HOARDING FROM AN ACT OF ACQUIRING TO A FAILURE TO RECOGNIZE WASTE BY MURRAY S. ANDERSON, PHD, RCC Psychological problems do not exist on their own, nor do they come out of thin air; they are connected to people’s social support, employment status, housing conditions, history of discrimination, and overall political power…therefore, promoting complete health means promoting social justice for there cannot be health in the absence of justice. — Isaac Prilleltensky, 1999 hile “hoarding” To encapsulate the roots of hoarding on his brother. The brothers gained is understood in North America, three disparate yet worldwide attention in 1939, when to be a mental linked events are worthy of explication: Helen Worden Erskine, a reporter health issue, the story of the Collyer brothers and, for the World Telegram, ran a story Wthe roots of the in the modern era, Dr. Randy Frost and on the developments. Langley was issue escape encapsulation. Historically, “hoarding disorder” becoming a stand- outraged and blamed Worden Erskine hoarding was linked to OCD, while alone entity in the DSM-5. for this invasion of privacy, which made recent changes to the DSM-5 now “collecting” more difficult. In 1947, THE COLLYER BROTHERS categorize hoarding as a separate form police were alerted and found their Homer and Langley Collyer lived in of mental illness. Additionally, hoarding home stuffed from floor to ceiling. their Fifth Avenue, New York family does not occur in a vacuum and is often Homer was found deceased, and for home, which they inherited when their linked with depression and anxiety, as a while, rumours floated around that mother passed away. Neither married well as various forms of trauma. Langley had fled. In fact, he had also or had children; Homer became a In my working capacity with Island died and was later found deep within a maritime lawyer; Langley worked as Health, I provide outreach services tunnel of debris, less than 10 feet from a piano dealer. Socializing, interacting where his brother had been found. Over to those dealing with mental health with others at public events, the 130 tons of material were removed; and addiction issues. Over the past brothers led seemingly normal lives. there was little of value, and the few few years, a significant percentage of Then everything changed. auctioned items fetched only $1,800.1 my portfolio involves working closely Over the next 18 years, the The Collyer brothers brought a with those impacted by clutter and brothers collected various items and public awareness of hoarding, though hoarding concerns. Though I had some stored them in the family home. emerging discourse was not positive. understanding of the issue beforehand, Langley, a one-time concert pianist it is only through engaging in thorough and Columbia engineering graduate, THE MODERN ERA individual work in the community that would go out at night to collect. Homer, Modern hoarding research owes much I now appreciate the severity of the now blind and limited by debilitating to the work of Randy Frost and his situation. arthritis, was completely dependent colleague Gail Steketee. Together, they 6 BC ASSOCIATION OF CLINICAL COUNSELLORS have researched and published widely on attachment to their items. Gross reported this issue, with a significant turning point that the majority of participants held strong occurring in 1991. Frost was conducting bonds to even mundane items. a lecture at Smith College on OCD. An • The study was the first to show that clutter observant attendee, Rachel Gross, asked and hoarding issues have a strong genetic link if there was any scientific, peer-reviewed and are deeply enmeshed in some familial work on hoarding beyond the link to OCD. histories. Subsequent genetic and twin Gross went on to conduct this investigation studies validated the genetic connection. for her honours thesis and provided the IN A LARGER, PEER- Of significance, this research created a first significant account of hoarding and REVIEWED STUDY working definition that formed the basis for associated phenomena. It also highlighted the hoarding disorder criteria proposed for some long-standing misconceptions:2 OF CLUTTER WITH SENIORS, OVER the DSM. In May 2013, the DSM-5 was • Until 1991, it had been believed that published. Among the diagnoses new to the hoarding involved saving worthless items. fifth edition was hoarding disorder (HD), However, Gross found that many of the 69% WERE WOMEN; no longer grouped in with the addictions or research participants had rooms stacked with obsessive-compulsive disorders. In short, 85 PER CENT WERE new items still in their packaging, clothes the DSM-5 defines HD as an accumulation LIVING ALONE, with labels intact, and presents still wrapped. and failure to discard a large number of • A second misconception was that UNMARRIED, AND possessions of questionable usefulness, individuals who hoard held no strong CAUCASIAN. extensive clutter in living spaces that INSIGHTS MAGAZINE 7 research on the rates of HD. Coupled with the stigma attached to mental illness and the lack of seeking treatment (and lack of access to treatment), it is understandable how these statistics might be inaccurate.4 However, with new research initiatives, there will likely be more accurate analysis. For example, recent studies suggest that out of every 100 people, two to six have HD, which translates into over 1.75 million Canadians. Other estimates suggest that between three per cent and six per cent of the population may be impacted. Roughly speaking, these precludes activities for which rooms A significant change as of May 2013 statistics indicate that the experience of were designed, and significant distress is that the main behaviour defining HD is roughly three times the incidence or impairment in a person’s functioning. the “disorder” is no longer the act of rate of Alzheimer’s disease in Canada. The diagnostic criteria also include acquiring but a failure to recognize In Canada, research suggests that two specifiers: whether symptoms are waste. Said differently, this relative lack on average more men than woman accompanied by excessive acquisition: of awareness regarding the condition’s engage in hoarding behaviour; however, “collecting, buying, or stealing of items real-world impact is paramount to the there is close to equal representation that are not needed for which there is formal diagnosis of HD. in those over the age of 54 years, with no available space”; and whether the women surpassing men in their senior hoarding beliefs and behaviours are HOW COMMON IS HOARDING? years. Note that, the research may characterized by good, fair, or poor Due to the recent addition of hoarding be inaccurate because HD is often insight or are delusional.3 into the DSM-5, there has been limited overshadowed by anxiety, depression, WHERE TO START In my experience, consultation is through collaboration between ? the most important step. fire departments, bylaw Concerned caregivers and enforcement, Island Health For those seeking to assist someone struggling with counsellors should seek services, SPCA, concerned hoarding, it is important to acknowledge these professional help — for example nonprofits, for-profit landlords, individuals are often unaware they have a problem. from the Hoarding Action volunteers, and de-cluttering This lack of awareness can make intervention or Response Team (HART) in services. HEAT also provides structuring treatment challenging. Attempts to help Vancouver and the Hoarding referrals to vetted, local must be gentle, consistent, and collaborative. Education and Action Team resources for individuals outside (HEAT) in Victoria. HART has a of Greater Victoria. Those THINGS TO BE AWARE OF: property-use inspector, fire interested can call the HEAT inspector, and two mental health hotline at 250-361-0227 for more Mass cleanouts not involving Talk with the individual workers. Concerned citizens can information. the person are rarely face to face about concerns call 311 to report unsafe Additionally, the HEAT Peer effective and not suggested. whenever possible. conditions throughout Greater Support Group is a twice- Use of labels (“you are a There is a story behind the Vancouver. monthly, non-judgmental hoarder”) are unhelpful and issue; allow the person to In Victoria, HEAT provides peer-support group for hoarders can further isolate the tell their story. assessment, addresses to share struggles, victories, and person. Use the four C’s: contact, immediate safety concerns, and tools for dealing with the What is junk to you is collaborate, consistent, offers ongoing support to emotional and physical aspects someone else’s treasure. consult.8 hoarders in Greater Victoria of a cluttered home. 8 BC ASSOCIATION OF CLINICAL COUNSELLORS and other mental health issues. to unforeseen physical limitations. For In Victoria, our statistics indicate example, a fall, heart attack, or chronic REFERENCES 1 Weiss, K. (2010). Hoarding, hermitage, that about four to six per cent of the pain can significantly impact a previously and the law: Why we love the Collyer population meets criteria for HD — that functioning individual, resulting in an brothers. Journal of American Academic Psychiatry Law, 38(2), 251-257. is about 15,000 to 23,000 homes in inability to engage in normal activities 2 Frost, R., & Gross, R. (1993). The Greater Victoria or about 40,000 homes of daily life.7 Seniors may have items hoarding of possessions. Behavior research and therapy, 31(4), 367-381. on Vancouver Island. As the clinician (groceries, food delivery, supplies) coming 3 American Psychological Association attached to the HEAT team, I believe in but are physically unable to take out (2013). Diagnostic and statistical manual of mental disorders (5th ed.). this number is inaccurate at best, and garbage and recycling. Rooms quickly Washington, DC. with a significant increase in the aging become cluttered, further limiting their 4 Lauster, N., McKay, A., Kwok, N., Yip, J., & Woody, S. R. (2016). How much of demographic, this number will continue ability to function and increasing risks to too much? What inspections data say about residential clutter as a housing to climb drastically in the next decade.