Why Hoarding Is Hard To See

SPEAKER_02 0:41

Hello everyone, I'm Michael Makniak, and this week we're doing a special episode of the Holding It Together kinda podcast. We're stepping into a space that many of us find difficult to look at and much harder to even understand. To use an obvious pun here, I'm talking about hoarding. And hoarding has really become an obsession with many people for a few years now, several years. You know, obviously the success of the TV show hoarders is a testament to that and maybe partly feeding that. In full disclosure, I've never seen a TV show. Um I have, however, seen some amazing, horrific impacts of hoarding in my work as an attorney in particular, uh, and with um obviously my work with Guardian and Care Coalition. I've even seen a situation, what I would call collective hoarding, where I had an entire family that was living together, and they seemingly morphed into this outrageous behavior of collecting things, everything from um dachshunds, the little dogs, to toilets. No joke. Now, when most of us see a home that's you know overwhelmed and cluttered, the first words that come to our mouths, again, oh, they must be lazy, they must be just messy people. But if we get beyond that surface level, if we scratch a little bit deeper, we gotta look at the people that are that are there in that home. It's not necessarily a choice, folks. There's really a psychological disorder that's very complex and it's rooted in some real profound challenges. Um you have the internal struggle, where an object isn't just an object, it can be a memory or a safety net or a piece of one's identity on some level. Um, and then you have what, you know, we might also call the invisible burden that's going on. And with that, uh, I'm talking about um the headlines that we see in the TV segments, the most significant impact beyond the piles and the crowded hallways. It's what's going on inside the home, the husband who feels like he's a stranger in his own home, the kids who feel like they can't walk in. Um, you know, the the literal and figurative wall that is being built up and it creates this silence and it and it's just profound throughout the home. It really lives at a really complex intersection of mental health, property rights, personal rights, and of course, community safety. So we're gonna go beyond just the stuff that people are collecting, and we want to get into like the meat and potatoes, the soul of it. So, joined by my usual panel. Uh, today Sarah's not with us, so it's just Stephanie and Angela joining me. And we're gonna get into a little depth around hoarding and some of the intricacies and some of the very fascinating aspects of it uh overall. Hello and welcome to the Holding It Together podcast. I'm your host, Michael Makniak. Here we will get real in our conversations about mental illness and caregiving and the messy reality of keeping it all balanced. There's no sugarcoating, no critical jargon, just real talk about the hospitalizations, medication battles, and the toll it takes on the home and everybody in it. This is for the parents, siblings, and partners who are doing the impossible every single day. Holding it together is a home for the overthinkers, the multitaskers, and anyone who's out there that's feeling like they're just one spilled cup of coffee away from a complete meltdown. Find us on YouTube at hit kinda, that is at H I T K-I-N-D-A, and subscribe, like, follow, comment, I don't know, vent, throw rocks, tantrum, whatever you need to do today. Uh, just make yourself feel better, but please follow

What Hoarding Is Not

SPEAKER_02 5:04

us. As we step out into our front line, the first question is what is hoarding? What is it? And in order to get there, I think it's important to start with what it is not. Hoarding is not a mental illness. Angela, is that correct?

SPEAKER_00 5:26

I mean, I would say, you know, as a definition by itself, it's not a mental illness, but I believe that everything that goes into a person with hoarding could be something else that could be labeled as a mental illness. I think that there are so many aspects to the individual who has the hoarding that could, you know, represents other types of mental illness, whether it be depression, whether it be trauma, whether it would be some type of perfectionism, you know, this space that you take up of who you are and how you were raised, and then what created this process.

SPEAKER_02 6:01

Okay, well, that's that that's a great question. Does it, is it something that is inherited or learned?

SPEAKER_00 6:08

I believe that it's both. I believe that it is inherited. I do believe that there are people out there who have had some other distant relative that they may or may have not even recognized was a hoarder until later on in their life when they are it's to their attention that they now are hoarding. And when they can go back and have really good therapy, more times than not, they find somebody else that they said, oh, you know, I didn't really realize that that was really hoarding. But my mother collected everything and had all these books of everything, and then it made everything feel important. And then you didn't feel like you could discard anything. And so that trait then was kind of embedded into, you know, this person's life and then other components, you know, depends on how you were raised with your family, how is your dad treating you? You know, so I do think it's a very, very complex, fully loaded picture when you're working with somebody who has been, you know, struggling with a hoarding, you know, situation.

How Hoarding Starts And Spreads

SPEAKER_02 7:08

Stephanie, in your experience, when you have this hoarding going on, is it something that is continuous? Is it ever growing?

SPEAKER_01 7:21

I think it's circumstantial for certain people. I've had clients that it is continuous and you know doesn't change really. It's the just the consistent behavior. I have other clients that, you know, are able to go through periods of time where it's mediated and kind of at bay. And then there's periods that it escalates and the shopping and hoarding starts all over again. So I think it's different on on multiple scales. It it could definitely escalate over periods of time and just go from like the hoarder show, which I actually have seen, you know, it starts small and they they kind of fill up one room and then it goes to now another room, now the whole house, you know. But I think it just depends on the on the person.

SPEAKER_02 8:02

Yeah, and what's amazing about that progression is the family that's sitting there, and okay, we're gonna let her have this one room. And then the one room bleeds into the next room, and then next thing you know, you're living in a house or a home with that's surrounded by stuff that can't be thrown away because of the various attachments. Hoarding is is classified as a disorder.

SPEAKER_00 8:26

Can I add to that though, Michael? Because as much as it is the, you know, when the family members are allowing their loved ones to have the room, right? It's, you know, it's a really challenging process. And maybe we can get into it later, but so much goes into the protection of the individual who is hoarding, that the people that live with them or surrounded by them also then try to mitigate or think that they're doing the best that they can to help them. And then everybody starts avoiding the anxiety. So once the hoard starts going in from one room to another, then that's when everybody's defense mechanisms come in, and people are either gonna run, you know, and hide from it and avoid it, or they're gonna approach it and try to clean it out, but then there's that anxiety side. So then I think that's where that struggle comes into, where they just the family and the person who's struggling with the hoarding don't want to approach it anymore because it's just so stressful on both sides. It's just so complex.

SPEAKER_02 9:26

Well, it's very complex, and you know, I'll I'll be the first to say I have not experienced hoarding in my personal life. As I said, I've seen it in my professional life on small levels and large, really nasty levels and everything in between. Uh, and it is mind-boggling uh to me how anybody, the hoarder themselves, can get themselves into this situation, but it it becomes even more perplexing to me how the loved ones and the impact that it that the hoarding does have on the family, and I don't have the answers for it. It's just uh you brought it up, so I have to address it in my own way because it's just mind-boggling. And for all the people who are listening out there that are perhaps going through it, they're probably completely shaking their head in agreement with you that yeah, this is something that crept up on us. Next thing you know, we're all kind of now part of this paper monster, no pun intended, that has enveloped our home uh without without giving it much attention at first, you know. I I it's and it happens, but let me let me get back to what I was saying because this fascinated me when I was doing research for today's episode.

The Data Behind The Disorder

SPEAKER_02 10:43

So, as I said, hoarding is classified as a disorder, it is not associated with any one uh severe mental illness any more than others. There are mental health disorders that uh it is associated with, but it's not one does not mean if you have this disorder, it does not mean you're gonna be a hoarder. If you have this illness, it doesn't mean or if you have hoarding, it doesn't mean you're gonna have this illness. So let me just give you some statistics. 50 to 60 percent of hoarders do have a form of depression. 20 to 30 percent of hoarders also have ADHD or have HDHD, maybe not also, but 20. This is what this is what blows my mind. 20% of hoarders have OCD. That really surprises me because I would have thought that that number would have been the number one. I would have thought that that would be more like 75-80 percent of people who are hoarding would be associated with some kind of obsessive compulsive disorder. It hoarding is associated with anxiety disorders and neurocognition issues like Alzheimer's and dementia. I can I can see that. I can see that for sure. Personality traits, and Stephanie, I think you were kind of touching on this a little bit, but some of the person some of the personality traits of people who are hoarding are indecisive, they're very often perfectionists, and they're procrastinators, and they have executive functioning issues, such as with planning and attention. So all that kind of makes sense, right? But uh what I what I want to discuss in detail is the reasons that we have assigned, as I said in my opening, to uh the uh interesting aspects of

Attachment, Cocooning, And Responsibility

SPEAKER_02 12:33

hoarding. And the first one, obviously, is the uh object as extension of self. So I have a widget that I'm uh refusing to give away, and it's because it has emotional significance to me. Great. I think every single one of us can point to something in our home that we keep around because it reminds us of our dad who passed away, our grandfather who passed away. But Angela, doesn't it get a lot more significant than just that?

SPEAKER_00 13:10

I mean, from my experiences, I mean, yeah, there that's a a big part for some people. But for some people though, it's more of the I can I can use this later, I can, you know, the the way that they view objects and things is very different than how I would view an object.

SPEAKER_02 13:30

Yeah, but I think that comes into the second part of the equation, the second pillar that I want to talk about. I'm talking about here where okay, I have a sentimental attachment to this painting that is in my house. It was my father's painting, he had it above his desk all through his career. And when he more or less retired, I took the painting and I've always held put it above my desk, you know, wherever I my workspace is, whatever, for whatever reason. It's a guy taking a nap on a on a boat in some Caribbean island. It's you know, it means not that much to the the place, but the it's that attachment. I'm talking about the guy who says, I have this receipt from when me and Stephanie went out to lunch 10 years ago, and it reminds me of that lunch day, and it reminds me of Stephanie, so I can't throw it out because if I do, it will kill my memory of Stephanie and and that day altogether. So that's that's more of the the extension of self that I'm talking about here. Did you want to add something to that, Steph?

SPEAKER_01 14:36

Well, I was just gonna say about this the sentimental stuff. You know, I have one of my clients where it's not definitely where the hoarding started, but definitely it was a contribution to a lot of it. Her father had passed away. She took almost every single item out of that man's house and moved it into her house. And then her significant other passed away, and she took every single item out of their home or apartment and moved it into their house. So, you know, I can imagine taking a few things that remind you of that person, but to then, you know, integrate their entire home top to bottom into your home. Now you have three homes worth of stuff in one house.

SPEAKER_02 15:14

Yeah, and and I think it's very touchy. I I had a a good friend that I was trying to work help work through separation of a believe it or not, a kitchen table. It was his it was his dad's kitchen table, and his stepmom was adamant that she was going to keep it, and he had to work through I mean, like trauma over having to get rid of this table. So it becomes very hard to understand, but at the same time, it's also so delicate, isn't it, when you're talking about someone's grief connection to an object or a series of objects. But in your case, you're talking about a woman who had three different houses full of stuff. Stuff, no matter what it was, just because it was related to that one person.

SPEAKER_01 16:01

Yeah, and I could see, you know, from my perspective as a more rational person, I could see, you know, keeping a shirt or a picture or a few things, but you know, I didn't see the connection to the coffee table or the 40 shirts that person owned, you know, and then that's where it became overwhelming for her too, because at that point the house is to the ceilings, every single room inaccessible.

SPEAKER_02 16:24

Yeah. No, I've seen that too. You know, I I remember walking into one little old lady's house. She had an apartment down in New Haven, and yeah, she barely could get the door open. Once she got the door open, it was Angela, I think you were at this woman's house. It was a path of stacked up newspapers for decades of newspapers, made the path, the hallway through her house. And there was really no place to sit down. It was just newspapers stacked from floor to ceiling. And that it's just I think that goes to the cocoon concept, this so the safety and security. I think she felt this is the second pillar, the clutter that we see I think for some people is an emotional uh screen or an emotional cocoon to keep out whatever it is they want to keep out, or to feel that sense of protection that they want to keep in. And the third pillar that we need to talk about is what Angela was bringing up, this responsibility on some level. Uh for instance, I can't throw this toaster away because it could be fixed someday. I I can't just let it lay in the landfill. It's bad for the environment, and somebody else may be able to use it someday. Well, next thing you know, you got six toasters, all with the same set of logic attached to them. Angela, you got any good stories about this? Because I know you do.

SPEAKER_00 17:44

I do. I want to go back to your cocoon though, because we also had that mutual client where he had all the magazines and the movies that were, you know, what kind of magazine? And he wouldn't move any of it, even if we tried to organize it and tried to like get it up off the floor and stuff, he just couldn't rationalize moving it because he needed to be able to see all of his pillars of stuff, and you know, to make sure that everything was still there, and you know, and he really did cocoon himself literally inside the middle of his living room, which was really funny.

SPEAKER_02 18:25

You know what's funny about you bringing that guy up? I totally forgot about him, folks. Not to beat around the bush, but one entire room of this man's house was dedicated to pornography. Another room was totally dedicated to historical documentaries and like action films, I think, or something like that. World War History. Yeah, his like history. Old Westerns, I remember. So you had films. He he had more films than the old video stores used to have. I can't believe I totally forgot about him.

SPEAKER_01 18:56

So it was organized hoarding.

SPEAKER_02 18:59

Well, it was at least uh it was at least uh categorized. I don't know. There was some organization to it. I think he did. In fact, you know, you go into the pornography room, and I'm pretty sure it was alphabetized at least. It was it was it was beyond mind-blowing.

SPEAKER_00 19:17

But that goes to the safety part too, right? Because he, you know, as much as we really wanted him to change and to clean out his clutter, you know, he wasn't able to do that, you know, it just wasn't his time. And so, you know, we had to go into harm reduction and safety and just make sure he at least had pathways and you know, but he did have his bathroom. He was still able to use his bathroom, he still had a bed area and he still had his chair, you know, in his kitchen, and his kitchen. So he had access to use everything, but you know, for us as treaters, it's really hard to because you want to see all of that be a nice living space for him. But, you know, at least he was safe in there, and you know, he just wasn't able to approach his clutter the way that we would like to see him approach it, like have it more organized off the floor, those types of things. But he was technically being safe, which I know you'll get to later on.

SPEAKER_02 20:06

Yeah, we're gonna definitely talk about that because that's where that's that's a tough one.

SPEAKER_00 20:10

The way that we look at something is very different. And you know, I did see Dr. David Tolin, which I will put a little plug-in for his book, Buried in Treasures.

SPEAKER_02 20:20

Buried in Treasures, right?

SPEAKER_00 20:22

Buried in treasures. It's really, really important in my life in 2012 when I first started my social work career, especially with you know hoarding and you know, those types of behaviors. Um, but one of the things that was a really big takeaway is that the way that they view things is so different than we do. So if I see a collection of pens, I'm gonna put all my pens together in one bin. But someone with hoarding, though, they're going to separate all those pens into different colors, lengths. Do they have a cap? What does the cap look like? And so they get overwhelmed with that process. And so they just end up sorting all these things, but not actually doing anything with them. And that's where people get kind of stuck.

SPEAKER_02 21:04

And and you know, I that's why I associate it in my mind with OCD. So I'm again shocked to find out that that's not necessarily true, but it also brings us to our next topic.

Files, Piles, And Decision Gridlock

SPEAKER_02 21:16

You just you just bled right into it. You made a beautiful transition, you know, the files versus the piles. Because on the one hand, we can be, you know, I will organize pens and things like that accordingly. I might even put all this like colors together, but you're right. If if I have to have all the bic pens in one place and all the paper mate plant pens in another, I I don't know. That's something that I don't do, but I'm sure people out there listening are it with hoarding. The the difficulty with the categorization that Stephanie and I were just sort of joking about is that the people who are in involved with hoarding uh they think that everything is special, and therefore nothing necessarily can be categorized together, right? So you can't just say a pen is a pen, let's put all the pens here. Am I saying that correctly, Stephanie?

SPEAKER_01 23:47

Yeah.

SPEAKER_02 23:49

Yeah, okay. But then we also have the issue of the problem with this decision making and problem solving, which then makes the act in some cases of sorting completely impossible, like the woman with the newspapers.

SPEAKER_00 24:07

So you just end up sorting it into other piles in your sorting area, so then one pile now becomes. And then those six piles now are going to become 12 piles. And then it's so overwhelming, you can't address any of the piles anymore because it's now they're they're too disperse. And then that's when the avoidance comes in.

SPEAKER_02 24:31

Well, from what my research showed, what I again I do not have great experience with hoarding in in on a on a case-by-case level on a clinical level like you guys did. So I did some research to so I can even engage in this topic with you guys. But what I think happens from what I researched, Angela, is that they have these fears of memory loss or attachment loss to whatever the object may be. And then they, as you say, they put them into their piles. And now their memory loss is such that, well, I can't remember why I had that pile, but I need that pile to stay there because there's a purpose behind it somewhere. And sometimes folks don't even remember why they had the pile, the meaning of the pile, the categorization that that Stephanie and I were talking about, or the or why something in that pile was special that led to the the creation of the rest of the pile. Does that resonate with what you're talking about?

SPEAKER_00 25:35

Yeah, absolutely. You know, it's it's it's hard to so when you're when you've got somebody that's sorting and then can't discard, right? For whatever the reasons might be, because it's well, sometimes it could be because I can use it, or it's something so good, why would I need to sell it? So I'm gonna wait and sell it. And then nothing ever happens with it. And then once you approach somebody about a certain situation like where you're noticing now that these piles are now intruding into your life, then these defense mechanisms come out and in various forms, right? Some people get depressed, some people get angry, you know, and kind of probably brings you to your next next part.

SPEAKER_02 26:14

I was just gonna say, are you reading the show sheet? You have it right in front of you, I bet.

SPEAKER_00 26:18

Yeah, I got my show sheet out.

SPEAKER_02 26:19

Yeah, because I was gonna ask Stephanie about that, the emotional regulation and the in the parting of the pain of parting. I, you know, when this is the third pillar that we often see. So we have we have our three pillars. We have the first one, which was let me go back the attachment, the extension of self. The second pillar is the information, the files versus the piles, and how we categorize or don't categorize. And then the third one is this emotional regulation. And I want I as soon as you started saying that, I thought of Stephanie's example of the woman whose husband passed or husband's passed away, or significant other.

SPEAKER_01 26:53

Dad and significant other, yeah.

SPEAKER_02 26:55

Dad and significant other. When you asked her or had discussion with her about getting rid of some of this stuff, what did that do to her, or from your from your perspective, what did it do? I mean, I did I did the research. I know what some of the things that physically goes on with somebody, but what did it look like on your end from your perspective as a clinician?

SPEAKER_01 27:18

I didn't actually for her in her case. So by the time I came in, that stuff was already in the house. It was already, I had learned to come to find out that a lot of the stuff in the house were belonging to these two people. But then in addition to that, she was also hoarding a lot of household items, home repair items. So there were other areas that were more in the focal point because the house was so heavily hoarded. So a lot of it I couldn't even see past a doorway to a bedroom of what was really in there. But a lot of the stuff in more, you know, the living room and the kitchen where I would walk by was stuff she had acquired on her own. And when I tried to breach those type of topics of, you know, all of the stuff that needs to be kind of managed a little bit better and probably disposed of if she wasn't using it, always came back to, oh, I can return that, or I need to use this PVC pipe for X project. And she's talking about returning things that are years old, purchased, like that Home Depot's not taking that back, you know? So they're really it, it was a very, very difficult thing. And unfortunately, in her circumstance when she was psychiatrically stable, she had the pathways. She had access to her fridge, which was clean and well organized. She had access to her sink and her bathroom and her bed was clear. So the necessities were being met. So it wasn't as high up on my radar to kind of delve into the hoarding issue. But it was it was very apparent every time you walked in her house. You know, if I kind of took one wrong step, this pile might collapse a little bit, or she had a dog and the dog would get very excited when people would come over. So the tail would start wagging, whack something off of there. Whack something off the table, really well off of a pile, you know, the the tail would hit the pile and then all of a sudden stuff would start to fall in into the pathways and we'd have to pick it up and kind of put it back.

SPEAKER_02 29:06

Did she react like in an anxiety-ridden way that oh my gosh, I can get that fixed immediately?

SPEAKER_01 29:11

No.

SPEAKER_02 29:13

That's where my my belief in the OCD comes in that oh my god, that fell over. I gotta fix this right away and organize it. But that's not the case, is it?

SPEAKER_01 29:20

No, she would kind of sometimes walk right past it. If it was something that happened in front of her, she would pick it up and put it back. But you know, if it happened when the dog was near me and she's on the other side of the island, she wouldn't come around immediately to pick it up. You know, she would just kind of fix as she went. But she was difficult too, because you'd ask her, like, here's this goal. I want you to clean off your kitchen island. Maybe we'd come back the next time. The kitchen island is clean, but I know all you did was move that stuff from point A to point B. It wasn't thrown away.

SPEAKER_02 29:48

Um moving pile A16 to from the left to the right. It doesn't matter.

SPEAKER_01 29:53

So I cleared this area, but now I've made this area worse. You know, it was so it was hard, it was challenging.

SPEAKER_02 30:00

But it and it to for these folks, it doesn't go to the physical area as much as it's all about the category or the sentiment attached to those particular items. When we talk about this emotional regulation, I could tell a story getting back to the family. I I I had a an entire

The Pain Of Parting And The Loop

SPEAKER_02 30:20

I was representing an older woman who had two of her daughters living in the home with her. You know, the two daughters had gone off on their own and came back because of divorces or whatever the case may be. And she had an adult son who was developmentally disabled, and he was living with her as well. Well, the oldest daughter and the son were had hoarding issues for sure. The mother did too, but but hers was very different. The son would walk around town with a shopping cart and he collected whatever things he could find that seemed interesting to him. He loved hubcaps from cars and he loved toilets, discarded toilets, and he had piles of these things down in their basement. And it was his thing. Again, he was developmentally disabled, that was his thing, and he he didn't have that emotional uh connection to it. Maybe it's because it was part of his developmental disability, but the older sister was collecting weird stuff, including uh dogs. She was she was every little and always little dogs. That's why I said I remembered there being like three or four dachshins among other dogs, and she just kept saying she had to keep them, she had to take care of them because they were on the street, and you know, I'm thinking, well, she's walking by somebody's house and she's taking the dog off of the the lawn. Meanwhile, I'm representing the little the little old lady who's the mother of this group, and the dogs are peeing and and pooping all over the house. There's nobody nobody was cleaning anything. The house was you know abhorrent. So it went to court. We had to go to court, and I had to report to the judge about this. And whenever he said that they had a certain amount of time to get it cleaned up, the uh horror uh the the visceral reaction that this family had collectively to having to get rid of this stuff was uh it just it was mind-blowing. But that's one of the things when people are asked to discard items like this, they very often feel this is what I wrote down a spike in anxiety that can feel like actual physical pain. And that's what I experience with this family. I mean, the wailing, the the crying and the begging, uh they have this avoidance of of uh this painful anxiety is part of the reason that they keep collecting the stuff. And Angela, I I don't do I think I know the answer to this, but some hoarders avoid the process of categorizing and organizing their hoards altogether, don't they?

SPEAKER_00 33:17

Yeah, I mean, there are there are some people with hoarding disorder that do not categorize and it's just placed down, and then that's when you see the extreme hoarders, right? Where there's so many like layers of possible garbage, newspapers, boxes, empty containers. They don't have that that organizational class. And they might just be people who are acquiring and not categorizing. So the process of acquiring gives you that dopamine hit where you're actually feeling pretty good, and so that might be the process.

SPEAKER_02 33:49

So you're getting the dopamine hit when you're getting the stuff, and to get rid of the stuff is the exact opposite, and I don't know the medical term for what the opposite of dopamine hit would be, but it's a real downer. So it's it's a self-fulfilling prophecy. Is that the right term? Basically, by avoiding throwing it away, you keep getting more of the hit, more of the hit, more of the hit by collecting more. So now you really got a hoarding situation going on.

SPEAKER_00 34:20

Yeah, that process of avoidance is is is real. So, you know, you want to feel better, and so you acquire. But then when you don't feel good again and you see everything that's going on, and most people can do have some insight into that there's a lot of stuff, but then that anxiety creeps up again. And so to make me feel better, I'm gonna go and go shopping or I'm gonna go and get this. And so it's a cyclical pattern of avoidance, really, right? I need to feel good and I want to avoid being anxious. If I acquire, I feel good. Now I'm feeling anxious again because now I'm looking at everything, so I'm just gonna go get something else new.

SPEAKER_02 34:55

Stephanie, did you experience that when you're dealing with your clients who have have exhibited the hoarding behaviors that they fully acknowledge all the stuff don't and don't make excuses for it?

SPEAKER_01 35:09

Yeah. My I had, I mean, out of the two of them, I think they both acknowledge at certain points that they they do have a lot of stuff, but it's hard for them to also realize like this stuff needs to go. You know, my client that actually that that had the worst horde out of the two of them, every three-bedroom, it was a three-bedroom house, every single room was filled in that house. The living room was inaccessible, you know, it was it was pretty severe there. She actually was forced, she had to was going to be have to having to move. And she was not able to participate in the moving process, but she wrote a list of what she wanted the movers to move specifically, which was asked of her to do. This list was 17 pages long, and it probably included everything in that house besides like the floorboards. Like she almost wanted every single piece to be moved into storage, which is just not feasible. Yes, but also, you know, that it's not possible. We would have to get so many storage units to show all that. So there, you know, there's a little bit of insight, but not enough to fix the problem. My other client, she's doing a lot better with her hoard. She's able to recognize it and say, I really need to start disposing of things, donating things. And she will also say, I don't go, I try not to go to the mall because I know I'm just gonna go shopping. Like she has very good insight into her hoarding. There is a walking group that she likes to attend with one of our community programs in the winter. They walk at the mall and she won't participate in the walking group because she can't be around that. She's she doesn't have emotional attachments to things. It's not things she's grown up with that she has difficult getting. She's a shopper. So for her, you know, she just wants to go out and get a little good retail therapy, but then it she has too much. So she's a lot more workable than my other client with one of those emotional attachments to her things on top of you know everything else she's purchased after.

SPEAKER_02 37:11

I could see that as more of a I'm probably this is probably a horrible analogy, but the guy who knows that he can't be around alcohol because if he's around alcohol, he'll drink it and it's not good. So I give her kudos for that, you know, that kind of insight.

SPEAKER_01 37:25

Yeah, it's just easier for her to avoid this situation because she just she knows she knows better.

SPEAKER_02 37:30

But but that's not in any way to insinuate that hoarding is necessarily on the same level as an addiction. Is that correct?

SPEAKER_01 37:37

I don't think so. I mean, I I I think it it has periods to it, like you know, you get that shopper's high or like the dopamine hit, like Angela was talking about, when you get something nice and new. But I think for her, too, after she's done shopping and she comes home and she sees I have nowhere to put this, I think that kind of comes back on her in a more negative way. She actually does have, when we're just saying how it ties into other mental illnesses, she has major depressive disorder. My other client is bipolar, has bipolar disorder. So I thought that was interesting too, that it wasn't bipolar disorder was not listed as one of the of the other mental illnesses that can be associated with hoarding percentage-wise.

SPEAKER_02 38:18

This, well, I I don't think that this was a mutually exclusive list that I'm sure 50 to 60 percent of hoarders do have a depression and have MDD, right? 20 to 30 ADHD and 20 OCD. I so I don't think it's mutually exclusive. I'm just saying that interestingly enough, here's something that we do see as a peer as a parent. So what's clear to this point is that these three pillars that we've identified, this this uh attachment, uh the the extension of self, the uh files and piles, and then the pain of parting, the pillars, uh, are not mutually exclusive either, right? One does they don't exist in isolation, one can feed into the other. I mean, we've talked about the uh fear of throwing something away because it could be useful in two of those three categories at least. So that's something to to bring in where the if you have a pile of paper, right? You you uh your information processing uh may lead you to believe that you need that paper, so it leads to a pile. Now you gotta now you got a pile of papers that leads to the attachment because that somewhere in there is that sentimental bit of it, and then the emotional uh dysregulation makes the uh idea throwing it away completely painful, and I think that's interesting because we we very often try to categorize things so so much that we forget that a lot of stuff is very much interrelated, and this is no different. So I want to uh uh talk about something that Angela alluded to before because as a lawyer, I have

Safety Risks, Blight, And Housing Court

SPEAKER_02 40:07

been involved in situations where I'm going in as a representative of an individual like the well, two women that I referred to already. I forgot about the gentleman with all the videos and and and books, but that wasn't a protective thing. This was to go in there and find out what's going on in the home almost like a safety check, right? And this is be this becomes tough because you're you're going into places where there's congregate living very often. And when you have piles and piles of stuff, very often, at least it piles and piles of garbage and waste, and waste attracts bugs and other critters environments that we don't want in our congregate living settings. You know, we've all heard about the bed bug blights and we've heard about the cockroaches, and and I mean, I walked into a woman's house one time and and I had a nice, nice suit on and and shoes, having just walked out of court, and I walked into this woman's house, and it was appalling. And the first thing I noticed when I looked down is that my feet basically had cockroaches all over them. My my nice shoes. It was just now those are gonna go into the next neighbor's house. So, you know, we really have to worry about that fire hazard, the woman with the newspaper stacked from floor to ceiling, major fire hazard. No, no landlord's gonna let that stay because of the danger to the person, but also to the rest of the people. We also have blight laws that require us to keep our homes presentable within a community so our neighbors don't have to look at what appears to the rest of us as garbage piled up on our streets. Now, I this stuff takes in fact Sarah's neighborhood, Sarah's not here, but she could talk about this. You know, when you drive into her very nice neighborhood of two and three thousand square foot homes, there's this one home that's just as lovely, but it is just absolutely covered with unkempt trees. The grass has never been cut. One home out of these 35 homes that are just beautiful, this one home is what you remember. And Angela, you're nodding your head, you know the home I'm talking about exactly. So these blight laws and these orders to get things cleaned up take a long time to go into process, which gives the person who is the hoarder uh much more time to continue their craft, if you will. What I'm getting at is uh most of us just don't get it. We just don't understand how you can live like that, right? We why don't you just see this mess and and get it cleaned up? Okay, welcome to our system overload segments where we talk about the clinical need

CBT, Exposure, And Earning Trust

SPEAKER_02 43:00

exceeding the infrastructure's capacity. We're looking at the you know, the blown fuses, the revolving door discharges, the 400-mile record gaps, and and data blackouts. This is where we stop asking how the patient is doing and ask more about why the biggest machine is glitching, why the machine is breaking down for that particular patient. So when we in in terms of getting to our sort of system overload uh segment that we do with this panel, on this podcast, on the holding together kind of podcast, we try to take a look at at the human impact of of mental health. So what I want to do is I I want to think more about the the the hammer of the legal remedy, which is when uh uh the city shows up with the dump truck, literally, and has stuff taken out of the home and thrown into the the trucks and taken to the dump. Uh but how does it affect the family? How does it affect the individual and and the caregivers beyond the obvious? What do you see is going in the trenches in that home? And and Angela, are there particular treatments that are used to address hoarding in the person who is doing the hoard the hoarder themselves? Is there particular treatments that send that tend to be more effective and impactful than others?

SPEAKER_00 44:32

I mean, the biggest you know treatment, you know, is you know, cognitive behavioral therapy. So if they can get a therapist that will outreach to them, to the home, to be able to start addressing the underlying issues of why they may be hoarding or not. Again, you're gonna come into all types of other things like you already mentioned, like you know, they could have some depression, they could have some trauma.

SPEAKER_02 44:55

So cognitive behavioral therapy is the explain, explain, explain to everybody and Stephanie, please chime in what CBT cognitive behavioral therapy strives to do, if you could, just just to dumb it down for people like me who don't practice this every day.

SPEAKER_00 45:11

Yeah, so it's really just kind of looking at the way you're thinking about things. So if you're looking at, and you know, we call it negative thoughts, you know, the thinking thinking kind of things, they kind of creep into your mind about, you know, all or nothing. Like I need to keep all of this because if I don't, then this is all gonna happen, or black and white thinking, like there's no gray, it's it's this way or no way. And that kind of feeds into like perfectionism, and and all of us have these negative thoughts, but for people with hoarding or other disorders, it the the pendulum is the tips too far on one side, and so then they they start believing these thoughts. And the cognitive behavioral therapy is hopefully going to help them see that there's another way to think of something, and how do you get there to get to that other side of thinking? It's not all or nothing. There can be some gray, it doesn't have to be perfect, it can be good enough. And how do you get there? So that's what CBT really does. And for people with hoarding.

SPEAKER_02 46:14

you know exposure therapy is the the other part of it is let's look at this this thing that you're attached to how can you let it go like what are what are your feelings what are your thoughts how are you how are you processing this this item and hopefully helping them address it so if it's you know I I'm afraid that I'm gonna mess up or I'm gonna throw away something that's really valuable the exposure therapy might be well let's throw away something valuable and see what happens let's let's do it together that that type of processing well and so then Stephanie when you're working in a clinical capacity with folks that are hoarding what is the value or what I mean how high is the value of earning their trust to be able to say that to them let me hold your hand and help you to throw this item in the garbage I mean that that says trust me if you throw this away the world is not going to end let's hold you know hold my hand hug me do whatever you got to do what is the value of building that relationship I think that's huge.

SPEAKER_01 47:17

I think that's all of it. Like if they don't trust you they're not going to be willing to work with you through all of this. It's very difficult for them to let go of even one singular item. It's also very time consuming. I mean if you were to go through an entire hoarder's house with them item by item it would probably take 17 pages worth years because then every every item has a backstory or you know a back and forth conversation of why they can't get rid of it. It's not a simple yes or no. So I think you know definitely building trust with that person so you know the process can move a little bit quicker and also them knowing that you understand their thinking and how they feel about these items and you're not just viewing it as junk and let's move this along kind of thing. I also think for people when the dumpsters show up and other people start just throwing everything away because it needs to go is very traumatic for them. Has to be you know they need to be involved in the process and be making the decisions and be okay or you know they're just going to start hoarding all over again. It's it's fixing the the issue at hand but it's not fixing the larger problem on a bigger scale where they'll just start hoarding all over again.

SPEAKER_02 48:25

You should have seen me and my friend trying to move my ex-wife from Ohio to Connecticut when we were getting married that that

Cleanouts, Evictions, And Family Burnout

SPEAKER_02 48:32

was and she wasn't categorized as a hoarder but some of the stuff that was sentimental to her we had to sneak stuff out of the house in anyway. All right so along those same lines then it you build the trust with someone and you theoretically can get them to recognize that there may be some stuff that can go theoretically does that trust building and is it is it a logical next step along those ways to impress upon the hoarder the emotional impact that it's having on the other people in the home and is that possible Stephanie Yeah I think so you know I think it's it's emotional for everybody that's in the home too especially if you're not the hoarder yourself.

SPEAKER_01 49:19

You know I I know a lot of people end up at like you know if their mother's hoarding you you get that behavior too and then you kind of start becoming a bit of a hoarder. But also for the people that you know don't want this and just have learned to live with it and are ready at any cost just to dump it all because it doesn't matter to them. I mean it's it's probably very emotional toll on them as well. And that you know you you just don't know how to approach it with your loved one like Angela was saying I think in the beginning that it could be very an anxiety ridden kind of conversation even breach. So sometimes it's easier just to not talk about it. So I'm sure it's difficult for them as well.

SPEAKER_02 49:55

I can't it's got to be I mean I it just gives me anxiety just having this discussion.

SPEAKER_00 50:00

Angela you wanted to add something here yeah I was just I was just thinking back to the the one time that we had to do a clean out you know the the landlord had already gotten involved and the the daughter you know had to move out her stuff or daughter the daughter was you know in her 50s and she had two adult grown children and they had been for years trying to help her manage this hoard so she wouldn't get evicted. And unfortunately the eviction still happened and sometimes when you have a hoarding situation like that the family needs the team to come in. They need the social worker there to help their loved one because they just don't have the emotional space for it. They just want them to be better but they also need to clean out this hoard that they probably have done three times already and don't want to repeat the same process you know now they have a homeless mother you know there's all these emotions that come into it but I do think that one of the things that was was good for this situation was that there was a team there was the landlord who was kind of the the enforcer that this had to happen the social worker and the clinical team supporting the family and you know the individual who was being evicted and you know the property manager was also involved and you know so everybody kind of took a role to be able to effectuate the change but then the the the clinical team would have to then carry out the actual hard work right which is the cognitive therapy the readiness for change so that it doesn't repeat the pattern but I think when you're first initiating the the hoarding situation and it usually comes from some type of law enforcement or housing you know where the family is already exhausted to that point.

SPEAKER_02 51:36

They've already tried three or four times to help their loved one you know so well okay so this brings

Who Helps, What Fails, And Resources

SPEAKER_02 51:43

us naturally into the final segment that we get into which was the cracks in the system as you've seen we often talk about this concept of a safety net but now I want to look at the cracks. This is our segment that we call the cracks these are the invisible lines where families lose their voice and and patients lose their way from rigid privacy barriers that prevent or isolate loved ones to financial abysses which are always halting progress. We're we're asking why are these gaps here and who is falling through them in this segment we stop looking at the person who fell and start inspecting the holes in the floor that they were forced to walk upon and one of those cracks you just talked about is the team of people that it takes to to effectuate the change in the event that we move to an actual clean out of the hoarding if it gets to that point. Our work at Guardian has always been to coordinate those teams very specifically assign roles and duties very specifically amongst the team we I mean we don't assign it the team assigns themselves to certain roles and it's extremely important in these kinds of interventions because that's what you're talking about. It's an intervention that everybody knows their roles sticks with it and follows through with that that piece of the role the interesting thing that I that I found in my research is that uh these clean outs often re result in a recurrence of a of a hoarding episode they they it does not usually work on the first time much like an intervention with somebody who is an alcoholic or a drug addict right it doesn't necessarily take on the on the first time so there's there's one of the problems one of the cracks in the system is getting that team really hyper organized and understanding that we may be back here again doing the same thing again I mean this is not a one and done kind of deal but one of the things that I see as a as a crack in our system is identifying who and where and what is available for the hoarder and for the family trying to care for the hoarder so since hoarding is not a mental illness does it fall under the auspices of the Department of Mental Health?

SPEAKER_00 54:26

Does it fall under the Department of Developmental Disabilities or social services or what what agency do you see getting involved with it most often I mean for me it's mostly the mental health side because I do think that a lot of people with hoarding have co-occurring disorders like you said with the major depression or OCD or whatever else they might be experiencing with anxiety I would say the Department of Mental Health is probably one of the bigger ones along with social services because the other side of people with hoarding that's gotten to a certain point is more older adults.

SPEAKER_02 55:01

That's what I was going to say you know your aging populations lead to dementia you know obviously that's that's uh one of the unfortunate things about getting old dementia kicks in dementia is a trigger for hoarding we've we've seen that and the the agency that I've seen involved most often in my work from the legal perspective is the Department of Social Services slash elderly protective services because very typically it's the landlord and other residents who are seeing this for on the the firsthand basis. You know very typically folks are not caught up in service systems. They're not caught up in mental health the department of mental health yes we see it in our work because as you said mental illness very often has a a component of hoarding to it or vice versa but you know in real life a good call to a local department of social services agency elderly elderly protective services for outreach even the police for a wellness check I think are good resources that are available to people in the in the community Stephanie do you had anything to what you you you agree with those? I mean where else do you what other resources do you see that people are using to address the hoarding in their lives?

SPEAKER_01 56:23

No I definitely agree with uh you know the Department of Mental Health and especially to Department of Social Services and the EPS when it gets to that point I think you know the a lot of times when hoarding is the biggest issue is when landlords or other people are noticing it and it becomes a safety problem. You know, I have a client that had a Section 8 voucher so you know the the voucher you have to have your home inspected on a a yearly basis or the fire marshal comes out to deem your home safe and appropriate and then you're kind of under like you know a time limit with okay I'm coming back in three weeks this these are the problems that need to be fixed before I could pass your home. And you know that's important too because if it doesn't pass Section 8 isn't going to pay their portion of the rent and then you know you're you're jeopardizing the the housing for that person.

SPEAKER_02 57:13

Well and that creates more stress and more anxiety and leads to more hoarding and wanting that dopamine. It's such a vicious cycle yeah and you know the last word on this from me would be that we also have to be cognizant and worried about the the dignity of the human right to collect their stuff versus the safety of other people the safety of that person and how we we make a balance for all of those things. You know we can get in as a fiduciary what what are my roles as a as a court appointed fiduciary to keep this person safe while trying to honor their wishes and and respect their wishes as well so there's no easy answers for this but folks I think that you know if you're listening you you good places to start are we your you're local some towns have social workers some you know if not you can go call your city or your state and ask them to get involved and make referral force now too there's a in Connecticut we have a hoarding task force it's a hoarding task force who is but who runs that wouldn't that be the Department of Social Services you know I'm not really sure who runs it to be honest. I'm not sure if it was a city by town type coalition type effort to so people can go to like their 211 helpline in their local community and ask for hoarding I mean that's great advice you know we we have the suicide hotlines you know there's there's people out there that can refer you to the right places.

SPEAKER_00 58:39

We also have professional organizers that have been involved with hoarding and cleanouts that are more sensitive to this population too. So you know if that was another resource where you could think that they could get organized or you know could do it with a professional organizer then that's also another resource that is available.

SPEAKER_02 58:57

Right. All right well this has been pretty interesting discussion from my perspective as I said you guys were fired

Clearing Paths Without Creating Trauma

SPEAKER_02 59:04

up to have this talk and I'm glad we did because it was interesting to me to do the research and I learned a lot about it and it opens up my eyes to you know I've I've dealt with it from the legal perspective you guys deal with it from the clinical perspective and we've both seen it boots on the ground in in the homes and the people who are listening are living with it. And again we gave you some solutions possibly but we're just pointing out to you that the mess no pun intended the messiness of this is not something that you're alone in and that there are other people that are on the same journey as you Angela and Stephanie thank you again we'll see you guys all in a couple weeks and till then try to hold it together kinda all right as we close out this episode of holding it together kinda I I'm I'm I'm something is resonating in my brain you can't just fix quote unquote a hoarding situation by just throwing the items away if you clear a house but leave the attachment or the processing struggle or emotional regulation issues that we talked about you haven't solved the problem at all you've just created trauma and that trauma is real it's pervasive and as I said earlier it's visceral. So for the families that are listening your frustration is valid. It's exhausting absolutely exhausting to feel like you're playing second fiddle to a stack of papers or a collection of broken clocks or old toasters but remember for your loved ones those items are not trash they're a shield they may be a connection to you on some level and you can't just ask someone to put down a shield like that until they feel safe. So for the professionals we gotta stop working in our trained silos and when we're working in a group on complex disorders like hoarding the hammer of the housing court may clear a hallway but it's not going to stop the cycle that we're talking about. So this is where we combine together as a care coalition where we approach as attorney as clinician as family we're all reading the same playbook we're all addressing and sticking together through what admittedly is a very difficult situation and can be for a prolonged period of time so this is more about clearing paths than just getting rid of junk. It's about clearing paths for people to live safely and especially in a manner that that's meaningful to them. I'm Michael McNak. I hope this episode helps you understand why your loved one may be you know in in in in a mode where they just insist that they aren't hoarding um and you know learn from the research I did and from we from what we heard today that folks feel that they they're just barely holding it together kinda and we'll see you next time