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Understanding Messiness and Hoarding
Some people are extremely tidy, while others tend to accumulate quite a bit of clutter. Some people live in filth and don’t seem to realize it. Then there is the hoarder, whose possessions pile up until their home is a fire and health hazard.
What goes on in the minds of very disordered people? I think they can be separated into two types: those who are disorganized and those who have psychological disorders. The first group includes people who have trouble keeping things tidy.
They may have problems with spatial organization and simply do not know how to deal with all the papers and objects that make up their home life. They are overwhelmed by it all, and as they give up in despair, the piles begin to pile up.
These people know they have a problem but can’t find the solution on their own. What they need is a lot of support and some simple systems to fall back on. Organizational consultants are people who know how to find the right place to put everything and can help those who suffer from clutter and disorganization to have a more orderly and less chaotic family life.
When even that doesn’t help, it’s because the person’s problems are more serious – perhaps they have attention deficit disorder – and they just can’t deal with trying to keep all their things organized. These people need a lot more support, maybe even medication, to manage all their papers and possessions.
A more severe form of disorder corresponds to those people who do not clean. We’ve all seen them on reality shows about dirty houses. These are the people who never change the sheets or the kitchen sponge; who rarely, if ever, empty cat litter, dust, sweep, scrub, or even scrub a surface. His kitchen and bathroom are petri dishes that grow pestilences and plagues, and yet they persist in their path.
Chronic non-cleaners live in an unpleasant, smelly and unsanitary environment, but they don’t seem to mind too much, which in itself is a sign of a serious problem. Many of these individuals have a mental disorder that allows them to create a mess and then live with it without a care. They may be able to function adequately in other areas of their lives, but their psychological problems are evidenced by the literal dirty secret of their dirty house.
A milder form of this problem is those people who let their dishes pile up in their sink for a week, don’t do laundry for a month, sweep the floor only occasionally and rarely, if ever they become dust They wouldn’t qualify for TV shows, but the level of mess and filth in their homes is unacceptable for a normally neat and tidy person.
These people suffer from low self-esteem, passivity and inertia. They are overwhelmed by life and feel powerless to have any control over things. Basically, they’ve given up and their messiness is just a symptom of the problem. They may benefit from supportive psychotherapy.
Finally, there are the hoarders. These people have an extreme disorder. His overwhelming anxiety and inner chaos is expressed through a need to hoard as many things as possible and an inability to throw anything away, be it old clothes, wrapping paper, newspapers, or even his Garbage.
When I was in pre-med, I ended up sharing a house with a 27-year-old woman, let’s call her Jenny, who had a form of this problem. She was apparently an attractive, well-groomed young woman from a pleasant, middle-class family. It was only by living with her that his problem was revealed. The first clue was that he locked his bedroom door and hid the key.
The one time I got to see his room, I was shocked. There were so many things piled up on the floor that I had to wade through them to get to the other side of the room. She had invited me only because she was in a panic: she had lost something in the two-foot-high piles and needed my help to find it.
Every week Jenny went grocery shopping and came home with enough food to feed a family of six. He was a small person, and yet he would buy a dozen grapefruit, ten pounds of potatoes, two quarts of milk, and three loaves of bread for his own consumption. Every night she cooked a big dinner, then dutifully put the leftovers into a plastic container that she never looked at again.
I went through the fridge and pantry every week, throwing away mushy grapefruit, rancid leftovers (wrapper and all), potatoes with long green sprouts, curdled milk and moldy bread. At the time I wondered if he just missed his family, but later I realized he just had to accumulate things. This was further demonstrated by his compulsive shopping; the evidence of which was piled on her bedroom floor in the form of assorted purses, scarves, belts, sweaters, jewelry, and shopping bags.
Jenny had filled the room across the hall with the overflow from her bedroom. One day I came home to find her sitting in the hallway, surrounded by bags and boxes and lots of stuff. He had emptied the room, hoping to get years worth of possessions and throw away as much as he could. She sat there, paralyzed, for several hours and finally gave up and put everything back in the spare chamber.
At the time, I thought she was weird. She was a little tense and had some strange habits, like stacking all the cutlery in the cutlery drawer without sorting the different forks, etc. in each tray slot. I didn’t realize his problem had a name. It’s actually a form of OCD, obsessive-compulsive disorder. There are many manifestations, and compulsive hoarding is particularly difficult.
Jenny started dating Harold and chose to hide her problem from him. On the few occasions he came to visit, they stayed in the living room. Throughout their entire relationship, Harold never got to see her bedroom. At that moment I wondered what it must be like to be intimate with someone and keep such a big secret from them.
I moved at the end of the year and never saw Jenny again. We got along well as roommates, but his problem made it impossible for us to be close. I thought about her from time to time, and once I became a psychiatry resident, I realized how instructive it had been to come face-to-face with someone who was described in my textbooks. There’s nothing like seeing it first hand to recognize the problem these people are in. And it turns out his was a mild case. The most severe patients cannot contain the disorder, and their lives are occupied by the problem.
It is clear that, except for those with organizational problems, individuals living with extreme clutter or hoarding are actually showing signs of a significant mental disorder. Unless these problems are recognized for what they are and treated by qualified mental health professionals, people living in extremely disorganized, messy, or dirty environments will have no chance of making any meaningful changes toward cleanliness and order.
(C) Marcia Sirota MD, 2010
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