"Hoarding: When Too Much 'Stuff' Causes Grief"

Psychologists Randy Frost and Gail Steketee are featured on the latest episode of Fresh Air. Their book, Stuff: Compulsive Hoarding and the Meaning of Things is now available in hardback. Below are some excerpts fromt he Fresh Air website.

Some theorists have posited that people with hoarding tendencies form attachments to possessions instead of people. Erich Fromm claimed that a "hoarding orientation" leads to social withdrawal. Hoarders, he suggested, are remote and suspicious, preferring the company of objects to that of people. Indeed, for some people prone to acute social discomfort, possessions can be stable and comfortable companions. Irene, however, defied this categorization. She had a wide circle of friends, some of whom I met in the course of my work with her. They displayed a great deal of affection for her, and she for them. She had a quick wit and a well-developed sense of humor. It was easy to see why people liked her. She laughed readily and was often amused by the ironies of her plight. One day, as she pondered why she had saved a newspaper ad for new tires, she fell into gales of laughter when she noticed the headline: SAVE THIS AD. She was also quick to shed tears when she encountered something sentimental, such as a picture drawn by her son when he was a toddler.

I have met few people who are as interested in the world around them as Irene, though I later learned that this attribute is fairly common in people with hoarding problems. As she talked, I could see the way each of her things was connected to her and how they formed the fabric of her life. The advertisement for the tires led to a story about her car, which led to a story about her daughter wanting to drive, and so on. A piece of the hoarding puzzle seemed to be falling into place. Instead of replacing people with possessions, Irene was using possessions to make connections between people and to the world at large.

As we were soon to learn, the hoarding phenomenon is composed of a number of discrete factors, some well hidden and unexpected. But the most obvious factor was the simple problem of accumulation: from a scrap of paper with an unidentified and long-forgotten phone number on it to a broken vase purchased at a tag sale, Irene had great difficulty getting rid of things. The value she assigned to objects and the reasons she had for saving them were many and varied. Irene's beliefs about what should be saved seemed isolated from everything going on around her. She was truly baffled that her son and daughter didn't share her penchant for keeping things. One day, as she went through the mound on her kitchen table, she found instructions for one of her son's toys. "I'll put it here in this pile of your stuff, Eric," she told him when he got home from school. Eric immediately picked up the instructions, walked to the wastebasket, and threw them away. She stopped what she was doing, looking surprised. Eric saw her and responded angrily, "I don't need it. I know how it works." She didn't say anything. A few minutes later, she found a bookmark. "Oh, this has all the book award people on it. Do you want it, Eric? I'll put it in your pile."

* * *"Churning"

Irene's TV room, where she and her children spent most of their time, was just off the dining room. One chair was completely clear; no other sitting space was apparent. Videotapes were scattered about — hundreds of them. Most of them were recordings of TV specials Irene had taped so that she wouldn't lose the information they presented, but none of the tapes were labeled. She lamented that there were so many, but she had no plans to reduce her collection. On one side of the room was what appeared to be a couch, completely engulfed in papers. In fact, all that was visible was a pile of papers four feet high, extending about five feet out from the wall and running the length of the couch. A coffee table was also submerged beneath the pile. One small corner of the couch, about six inches wide, was clear. This was Irene's sorting spot. She reported that she sat there for at least three hours every day trying to sort through her papers, but the pile was growing steadily despite her efforts. We asked her if she would show us how she worked.

Irene began by picking out a newspaper clipping from the pile. It concerned drug use among teenagers and the importance of communication between parents and teens on this issue. The clipping was several months old. She said she intended to give it to her daughter as a way of initiating a conversation about drug use. However, since her daughter was away at school, she would have to wait until she got home. She said she would put it "here, on top of the pile, so I can see it and remember where it is." She then picked up a mailing from the telephone company offering a deal on long distance. She said she needed to read it to tell whether she could get a better price on her long-distance plan. She put it on top of the pile so that she could see it and wouldn't forget it.

She followed a similar logic with the third item, which also went on top of the pile. This process continued with a dozen more objects. The clipping about drug use was soon buried. For each item, she articulated a reason to save it and a justification for why it should go on top of the pile. Most of her reasons had to do with the intention to use the object. Her rationale was that if she put it away in a file or anywhere else, she would lose it and never find it again. The result of all this effort was that the papers in the pile got shuffled and those on the bottom moved to the top, but nothing was actually thrown away or moved to a more suitable location. We have seen this process so often among people who hoard that we have come to call it "churning."

The churning we saw in Irene's TV room was driven in part by something we'd found in our earlier studies of hoarding—a problem with making decisions. With each item Irene picked up, she failed to figure out which features were important and which were not, in the same way that she struggled to distinguish important from unimportant objects. Moreover, she thought of features and uses most of us wouldn't. When she picked up a cap to a pen, she reasoned that the cap could be used as a piece in a board game. She couldn't throw it out until we had talked through whether this was a reasonable and important purpose for the object. The same problem arose with a piece of junk mail from a mortgage company. She couldn't get rid of it until she figured out what was really important (or unimportant) about it. Sometimes she could decide to throw things away, but the effort it took was enormous. Often the effort was simply too much, and things went back on the pile.

* * *Most hoarders are capable of discarding things if they can convince themselves that the object will not be wasted, that it will go to a good home, or, as in this case, that the opportunity it presented is no longer available. But the amount of time and effort involved in attaining this certainty makes it impossible to keep up with the volume of stuff entering the home. Eventually, most hoarders give up and simply let the piles accumulate again. Irene could have called the number and perhaps realized the opportunity it presented was lost. Then she may have felt comfortable discarding the number, but she would have learned nothing about how to give up on opportunities that have passed her by. One goal of the experiment was to teach her how to tolerate uncertainty regarding unrealized opportunities. We talked some more about this, and she agreed to keep going with the experiment. She put the paper back in the recycling box but couldn't keep from glancing at it every few minutes. Each time she did, she reiterated her urge to make the call and how it would make her feel so much better. Finally, she said, "Having the paper in sight, it's like a beacon. It pulls my eyes and then my thoughts. I'm going to cover it up so I can't see it." She covered the paper and never brought it up again.

The more experiments like this she did, the more her thinking about things changed and her ability to make decisions improved. In the beginning, Irene could tolerate very little of the work I asked her to do. "Can we stop now?" she asked just five minutes into our first treatment session after she had discarded one scrap of paper. But Irene persevered and worked very hard for a year and a half to clear out her home. Each step brought her more of a normal life. When her kitchen table was cleared, she and her children started sitting down to eat together. When her whole kitchen was cleared, she resumed cooking, and it began to feel normal to be in an uncluttered room. By the time we stopped working with her, the majority of her home was virtually clutter-free.

As I got to know Irene, it became clear that she was a prototype. She possessed all the characteristics we had been observing in other hoarders: perfectionism, indecision, and powerful beliefs about and attachments to objects. Possessions played a role in her identity, leading her to preserve her history in things. She felt responsible for the well-being of objects, and they gave her a sense of comfort and safety. In addition, things represented opportunity and a chance to experience all that life had to offer.

Irene's recovery taught us a great deal about how these behaviors can change. Most significant was the fact that she made every decision about what to keep and what to discard. Such freedom might have been a license to do little. Yet Irene willingly challenged herself to experience the distress of discarding cherished possessions. Had she not done so, she would not have succeeded. Each possession held a story. Often just telling that story loosened her connection to it and allowed her to let it go.

Excerpted from Stuff: Compulsive Hoarding and the Meaning of Things by Randy O. Frost and Gail Steketee. Copyright 2010 by Randy O. Frost and Gail Steketee. Reprinted by permission of Houghton Mifflin Harcourt. All rights reserved.