Stuff (34 page)

In our attempts to help people who hoard information, we frequently emphasize the fact that most information in print is easily accessible over the Internet. We haven't found this fact to be very helpful in convincing hoarders to change their information-saving habits, however. There is something compelling about having a physical representation of the information that makes it seem more accessible. Many hoarders have also complained to us that their computer hard drives and e-mail accounts are stuffed with files and messages too numerous to sort but too valuable to discard. We suspect that this may be a function of the same information-processing problems that contributed to their hoarding.

We live in a materialistic culture rich with stuff, so why should a passion for collecting be considered pathological? People often come to our talks uncertain whether their collecting habits and the piles in their homes and offices are problems or simply eccentricities. The acquisition and saving of possessions is not inherently problematic. In fact, within our culture, it is normative. However, for the people described in this book, who represent up to 5 percent of the population, these behaviors are out of control and resuit in serious impairment and distress. This group is the subject of the mental health and neuroscience research on compulsive hoarding that we have described here.

Interest in and attention to hoarding has been heightened in recent years by reality TV shows featuring messy homes. The heroes of these shows are professional organizers who save the day by turning cluttered homes into showplaces worthy of
House & Garden.
Professional organizers market their services to people who can't seem to get organized on their own. The National Association of Professional Organizers (NAPO), which represents this profession, has grown rapidly, from sixteen members when it was founded in 1985 to more than four thousand today. A subgroup of professional organizers, the National Study Group on Chronic Disorganization (NSGCD), specializes in dealing with what it calls the "chronically disorganized," a euphemism for hoarders. Their services are often helpful to people who hoard but insufficient for those with serious problems.

The rapid growth and high profile of professional organizers have led some to question the necessity or wisdom of eliminating disorder in our lives. Eric Abrahamson, a professor of management at Columbia University, and David H. Freedman, a writer and editor, wrote a book called
A Perfect Mess: The Hidden Benefits of Disorder.
In it they argue that messiness and clutter are markers of efficiency and creativity and that spending too much time and effort organizing may not be wise. They describe examples of highly successful people who lack basic organization and planning skills and conclude that messiness should be celebrated rather than treated as a disorder. Our observations lead us to agree with them to a point. For most of us, a certain degree of disorganization is not harmful and can help us be creative and productive. But at the point where severe disorganization begins to impinge on quality of life, the detriments outweigh the benefits and may qualify as a disorder.

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.

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.

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.

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.