Stuff (11 page)

Still, it was difficult to resist the urge when she experienced a buying trigger—such as driving near the mall. Clearly, it takes more than just understanding how buying occurs to control one's urges. Early in treatment, Janet found herself "in the zone" several times, unable to control her buying. Our approach to gaining control is much like a physical conditioning program, but instead of exercise, we gradually increase the intensity and duration of urges to acquire. To do this, Janet's therapist accompanied her on "non-shopping trips," or more accurately for those who also pick up free things, "non-acquiring trips." This meant exposing Janet to the very cues that enticed her to buy, in order to build up her resistance. This method is similar to those that have been used effectively to help people resist the urge to drink, use drugs, or gamble excessively. Rather than avoiding cues altogether (impractical in daily life), Janet needed to learn how to face her problems and the world without the pleasure and comfort of shopping. She began by simply driving past a store (what we call drive-by non-shopping) and worked her way up to handling an item in the store and then walking away without it.

This process sounds simple, but it can be painfully challenging for those who are unaccustomed to resisting their urges and have no emotional armor to protect them. On her first non-shopping trip alone, Janet had a difficult time. She wanted to buy a pair of jeans so badly that she felt sick while she was in the store. Despite her feeling, she persisted, and the urge to buy gradually declined. She went home empty-handed and proud of her accomplishment. Our work with compulsive hoarders shows that both the urge to acquire and the sense of distress at not doing so subside as the minutes pass during these non-shopping exposures. The more frequently our clients engage in non-shopping, the more quickly the urges subside and the less powerful they become. Understanding this is crucial for treatment; when one of our therapists met his client at a store for a non-shopping trip, the woman announced proudly that she had arrived thirty minutes early and shopped for items she was eager to show her therapist. Now, she asserted, she was ready to practice non-shopping. Clearly, she had missed the point. She couldn't properly engage in the treatment until she understood why she must endure the urge.

Our non-acquiring trips work in part because a therapist is available to help talk people through their urges and place them in context. Since therapists can't accompany people everywhere they go, we ask our clients to create a list of acquisition questions to carry with them. These are simple, commonsense considerations such as "Do I have anything like it already?" or "Do I have a place to keep it?" Janet found these questions particularly helpful. They seemed to work nearly as well as having her therapist present, although they will work only if they are used. On one occasion, I overheard a member of one of our treatment groups tell another member, "I went shopping last week, but I didn't bring my questions because I knew if I did, I wouldn't buy anything."

Our research indicates that most people who undergo this treatment learn to control their acquiring more easily than they manage to get rid of their clutter. For some the effect is financially rewarding. Janet, for instance, paid off her credit card debt and ended treatment with more than $10,000 in the bank. By the end of her treatment, Janet could look through clothes racks and walk away without buying. Whereas controlling acquisition is pretty straightforward, changing the meaning of one's possessions and ridding one's home of hoarded clutter is far more difficult.

I had such a terrible week that I just wanted to come home and gather my treasures around me.

—Irene

Chris lived in a small bungalow on the edge of Berkeley, California. Overgrown trees and shrubs hid her house from the street. Potted plants covered most of her porch. She had an eye for Persian rugs and hung them from ceiling to floor along her hallway. There were eight or nine of them on top of one another, narrowing the hallway by at least a foot and giving her home a cavelike feel. Goat paths threaded through the waist-high piles of books, clothes, magazines, and other stuff filling the house—certainly enough clutter to impair her quality of life. She told us her refrigerator had broken recently, but she couldn't remove it through the maze of stuff, nor could she get the new one in. So the new refrigerator ended up in the basement, adding one more inconvenience to her already complicated life. Like so many of the people we've met, she was very intelligent. It was clear that she had read most of the hundreds of books that were strewn throughout her home. Chris was a nurse who had found me through an online hoarding support group, and we corresponded for quite a while before we met. Though she was a great resource for others, she had trouble controlling her own passion for collecting.

"I have pioneered a method of spotting hoarder houses from the street," she wrote to me once. "I just drive slow and look for front yards that look like mine, a jungle of hundreds of plants. Porches are often full too." She offered to make a study of it, taking pictures and sneaking by when a door or window opened to get confirmation. "I estimate the incidence of H-C [hoarding and cluttering] homes at about one household per block here in Berkeley," she claimed. Chris knew her neighborhood and the characters who lived in it. She accompanied us on a "hoarding tour of Berkeley" (see chapter 13), and she pointed out homes occupied by people she knew or suspected were afflicted with hoarding. "Like mine, complex and jungly" was how she described them. Pruning trees and shrubs was clearly a low priority. Permanently drawn shades pressed against the windows; apparently unsteady piles of stuff had fallen against them inside. Old and dented buckets, broken lawn mowers, paint containers, and piles of wood littered the yards, which were often obscured by tall grass and weeds.

Many of these homes needed repair and painting, but there is some variability on this point among hoarders. One of our most severe hoarding clients lived in a home whose exterior could be featured in
House & Garden
magazine, but whose interior was a horror. Our research has shown that only about half of identified hoarders live in dilapidated homes, so I guessed we were probably seeing only half of the hoarding population of Berkeley.

The darkness of the houses we drove by struck me: they were practically caves. To me they seemed dreary and menacing, but I came to understand that many hoarders, like Chris, view their homes very differently. It's possible that people who hoard prefer small, enclosed personal spaces—almost the opposite of claustro phobia. Perhaps they close in their living spaces to achieve a cocoon-like feeling of comfort and safety. I remembered how Irene, after a stressful day, wanted to come home and "gather my treasures around me." Irene's "treasures" helped her feel safe; when threatened, she wanted to surround herself with them. Investigators who study fear make a distinction between events that signal threat and events that signal safety. We commonly think of fear as occurring in the presence of threat signals. But fear can be activated by the absence or removal of safety signals as well. For many hoarders, the thought of losing possessions fills them with fear.

In many yards, we saw cars and trucks given over to storage. The truck beds, back seats, and even driver's seats were full of newspapers, clothing, and other overflow from the homes. Rusty charcoal grills, usually in multiples, peppered lawns, as did containers of various sorts, barrels, beat-up trash cans, and planting pots. The stuff the containers held looked disorganized and chaotic and had obviously been untouched for years. As we passed block after block, every street seemed to have two or three cocoon-like houses. It reminded me of the surprise I felt at the large number of phone calls we got when we placed our first ad looking for pack rats. Is it possible that so many of us have lost control of our stuff? Were all these houses just containers for the things that make us feel safe?

Bernadette was a large, light-skinned black woman, attractive and stylishly clad when she first came to therapy. Her personality filled the room when she wasn't depressed. She dressed very well on some days, with matching shoes, purse, and scarf; she favored pink and patent leather. On other days, she dressed to match her depression, throwing on whatever she found in front of her—even pajamas with snow boots. She had been a schoolteacher for many years until the birth of her daughter when she was forty-four. Shortly thereafter, she and her husband adopted a little boy. Her daughter and son were now five and three, respectively. Her husband was a committed preacher, busy taking care of his flock in a largely African American community. Bernadette's and the children's lives revolved around her husband's church as well. She assisted her husband as a deacon, attended a Bible study group, and joined her fellow churchgoers to pray whenever anyone needed help. Now she was the one in need. Bernadette and her family lived amid mounds of clothes, shoes, kids' drawings, pet projects, and assorted everyday family paraphernalia. After years of struggle and conflict with her husband over her hoarding, which had taken over their three-story, fourteen-room Victorian home, she finally decided to seek treatment for her problem.

By then, her home was nearly uninhabitable. The entry hallway and first-floor landing were full of children's clothing and toys, shoes, decorations for various holidays, books, Sunday school papers, and lesson plans from her teaching years. Just as we've seen in so many homes, ineffective efforts to organize were evident in the innumerable empty plastic bins and lids stacked elsewhere. The living room and adjacent dining area were waist-high with clutter of a similar sort—lots of clothes and shoes, plus place mats and table decorations, random papers, and assorted knickknacks. The stairwell contained more plastic containers and covers, cascades of newspapers and magazines, and more clothes and shoes. The bedrooms ranged from waist- to ceiling-high mountains of mostly clothes and shoes. The children could still sleep in their beds, but barely.

Most of what filled Bernadette's home came from her daily shopping sprees. She was devoted to her kids and insisted that they should have the things she never had. She tried to be frugal, shopping primarily at discount stores, because the family had very little money. Nonetheless, her buying so taxed their finances that the electricity had been shut off for nonpayment, and the family was facing bankruptcy. To cope with the loss of electricity, they stretched extension cords up the cluttered stairwell from the single working outlet in the basement. Although this provided them with light, it increased the risk of fire in a home from which escape would have been difficult.

Child and Family Services had been inquiring about the conditions in the home, and the loss of her children was a possibility if Bernadette could not learn to stem the tide of clothing and toys. Still she shopped. Her husband was angry. The chaos at home prevented his finding important papers or inviting anyone from the church to their home, and it kept their kids from having friends over to play. He wanted to know how she had let this happen and why she kept bringing new stuff home.

From our earliest studies of hoarding, we've noticed a connection between possessions and security. Violations of ownership lead to extreme feelings of vulnerability. When describing their reactions to someone else discarding one of their belongings, a number of our clients have said, "It feels like I've been raped." It is possible that in some people, hoarding might develop as a response to severe trauma. Compared to people who do not suffer from hoarding problems, clutterers report a greater variety of traumatic events (an average of six versus three), as well as a greater frequency (an average of fourteen versus five) of such events. The types of trauma most often experienced by hoarders include having had something taken by threat or force, being forced into sexual activity, and being physically assaulted. Traumatic events often cause people to reach for things. A survey of survivors of the World Trade Center attack in 2001 found that nearly half spent time gathering possessions before evacuating, even as the building shook beneath them.
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Hoarding may be an extreme version of this phenomenon in response to trauma.

Of course, not every case of hoarding stems from trauma. But in some cases, the connection is undeniable. One study showed that hoarders who experienced traumatic events had more severe hoarding problems than those who were not exposed to trauma. One unexpected finding in this study was that clutter, rather than difficulty discarding or excessive acquisition, was associated with trauma. For some hoarders, such as Irene and Bernadette, clutter helps them feel protected within their homes. In cases where a traumatic experience precedes the onset of hoarding, perhaps the trauma triggers a nesting instinct to protect the person from further harm.

Bernadette had coped with adversity most of her life. As a child, she saw more than her share of violence, both in her rough neighborhood and within her own family. Her father was a pathological liar and petty criminal, in and out of prison from the time she was born. Her mother criticized her mercilessly, demanding perfection of the sensitive young girl but spending little time attending to her needs. After her parents divorced when Bernadette was small, she and her siblings rotated among relatives. She formed the strongest bond with her great-aunt, the most stable figure in the large extended family.

When Bernadette was ten, she was sexually abused by her stepfather. The experience left her with doubts about her own basic safety and self-worth. As a teenager, she sought comfort in drugs and casual sex. About the time she went off to college, she began to shop. She bought mostly multiples of things, such as boxes of tampons, to avoid having to borrow them from others. But her excesses left her more than $10,000 in debt. Some "messy piles," as she described them, grew in her room, but at that point she had little trouble getting rid of things.