Not until my mother died last year, at 82, did I realize how much she had saved. Her attic, closets and drawers overflowed with Playbills and travel brochures; size two designer dresses from the 1960s; broken appliances; baby furniture; expense receipts and stock annual reports; scrapbooks and photo albums; magazines and newspaper clippings; and every letter, greeting card and announcement she had ever received. It was an embarrassment of riches—and of junk. My exasperation was tempered by a sudden realization: I was hoarding identical emblems of my past, from Playbills and newspaper clippings to ancient letters from almost-forgotten lovers.
So it was with both interest and trepidation that I picked up Randy O. Frost and Gail Steketee’s new book, Stuff: Compulsive Hoarding and the Meaning of Things. To my relief, I discovered that my mother and I were rank amateurs compared with the pseudonymous subjects of this book, who live among clutter so overwhelming that they scarcely have room to walk, or eat, or sleep. Before treatment, Irene mixed empty boxes, expired coupons and old newspapers with photographs of her children, important documents, even cash. Pamela tried to take care of 200 cats, filling her house with excrement. Ralph stockpiled rusty, broken objects and stacked moldy newspapers so high that they threatened to crush him.
Frost, professor of psychology at Smith College, and Steketee, professor and dean of the School of Social Work at Boston University, have been studying hoarding for nearly two decades and have developed a cognitive-behavioral approach to helping hard-case hoarders. But their book, with its insight into the magic and meaning of ordinary objects, speaks to the hoarder in all of us. I asked Frost to elaborate on some of their findings. (Read an excerpt from Stuff.)
Q. How did you first become interested in hoarding?
A. My interest began with a simple question from a student. We were discussing obsessive-compulsive disorder, and the student asked, “Why are there no studies of hoarding?” I couldn’t answer. So we placed an ad in the local newspaper looking for a “pack rat” to interview. We got more than 100 phone calls. I was hooked.
Q. Don’t many of us have hoarding tendencies?
A. We certainly do. The reasons people give for hoarding are the same reasons we all have for the things we save: We have a use for it, we don’t want to waste it, we like it, or we keep it for sentimental reasons. The difference is in the number and variety of objects to which those reasons apply. For all of us, possessions can have special, even magical qualities. They help to define who we are and how we experience the world. Most of what we see in people who hoard is just an exaggeration of the attachments we all have to our things.
Q. What distinguishes hoarding from collecting or simply having too much stuff?
A. Most of us probably have more stuff than we need, but the stuff typically doesn’t interfere with our ability to live. In hoarding, the acquisition, difficulty discarding, and clutter create chaos in the home, making large parts of it unusable.
Q. How many people are affected?
A. There are now three good epidemiological studies of hoarding, in the U.S., in Germany and in the United Kingdom. The studies found that between 2.3 percent and 5.3 percent of the population had significant hoarding problems.
Q. Are there different types of hoarding?
A. We think there may be three categories. First are people who suffer from hoarding disorder, like most of the people described in Stuff. Second, there are people who hoard exclusively animals. Third are people whose hoarding stems from another disorder, like obsessive-compulsive disorder or genetic or neurological causes like Prader-Willi Syndrome.
Q. What are the most common causes of hoarding?
A. Hoarding is a complex disorder. There are deficits in information processing—problems with attention, categorization, decision making, and overly complex thinking. People who have hoarding problems pay attention to details and can easily lose sight of the big picture. Added to these deficits are the intense attachments to objects in their environment. The evidence is mounting that hoarding may be at least partly inherited. What is inherited may not be hoarding per se, but some of the information-processing deficits.
Q. How do people justify this behavior?
A. Most people with hoarding problems are conflicted. On the one hand, most recognize that the clutter and resulting chaos are problems. On the other hand, each of the objects they’ve saved holds a special purpose and meaning. Getting rid of them feels like torture, like losing a loved one.
Q. You say that hoarding may represent “creativity run amok.” Can you explain?
A. When most of us look at something like a bottle cap, the one prominent feature we focus on is its uselessness. We then relegate it to the trash. But Irene excitedly showed me a large clear plastic bag filled with bottle caps: “Look at these bottle caps, aren’t they beautiful? Look at the shape and color.” For her, these details gave the bottle caps value. The ability to appreciate the unusual detail of objects may reflect a kind of artistic creativity.
Q. In the popular imagination, hoarding is often associated with older people. Is that accurate?
A. Although hoarding does occur in children, for most people it begins in their early teens and slowly gets worse. Most don’t seek help till middle age, around 50. We seldom see hoarding that begins late in life, and most psychiatric disorders actually decrease late in life. It seems that hoarding does not; if anything, it seems to get worse. The reasons for this are not entirely clear, although there are age-related changes in cognitive flexibility, categorization and cognitive efficiency that may contribute.
Q. Does anxiety about mortality play a role?
A. Rather than mortality fears, there is concern about losing out on life. Irene expressed it very well: “Life is a river of opportunities. If I don’t grab everything interesting, I’ll lose out.”
Q. What other syndromes are associated with hoarding?
A. Attention deficits are very common in hoarding and contribute to people’s inability to organize their possessions and their time. Oddly enough, people who hoard tend to be highly perfectionistic. This plays out in a variety of ways, but usually results in decisions to save things rather than risk making a mistake by discarding them. Difficulty making decisions is an almost universal characteristic among people who hoard.
Q. How strong an association is there between hoarding and life history—for example, having lived through the Great Depression?
A. Our research has failed to find a link between material deprivation early in life and later hoarding behavior. We do suspect there is a connection between hoarding and traumatic experiences or important losses or chaotic or disruptive circumstances early in life.
Q. What cultural factors influence hoarding?
A. What little research has been done across cultures suggests that hoarding exists everywhere. We suspect, however, that it will be worse in places where there are a lot of relatively inexpensive objects that are easily available. Interestingly, hoarding appears to be worse in places where the living spaces are smaller, like large cities. Materialism may play a part in hoarding, but only a small part. Materialism involves using possessions as a way of presenting oneself to the world. People who hoard try to hide their possessions.
Q. Would moving change the hoarding behavior?
A. Hoarding problems don’t vary much based on changing circumstances. One exception is when someone with a minor hoarding problem inherits possessions from deceased family members. This can turn a minor hoarding tendency into a serious hoarding problem.
Q. How intractable a problem is hoarding?
A. Hoarding is a difficult problem to treat. Animal hoarding is especially difficult, in part because it seems to be associated with more serious mistaken beliefs that animals are happy and healthy, when in fact they are just the opposite.
Q. What is “clutter blindness”?
A. In our work with people suffering from hoarding, we’ve noticed something peculiar: They often do not notice the clutter. We describe Nell, a grandmother in her 70s who does not notice the clutter when she comes home from work each day. But when I showed up at her door, she noticed. As long as I was there, she felt horrible about it.
Q. You mention that forced clean-outs can be traumatic, even fatal, for hoarders.
A. They should be a method of last resort. A forced clean-out may change the condition of the home temporarily, but it does nothing to change the individual’s behavior. In most cases, the condition of the home deteriorates quickly, and the person is less likely to cooperate in the future when others try to help.
Q. Describe your therapeutic methods.
A. We’ve developed a form of cognitive behavior therapy to treat hoarding, focusing on excessive acquisition, difficulty discarding, and disorganization/clutter. For example, people with hoarding problems acquire too much stuff, usually by buying more than they need or picking up free things. We teach them how to tolerate their urge to acquire in much the same way we would conduct a physical conditioning program, by gradually exposing them to increasingly more difficult situations.
Q. For example?
A. We often begin with what we call “drive-by non-shopping,” where we drive by a store that is difficult for them to resist. By the time we are through, they can walk through the store and leave without buying anything.
Q. Is there a pill to control hoarding?
A. Very little research exists on the effectiveness of medication. Several early studies seemed to suggest that antidepressants used to treat OCD did not work for hoarding. A more recent study, however, suggested there might be some benefit. The answer to this question is still pending.
Q. How can people help hoarders they know?
A. The first thing is to find out more. The International Obsessive Compulsive Disorder Foundation is launching a Hoarding Center on their website to coincide with the publication of Stuff. The second thing is to make a connection with their loved one about the hoarding. Get them to talk about it, both what they enjoy about their possessions and what troubles them. Once they can talk freely about the behavior, it is much easier to take the next step and seek help.
Julia M. Klein is a cultural reporter and critic in Philadelphia and a contributing editor at the Columbia Journalism Review.