CHAPTER 1 PACK RATS, CLUTTERERS, AND COMPULSIVE HOARDERS YOU WOULD NEVER HAVE SUSPECTED that Joan suffered from compulsive hoarding. When I first met her at my office in Sacramento, I saw an impeccably dressed African American woman of 50, who I knew from the referral was a highly regarded administrator at an insurance company, the model of efficiency and attention to detail at work for 2 decades. The first time I saw her home, however, was a very different story. Joan was at Level 4 (out of 5) on the Clutter Hoarding Scale, an assessment tool devised by the National Study Group of Chronic Disorganization (NSGCD) in St. Louis. In broad terms, someone at Level 4 would have significant difficulty cleaning a home without professional help; conditions of the home are unsanitary or otherwise hazardous (food is often rotting on counters, and rodents and insects may be visible in multiple locations); rooms in the home are so packed with objects that they are unusable for their original purpose; there's mold and structural damage to the home; and when pets are present, there is accumulated animal waste. Joan's house met all of these conditions. It was hard to imagine that this calm, confident woman could emerge every day from such a place. The first thing I noticed about Joan's house was the smell. Even with my impaired sense of smell, the odor of ammonia and feces was overwhelming. The cats' litter box, which was in the dining room, was overflowing, but a walk through the house made it clear that the two cats had long since given up on it and were urinating and defecating everywhere. Joan's three bedrooms were unusable--piles of clothes and books, many contaminated with cat waste, were everywhere, and disorganized to-do piles of bills, receipts, and laundry covered the living room. In the kitchen, the counters were piled with old food and dirty, empty food containers. Canned goods and packaged foods overflowed from the pantry because Joan had bought multiples of the same items. The freezer was so full that it had frozen shut. Gnats flew everywhere. When I pulled open the freezer door and peered inside, I saw countless dead insects that had somehow worked their way into the seal. I pointed this out to Joan, who didn't seem terribly bothered by it; she said something vague about meaning to call the exterminator. I'd seen worse homes in my years of treating people who hoard, but what I remember most about Joan's house is the plastic bags filled with cat feces that were sitting by the litter box, leaning up against the sliding glass door to the backyard. Apparently, Joan would scoop the contents of the litter box into the bag, intend to place the bags into the garbage, and either forget or find herself unable to lift it. She said she was always meaning to call someone to help her throw it out, but she never did. As a result, bags of cat waste sat in the living room. Joan, like many who compulsively hoard, had a system, albeit one that didn't work well. She was full of good intentions, but the time to take care of all the things she meant to simply never came. There were always, as with many of us, more important things to do. Joan's case exemplifies to me many of the things people don't understand about hoarding. Many people judge hoarders harshly, believing them to be lazy, unsanitary, uncaring, selfish, self-absorbed, or narcissistic.* Joan's personality couldn't be further from any of these traits. She was desperate to live differently--she just didn't know how--and she needed help. Joan completed the 6-week Intensive Outpatient Program at my clinic, which involves extensive hours of therapy and home visits. While her home wasn't perfectly free of clutter when she was discharged from the program, she now lives a very different life than she did before treatment. She currently works with a therapist one-on-one, and she continues to improve. In my practice and on the A&E show Hoarders, I work with people like Joan, who suffer from compulsive hoarding, an anxiety condition in which individuals are simply unable to prevent themselves from accumulating and saving oftentimes shocking amounts of stuff, most of which an outside observer would consider useless garbage. Some 3 million people in this country are thought to compulsively hoard, but I believe that number is a gross underestimate due to the shame, guilt, embarrassment, and fear that prevent many people from seeking help. In extreme hoarding situations, people may live in squalor, with conditions so unsanitary and hazardous that their physical safety and that of their loved ones and pets is at risk. I have seen contamination from food, garbage, and human and animal waste eat through the walls and floorboards of a home, leaving gaping holes and wood riddled with insects. It's difficult to imagine how someone could think a platter of food with visible mold could ever be worth saving. You have likely heard of the legendary Collyer brothers, two wealthy eccentrics who were found dead in their brownstone by New York City police and firemen in 1947 amidst their 130 tons of belongings. (E. L. Doctorow novelized their lives in a book released in 2009, and for years, mothers in New York City cited their example--"You don't want to wind up like the Collyer brothers, do you?"--to motivate their children to clean their rooms.) Extreme and sometimes tragic cases of compulsive hoarding continue to be reported regularly. Just last year, a Las Vegas woman who was reported missing by her husband was found dead 4 months later in her own home, buried under a pile of her belongings. Law enforcement and investigators had searched the place several times. "For our dogs to go through that house and not find something should be indicative of the tremendous environmental challenges they faced," a police spokesperson said. It is impossible to walk into a home like that and not wonder, "How did things get this bad, and how can a person live this way?" The answer is complicated, as complicated as the minds of people who suffer from compulsive hoarding, a condition that can lead to severe isolation, depression, and physical degeneration, as well as interfere with someone's ability to earn a living and function in society. One reason people can live like that for so long is because they become habituated to their environment. That is, they simply get used to it--they adjust, accommodate to it, and work around the obstacles. Randy O. Frost, PhD, who studies compulsive hoarding at Smith College, calls this symptom clutter blindness. It's an apt term, because those who hoard often do not see what the rest of us do when we look at the same pile of stuff. They see lots of useful possessions or rooms that are "a bit disorganized," while we see complete chaos and mountains of randomly collected items. It is a problem of perception. Sometimes it is not until an outsider comes in--be it a friend, someone like me who is there to help, or an agent from the state or county who is evaluating whether children or animals can live safely in a home--that the wall of denial that many hoarders have built around themselves can be broken down. Sometimes, but not always, they see the way they've been living through others' eyes and realize that their lives have spun out of control. On other occasions, sadly, they are unable to recognize the severity of their problem. A CLUTTERED LIFE I'm like many people in that I'm far more likely to want to give the bathroom an extra scrubbing, or perhaps finally go through that stack of junk mail on the side table, if I have company coming over. I am a very organized person, and somewhat private; I don't want the world to see my mess, the minutia of my life. I like to present a polished exterior, and my home is a reflection of that, by and large. Of course, a few piles that need to be sorted through, or even a crazy messy laundry room where random holiday decorations and outgrown bicycles are stored isn't a big deal, and many people have messy basements, garages, or attics where they keep things. Still, we can all do with less mess, and I think what we have in common with those who are compulsive hoarders is a large part of the appeal of the A&E show Hoarders, and why there has been so much coverage of the condition in recent years. Fortunately, this media exposure has led many more people to seek treatment because they know that they are not alone. I think the majority of us see a tiny bit of ourselves reflected in hoarders. And as you'll soon discover in the chapters to come, the way hoarders think about their possessions is in many ways not terribly different from the way non-hoarders approach the stuff in their lives. (For the purposes of this book, I will refer to people who are not suffering from compulsive hoarding, but who have a problem with clutter, as "non- hoarders" or sometimes "clutterers.") I can't tell you how many times I've asked my clients why they can't get rid of an individual item, and their answer is, "Because I'm afraid if I throw it out, I'll need it in the future." On other occasions I hear, "Because it would be wasteful to get rid of something that could still be used," or "It was such a good deal, I couldn't pass it up," or "This item was given to me by someone I love, and I don't feel right about throwing it out." Those are very common reasons to acquire or keep things--who doesn't think some version of those thoughts when going through his or her belongings? What differentiates someone with this condition from a non-hoarder, of course, is that a hoarder is unable to take into account important factors like whether keeping an item may cause him more harm than good. The inability to make rational decisions about whether to keep things or let go of them; the degree of anxiety experienced when trying to sort through personal effects; and the sheer volume of belongings are all hallmarks of a compulsive hoarder. But the thought processes of a person on the far end of the hoarding spectrum and the thought processes of a person like me are not so different. While there are clinical differences between people who suffer from compulsive hoarding and those who are not struggling with this condition, when it comes to some of the behaviors and thought patterns, it is to some extent a matter of degree. For that reason, I believe we can all benefit from gaining a better understanding of this condition and how it's treated, even if your home has only an average amount of clutter and mess. It's easy to see how clutter-- even if it's not on the level of the Collyer brothers--can interfere with your life in very practical ways, and cause you to waste many hours of your week searching for things that you need. It can also make it difficult to be calm and present and enjoy your life to the fullest, and cause unnecessary stress and frustration. Teresa's story perfectly illustrates how too much stuff can add stress to your life, even if you don't have an actual hoarding problem, but struggle with clutter, like so many more of us. A nurse and the mother of two boys, Teresa, age 43, is always panicked in the morning, no matter how early she sets her alarm. She allots sufficient time to shower and get her kids ready for school, but inevitably she can't find one essential item she needs before heading out the door. One day it's her sunglasses; another, it's her passport, which is required to complete a tax form at work. It's not uncommon for her husband to find Teresa, 5 minutes after she should have left to drop off the kids, dressed in her uniform, on her hands and knees, cursing like a sailor and searching through dust bunnies under her bed for the left shoe that matches the one on her right foot. Teresa's house isn't terribly messy--just the usual explosion of stuff that comes with living with two sons and never having time to put things away properly--but it drives her batty. Teresa is a perfectionist: She can't think of the perfect place to put things, the perfect system to keep everything organized, so she procrastinates on organizing and frequently cannot find what she needs. More often than not, Teresa gives up, slips on a second-choice pair of shoes that she's not happy with, and races out the door. Once at school, her boys race from the car to their classrooms to beat the morning bell. Teresa sits in the parking lot, feeling frazzled and stressed, and applies her makeup in the rearview mirror. If you asked Teresa if she likes her morning routine, she'd say no, but that she's too busy to constantly clean up, and the amount of stuff that a family of four requires is simply too much for her to keep under control. She does what she can to contain the chaos, but has largely surrendered to it. Frankly, she'd rather spend time with her kids and relax on the weekend than organize. Still, living the way she does affects Teresa and her family on a daily basis--she's overwhelmed, often late, and never feels quite together. There's always something she should be doing to get her house in order, and it weighs on her, so she can't just relax at home after work. Every pile is a reminder of a job not yet done. If her house were in better shape and if she could find a way to function more efficiently within it, she would without a doubt be happier, and so would her family. LEARNING FROM THE EXTREME CASES Because we are all on a continuum of clutter, it can be helpful to know more about what compulsive hoarding is and how the condition manifests. Surprisingly, it was not until 1996 that psychologists Randy O. Frost and Tamara Hartl proposed a theoretical framework to describe hoarding. In their model, they suggested that people who hoard experience a combination of information-processing deficits, distorted beliefs about and emotional attachments to their possessions, and difficulty with organization. Excerpted from The Hoarder in You: How to Live a Happier, Healthier, Uncluttered Life by Robin Zasio All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
