of reference for making better decisions and living a cleaner life. They just don’t know what’s normal and what’s not.

5) Not all hoarders look like hoarders. It’s pretty common that I see someone on Hoarders and think, how do you keep yourself looking so put together when you’re starting your day in that mess? If I passed one of these people on the street, worked with one, or even went out for a beer with one, there would be nothing in their appearance or demeanor that would tip me off that they had a hoarding problem.

6) I don’t believe that hoarding is itself a discrete mental illness. It seems to me that it is a way that several illnesses are expressed, whether they are ADD, OCD, depression, reaction to trauma or loss, or PTSD.

7) Although people hoard for a variety of reasons, there seems to be common thread of inability to make appropriate decisions and assign appropriate values. We all know that many hoarders have trouble deciding what to get rid of and what to keep, but what I’ve found really striking is the inability to place appropriate value on things – valuing an item over the health hazard it presents, valuing a collection over the personal space of another family member, valuing the ownership of a pet over the ability to care for it. There was one episode where the therapist had to call child services, and the hoarder said that they would rather the show pack up and leave than place the call. No one wants child services called on them, but at the same time, the fact that the call is warranted is a sign that there’s a massive problem here and maybe the appropriate solution is to deal with it rather than ducking the authorities. These parents made it clear that they would rather continue their lives as-is (i.e. dangerous to their children) than take steps to remedy the situation. Or that family that had the bedbugs, so they slept outside in a tent rather than clean the house so an exterminator could get in. That’s not a good long term solution. The inability of hoarders to see the big picture is staggering.

8 ) It seems like a lot of hoarders have dysfunctional marriages. As a general but certainly not universal theme, the hoarder seems to have a very dominant personality while their partner is very passive and submissive. There have been times during the show when I have looked at my husband and said, “If I ever let the house get like that, just throw all my stuff out.” I have a feeling many spouses of hoarders have tried that, to explosive results. Many of these partners seem like the situation and the length of time it has gone on have really worn them down. They’re afraid to speak up, afraid to challenge the hoarder, afraid to assert the fact that they have rights in their own homes. They avoid their spouses, avoid their homes, make concessions, and try to ignore the problem in the hopes it will go away. Often, the hoarder seems to have shutting their partner up down to a quick science, usually through yelling and threatening. Sometimes the show is called because the partner has threatened to finally leave, or finally take the kids out of the home, and you can tell that just making the threat took every fiber of their being. These people are beaten down from living with a hoarder, sometimes quite severely. More than once, I have watched a spouse or partner interact with a hoarder and thought, “I hope she leaves him.” That’s a terrible and scary thing to think.

9) In extreme cases, hoarding can destroy your house. There have been a few episodes where even with the house cleared out, the structure remained uninhabitable. The damage from mold, leaking items, pests, etc. is still there, even when the offending items are removed, and it’s bad enough where the home is still not fit to live in until major repairs are completed.

10) Severe hoarding can also affect your health. There are a lot of hoarders who have underlying problems – disabilities, illnesses, etc. that are made worse by the hoard. Hoarded houses are dusty, dirty, moldy, and can have pest infestations. A lot of time the children in the house complain of asthma, allergies, and breathing problems. Plus, there’s the hazards of a hoarded kitchen – the expired or rotten food, unclean cooking surfaces, and bacteria-laden counters that make any food prepared or stored in the house potentially unsafe.

So there you go. Who says TV can’t be educational?

Hoarders, etc. January 26, 2011

A lot of people ask me about hoarding, and do I watch Hoarders (I do, religiously), and recently a few people have asked me if I’ve read Stuff: Compulsive Hoarding and the Meaning of Things. I can now report that I have read it, and it was very interesting.

I should probably preface this entire piece by saying that I am not in any sense clinically trained and I have no educational or professional background in psychology aside from AP psych in high school and 2 college courses to complete my science requirement. Just so you know.

I don’t know that I agree with the idea that all hoarders are sick, or that they are all sick in the same way. Most psychologists seem to lump compulsive hoarding in with OCD and anxiety disorders. I see a few problems with this. One is the success of exposure therapy in treating OCD symptoms. There has been great progress in guiding people with OCD to face their fears, allowing them to progress into more and more anxiety-producing situations until their fear or compulsion is conquered. Yet with the treatment of hoarders, the conventional wisdom is that this type of treatment will not work. It’s generally agreed that a forced cleanout will cause additional stress, possible breakdown, and ultimately lead to the hoarder re-filling their home with stuff, possibly to a greater degree than before. So I find it a bit odd that we can treat fears and compulsions with exposure therapy – except this one. That, to me, says that hoarding is somehow different.

The second issue is that the hoarders I have read about and seen on TV are not all the same. If you watch Intervention, or The Biggest Loser, or any show about different people overcoming a common challenge, there is a common thread between them. In some sense, these people share the same story. With hoarders, that doesn’t seem to be the case. Some show hoarding behavior from the time they are young. Some can point to a life event – usually some sort of loss – as a trigger. Some hoard items indiscriminately while others hoard specific categories of items with a specific purpose. Some are very outgoing and social and some are very lonely and closed-off. Some hoarders seem completely incapable of making decisions. Some are much much cleaner than others. There’s no common story. I don’t think these people have a common illness. I think some have OCD or anxiety disorders. Some have a disorder that makes decision-making difficult. Some have paranoia or control issues. Some are traumatized. Some are depressed. These are all very different mental problems – they just happen to be expressing them in similar ways.

And yes, I do think some of them are just lazy. I think that by the time your situation is bad enough to merit inclusion on a television show you’ve probably progressed beyond lazy to overwhelmed and scared and desperate and probably depressed, but in some cases I do think it starts out as sheer laziness.

There are still a few things that I don’t understand about hoarders. I don’t understand why, if their possessions are so precious, they don’t treat them well. They don’t store things properly, they bury their treasures under mounds of stuff, they let things rot or mold or break. A hoarder with dozens of carefully arranged curios of figurines makes sense to me. A hoarder with half-crushed boxes of mixed items that they can’t easily access does not. This goes double for animal hoarders.

I don’t understand why the people on TV – especially the doctors, who I would assume are mandatory reporters – don’t call child and animal welfare services more often. There was one episode of Hoarders where they did call child services, and it was a big deal. The thing was, it was not by any stretch the worst house with children in it that was featured on the show. Why did they call then and not other times? (Sub-question, goes to mental illness: Why was the parents’ response to this to try and stop the show rather than to change the situation so that the home was fit for the children? Their solution was to let things stay as they were, i.e. unfit for the childrens’ well-being (a point they agreed with!), and let their children continue to live in that environment, rather than change the situation so that their children had a safe home. That’s a huge mis-prioritization that I see over and over with hoarding stories. People know how bad the situation is – they know that child services, adult services, animal services, and the housing inspector are threatening to make the worst happen, but they still don’t act to change their situation. They misplace their anger at the government agency. They choose the unhealthy situation over the healthy solution. It’s a lack of ability to prioritize and make decisions and see the big picture.)

I also don’t understand the filth. Not all hoarders are filthy, but a good number are. Sometimes it’s a function of the hoard – mold that can’t be seen or treated, dust that can’t be reached, floors that can’t be vacuumed. But often times, there is a mess on top of this. Animals that are not cleaned up after, ash trays that are not emptied, garbage – that the hoarder knows and agrees is garbage – not removed from the house on trash day. What gives? What is it about hoarding that makes you unable to wipe up a spill or empty a litter box? I don’t understand that.

So that’s kind of my high-level thoughts on the whole hoarding phenomenon. I could probably write more on it, but at some point I have to get back to my day job.