Compulsive Hoarding: Time to Clean Out the House
The hallway looked like any other. But the smell was overpowering the moment the elevator doors opened. Getting into apartment 411 was like going into another world. The stacks of garbage and trash were so tall and so closely crammed together that there was almost no way to open the front door. Hundreds of soda bottles filled with a gold liquid were throughout his home – it wasn’t soda….
- the acquisition of, and failure to discard, a large number of possessions that appear to be useless or of limited value;
- living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed; and
- significant distress or impairment in functioning caused by the hoarding.
Our first encounter with the compulsive hoarding phenomenon was in 1998 with Mrs. X, a widow whose apartment management had notified residents that new windows were to be installed. Residents had to remove all furniture and other objects three feet from windows in front and two feet on either side. When we arrived, we found an apartment so filled with hoarding clutter and accumulations it was nearly impossible to enter or get around.
The shocked question was, “Where do you expect us to put anything we move?” Boxes filled with paper – newspapers, invitations to exhibitions, letters, junk mail, tissue, stuff – were stacked all the way to the ceiling next to the walls, and waist to chest high throughout the rest of the apartment. Other accumulations were scattered about. There were only narrow paths from room to room, and not enough clearance for two people to pass. We did not have to do anything in either the kitchen or bathroom, but both were so filthy any normal person wouldn’t use them.
Then Mrs. X took us to her second apartment – she’d rented it in the same building after she couldn’t get anything more in her first apartment. The second apartment looked just like the first.
We didn’t even have a word for what we saw. Today if one Googles™ ‘hoarding,’ nearly three million hits will result, yet even a few years ago little was in the mainstream media about this obsessive compulsive disorder. Care for You is not in the business of medical diagnosis, but we certainly knew that what we were seeing was abnormal.
Immediate and Long-Term Consequences of Compulsive Hoarding
After completing the work for the day, we chatted awhile, getting to know her. We also pressed our case that she continue using our services. We stood the whole time because there was only one place to sit and she needed it. She was worried that management would discover her mess and evict her.
Mrs. X agreed to have a Care for You Companion visit one day per week for three hours to help with daily chores. However, upon arriving Mrs. X would not allow the Companion to do anything. After about six months we quit trying, as companions were unwilling to go there and stand in clutter and filth, doing nothing. And Mrs. X decided she didn’t need our help anymore.
Mrs. X, six years later: The social work agency called with another hoarder case. A lady had fallen in her apartment and broken her hip. The stacks of accumulations had fallen on her, trapping her for two days before someone in the hall heard her weak cries. When the EMT arrived, they could not get in and contacted the building management before breaking down the door. They also had difficulty getting her out of the apartment.
Upon release from the hospital, she entered a rehabilitation facility for several weeks. Mrs. X still had the two apartments. Both were still hoarded, worse than when we worked with her in 1998. Over an intense four-week period, Care for You sorted the garbage from the real possessions, hauled innumerable loads of trash, and cleaned her apartments so she could return home. In the process we unearthed a bed in one living room that we didn’t know existed, her Will, stock certificates, uncashed checks from years ago, and over $6,000 in cash – between papers, in canisters and jars, under cushions, as bookmarks…. What about Mrs. X? She wasn’t able to recover from the severity of the injury, the two days without food and water and lying in her own waste. She died within two months, and never returned home.
Mrs. X was the first of our clients to die because she refused help, and no one was there to ensure that the problem was addressed. Over the years, three other clients have been killed by their accumulations. Unlike Mrs. X, they all lived in single-family homes, with no shared walls with anyone else. Therefore, health and fire were not able to issue citations in a timely manner. When no one else is endangered, the legal process is long and slow at best – it’s not against the law to be a hoarder. In two cases the family was not able to withstand the violent, searing attacks of the parents. They backed off, traumatized themselves – “it’s their life, they’ve been like this as long as I can remember, that’s why I left, I’m not taking it any more.” In the third case there was no family. We worked with a medical social worker who was familiar with the situation to try to prevent what we knew was life threatening. We had no authority, the law had no authority. What we feared would happen, did. So, by the individuals “winning,” they lost their lives.
We’ve learned a lot since then. In upcoming installments we’ll discuss what compulsive hoarding syndrome is, the professional team needed to deal with it, case studies, legal issues, government interests, and how to maintain the progress once dehoarding has been achieved.
(Hoarding definition from Frost, R.O., & Hartl, T.L. (1996). A cognitive-behavioral model of compulsive hoarding. Behavior Research and Therapy, 34, 341-350)