Stuff (12 page)

By her mid-twenties, Bernadette had found strength and solace in religion. She devoted herself to God and pulled her life together. She remembered the moment that God spoke to her, and she vowed to give up sex for God—to remain celibate until marriage. In the wake of her newfound faith, she encountered little difficulty with shopping or hoarding.

That changed when she was thirty. By that time, she was working as a teacher and had her own home. Late one night, a man broke into her second-floor bedroom by climbing up the rain gutter. He raped her at knifepoint. This horrifying assault—an unpredictable and uncontrollable event—was especially damaging to Bernadette, already cursed with a fragile sense of security from her earlier abuse. She found little help in her community. When she approached the minister of her church, he was too busy to talk to her and seemed to imply that she'd done something to invite the rape. She felt angry that God had seemingly abandoned her, and at the same time she felt ashamed, as if perhaps she
had
done something wrong.

Bernadette's family helped her pull down the gutter, but that wasn't enough to make her feel safe. She moved to a different room and locked the windows, but she couldn't shake the feeling of vulnerability and grew depressed. The world was not a safe place for her, and perhaps, she thought, she didn't deserve to be safe. A life of happiness must be reserved for those more worthy.

Despite her disillusionment, Bernadette did not abandon her religious beliefs. She shut out all thoughts about the rape and got on with her life. She fulfilled her Christian responsibilities as best she could but found little comfort in them. She did, however, return to one activity that pleased her—shopping. She loved buying clothes. She bought more and more things, which she put in the now unused bedroom where the rape had occurred. Soon the room was full, and her things spilled out into the hallway and eventually down the stairs. The rest of the house began to fill up as well.

Almost ten years after the rape, Bernadette met and married the pastor of a nearby congregation, and he moved into her house. Their first few years were happy, and although their home was cluttered, it was still manageable. At age forty-two, Bernadette experienced another disaster. She had a miscarriage, but her body would not discharge the fetus. She was devastated. Three weeks later, she finally acceded to her midwife's insistence that the dead fetus be removed medically. Afterward, her shopping and saving grew worse, and the clutter took over her home. She soon became pregnant again and this time gave birth to a daughter. A year later, she and her husband adopted a son. Despite her improved fortune, Bernadette could not escape the effects of her earlier traumas. She felt guilty and depressed much of the time, convinced that something was fundamentally wrong with her.

She continued her shopping sprees. Buying lifted her spirits for a few hours, but then the disappointment and depression set in again. She tried establishing rules for acquiring, but she couldn't stick to them. The urge to buy had become too hard to resist. When she was shopping, her world felt safer and things seemed clearer to her. Her goal was to look "classy," and she prided herself on her taste in clothes, choosing brilliant colors and styles that looked good on her. She felt important when she dressed well. Soon she was able to wear only a fraction of the cartloads of clothing she bought, and so she then turned to her children's needs. She justified her purchases as a means to ensure that her children wanted for nothing, and her old habit of buying in multiples returned.

She described the typical shopping trip: "I'm out looking for white shirts for my son—he's hard to fit because he's a big boy. And there I am at Wal-Mart, and lo and behold, there are the white shirts in his size. So I start thinking about how many to buy. 'Course he'll mess up the shirts, so I gotta have at least five, and they are a really good price. It's a hard item to find, so I buy six of them, and I find sneakers for him, too."

Getting rid of her purchases, or for that matter anything in the house, was next to impossible. Bernadette spent little time organizing or sorting and wouldn't allow her husband or children to discard anything without her approval. Whenever she tried to get rid of something herself, she felt vaguely uneasy and afraid. Understandably, her husband was becoming frustrated, but his criticism of her excess strengthened her conviction that she was bad, inadequate, a failure. Her only respite from these feelings seemed to be shopping. Like Janet in chapter 3, Bernadette was caught in a vicious cycle.

Bernadette self-medicated with things the way other trauma survivors self-medicate with drugs or alcohol—but the cure was getting worse than the disease. Still, the pain she was treating was very real, and her methods had an immediate effect. Despite the high frequency of traumatic events in the lives of people who hoard, relatively few of them develop posttraumatic stress disorder (PTSD). Whereas other anxiety disorders and depression are often accompanied by PTSD, in a 2006 study we found that it afflicted only 6 percent of compulsive hoarders. A low frequency of PTSD among people with a high frequency of severe traumatic events suggests that something is operating to limit the development of PTSD. Perhaps hoarding actually helps prevent the development of PTSD following a trauma.

To understand the reasons for hoarding, it's often necessary to examine what's going on in the lives of individuals at the time the hoarding develops. In our study of the onset of hoarding, we asked hoarders to describe their lives at around the time they first noticed the hoarding. More than half remembered some kind of important event, either positive or negative, many times associated with a loss or death. The hoarding problems of those who remembered such an event, like Bernadette, began later than the hoarding of those who did not identify a particular trauma. It appears that for some, a stressful life event precipitates hoarding, while for others hoarding begins early and continues on a steadily worsening course.

We knew that the common wisdom of hoarding being a response to deprivation was not the whole story. As we've already discussed, plenty of hoarders have lived comfortable lives. But deprivation is not always material, and emotional deprivation also can be devastating. To examine the relationship between emotional deprivation and hoarding, we compared people with hoarding problems to people with OCD and people without either problem (our control group), based on the nature of their attachments and recollections of their early family life. Both the hoarding group and the OCD group experienced more tenuous attachments to people than did the control group. They endorsed statements such as "I have always been 'hot and cold' with other people" and "I've not been sure how others feel about me" more frequently. We found no difference between hoarders and people with OCD, however, indicating that poor attachments may be a consequence of having significant emotional problems rather than anything specific about hoarding. On the second measure, recollections of early family life, people with hoarding problems were much less likely to report having been reared in a warm and supportive family than people in either of the other two groups. Hoarders were less likely to endorse statements such as "My childhood featured a constant sense of support" and "My family was always accepting of me." Perhaps the comfort provided by possessions developed during a childhood filled with inadequate protection.

The findings on trauma and attachment, together with the soothing effects possessions seem to have for people who hoard, suggest that part of this problem relates to feelings of vulnerability generated by difficult life circumstances. Hoarding affords many of its sufferers the illusion of control and replaces fear with a feeling of safety. For those for whom safety and control are a driving force, treatment necessarily requires exploration of a painful history. Resolution requires them to observe themselves closely so that they can fully grasp the causes of their hoarding. They must also shift their misguided thinking and beliefs along with their acquiring and hoarding behaviors. Put another way, they must "put their money where their mouth is," so that core values, such as Bernadette's commitment to her children and her religious beliefs, can translate to appropriate buying and saving behavior. Of course, as Bernadette's situation illustrates, this is easier said than done.

Bernadette's treatment progressed in fits and starts. Sometimes she could work on her clutter and clear space, and sometimes she couldn't. Her therapist noticed that whenever she encountered something reminding her of the rape, such as a picture of her room at the time or a fabric resembling the curtains, she shut down emotionally and couldn't go on. A similar thing happened whenever they got close to the point of sorting stuff from the bedroom where the rape had occurred. She had, in effect, walled off the still frightening bedroom, and indeed the entire third floor. Her therapist mentioned one day that she'd done an effective job of making sure no rapist could ever get into that bedroom again. She thought about this carefully. "I never realized what I was doing," she said.

To break this cycle, the therapist suggested that she and Bernadette spend time working only on the rape to help her come to terms with it. As they talked about the trauma and her reactions to it, it became clear that Bernadette had interpreted the rape in a self-damning way. Unable to face her guilt and vulnerability, she had blocked the rape out. In the same way avoidance forms part of the cycle of hoarding, not thinking about traumatic or emotional events forms part of the cycle of anxiety, depression, and posttraumatic stress.

Bernadette's acquiring, saving, and clutter served a purpose. Buying clothes provided temporary relief from her depression; saving things made her feel safe; and the clutter, especially in the bedroom, shielded her from memories of being raped and feelings of vulnerability. Gaining control over her acquiring, saving, and clutter required that she face those memories and feelings. After spending a few sessions talking about the rape, Bernadette's need to hang on to objects to feel safe began to wane, and she was ready to return to treatment for hoarding.

The main focus of that treatment was the powerful beliefs she had about her possessions and their value. We discussed these beliefs during therapist-assisted sorting sessions. Bernadette sorted possessions into categories—items to save, give away, recycle, or discard. The therapist asked Bernadette to describe her thoughts as she evaluated each item. In one case, she said, "Oh, I should save that sock; we'll probably find the other one. I know it's too small for him now, but maybe someone could use it." In another case, she explained, "I loved those shoes [pink patent leather with black smudges on them]. They don't fit now, but I want to remember [how I felt] when I wore them." After she became good at recognizing the patterns of her thoughts and emotions, she was ready to evaluate and challenge them. One method that worked especially well for her was considering her real need for an item versus her simple desire or want. For example, after considering this question, she concluded that keeping clothes that no longer fit either of her children was a fantasy wish, not a real need. Further consideration of the advantages and disadvantages of keeping things she had no real need for (e.g., the outgrown clothes) led her to conclude that the disadvantages of saving them (taking up a whole dresser that the kids needed for their current clothes) far outweighed the advantages (nice memories, but she had pictures for that). Although these considerations seem rather simple, beliefs such as Bernadette's are usually rigid and strongly held. Our goal was to loosen the grip of these beliefs and get her to start thinking from a different perspective. When she had mastered these strategies (evaluating need versus want and advantages versus disadvantages), her therapist asked her to take the perspective of another person—that of a trusted woman friend from her church community—when trying to make decisions about specific items. When considering each decision in light of what her friend would choose, Bernadette nearly always discarded the item, recognizing her friend's "wisdom" in simplifying her life.

During the early stages of Bernadette's treatment, we didn't emphasize getting rid of things. Instead, we focused on changing the way she thought about her possessions. Once she had some success in challenging or testing her thinking, we put more emphasis on discarding. For most of our clients, this involves a slow and time-consuming process in which they spend many months sorting through the things in their homes. Midway through treatment, if a client has been able to challenge his or her hoarding beliefs and tolerate other people touching his or her things, we recommend a more intense approach.

Bernadette was such a client. She had succeeded in loosening her attachment to the clothes she purchased for her children. Because of the huge volume of clutter in her home and her success in challenging her thinking about the clothing, Bernadette's therapist suggested a "team cleanout." This is a highly structured session in the client's home with a team of therapists and assistants. Gail and five staff members showed up in two shifts at Bernadette's home. Bernadette and her therapist had already decided on and written out the rules for the day. Clothes that were too small for her children could be bagged and taken away for donation without Bernadette's approval. So could duplicate clothing if the team kept the two or three nicest items. Bernadette had already put the children's current shoes in the closet, so all shoes found lying around could be donated. The team agreed to organize papers and other household objects by type and put these in bins for later sorting by Bernadette and her therapist.

Bernadette and her therapist sat in the bedroom on the second floor as team members paraded by with items that fell outside the rules. Bernadette's job was to make decisions on these items. Her therapist's role was to keep up her spirits and ask challenging questions, such as "When will you use it?"; "Where will you put it?"; and "Do you have other things like it?" The process was designed to train hoarders how to make decisions about saving and discarding. Bernadette's typical pattern had been to think only about how great these clothes would look on her or her children. Now she had to consider other issues, such as space and likelihood of use. Her therapist was careful not to put any pressure on her to get rid of things. Bernadette made the decisions. If she decided to keep something after reflecting on the therapist's questions, that was considered a successful decision.