TERRY GROSS, host:
You probably know pack rats, people who tend to store things they might need someday. And you've probably come across someone whose home is so cluttered, you can't imagine how they live there.
Our guests Randy Frost and Gail Steketee are both specialists in obsessive behavior. And they say compulsive hoarding, the pathological accumulation of things, is shockingly common. Estimates vary, but they say the disorder likely affects roughly one out of every 30 Americans. Many lead miserably unhappy lives because of their compulsion, but find it nearly impossible to control.
Randy Frost is a professor of psychology at Smith College. Gail Steketee is a professor and dean of the School of Social Work at Boston University. Both have treated many hoarders, and they draw on their work in a new book called "Stuff: Compulsive Hoarders and the Meaning of Things."
They spoke with FRESH AIR contributor Dave Davies.
DAVE DAVIES: Well, Randy Frost and Gail Steketee, welcome to FRESH AIR.
We typically think of people with this problem as being introverted -maybe to the point of being shut in - perhaps a little disheveled, not somebody with a lot of friends, contacts. But you found this is not the case - at least often not the case. And one of the first people that you write about in the book is a woman named Irene. Tell us about her.
Professor RANDY FROST (Psychology, Smith College; Author): Well, Irene was a delightful woman. She - when I first met her, what happened was that her husband had told her that she needed to clean up the clutter, or he would leave. And she couldn't do it, so he actually left. When I met her, I was surprised by how outgoing and lovely and - a woman she was with a great sense of humor. And so we'd done some follow-up research on this and found that people with hoarding problems don't seem to have any more emotional-attachment kinds of problems than other people.
DAVIES: What did the clutter in her house look like? What kinds of things were there? How high were they stacked? How much of the rooms did they occupy?
Prof. FROST: Well, it occupied virtually every room in her house, except for her bathroom, and the bathroom sort of varied from person to person with hoarding problems. But her bathrooms were pretty much the same as any bathroom you would see in most people's homes. The rest of her house was somewhere between knee-deep and head-deep in clutter, with goat paths going through each of the rooms.
DAVIES: When you say goat paths, you mean, literally, a narrow passageway that one can traverse...
Prof. FROST: Exactly.
DAVIES: ...and clutter everywhere else.
Prof. FROST: Exactly.
DAVIES: And what kind of stuff was there?
Prof. FROST: Well, it was virtually everything: lots of newspapers, lots of clothes. Irene kept toys - toys that her children had, broken toys that her children had. She had this box that she called her amazing junk, and it was little pieces of games, and little pieces of plastic, and little things that came in McDonald's meals, and things of that sort.
DAVIES: She collected toys, things like that, what - newspapers. A lot of hoarders collect newspapers, don't they?
Prof. FROST: A lot. One of the motivations that seems key in people with hoarding is to maintain information. And we think it's related to a sense of wanting to acquire and preserve opportunities. So for Irene, when she looked at a newspaper, she saw lots of potential opportunities. And this carried over in a number of spheres. One was her difficulties with acquiring things. She told me that she couldn't go to New York City because if she goes to New York City, she walks by a newsstand. And when she sees a newsstand, she thinks to herself, look at all those newspapers, and all those magazines. Somewhere in all that, there's a piece of information that could change my life. How can I walk away without it?
DAVIES: Now, it's interesting, when you interviewed hoarders, I mean, there were so many cases where apartments were so cluttered that they were virtually unlivable. And I'm curious: Did the hoarders realize what their circumstances where like? If you showed them a picture of their home or apartment, would they recognize it?
Professor GAIL STEKETEE (Dean, Boston University's School of Social Work): Dave, it's interesting, because there's a phenomenon that we refer to as clutter blindness. And I think in "Stuff," we mention that Nell had this problem. And what's interesting, in particular, is that when you do take pictures and show them the pictures later, they often seem to have the impression that - it's shocked. It's like somebody else's home that they're looking at in the photograph because to them, that's not what it looks like when they walk into the house.
DAVIES: And if you ask them to draw a map of their house, what do you get?
Prof. STEKETEE: One of the interesting experiences that we had early on was asking someone to do just that - to draw, on paper, a layout of the house. And the person actually left off two of the rooms of the homes because they were so full that he hadn't been into them in a long time. And so they just disappeared from his point of view.
DAVIES: So they live in these little, narrow passageways and in effect, are - what, oblivious to the clutter? Or comforted by it?
Prof. FROST: Well, interestingly, when I showed up at Nell's house, what she said to me was, you know, when you are here, I notice the clutter, and it makes me feel awful. I get depressed. I look at myself as a horrible person. But when you leave, I don't notice it anymore. And that is something that a number of the folks that we've talked to have told us about their hoarding.
DAVIES: Now, I'm sure a lot of people are listening to this and thinking about their own basements and attics and closets and wondering: Do I have a problem? How do you know when this becomes a pathology?
Prof. STEKETEE: When it crosses the line from - shall we just say, being a pack rat or collecting things to the point where there's distress, either on the part of the person who's got the problem or those around them - so distress on either side; and impairment, when they can't do the things that they would like to do in their ordinary lives, when they can't socialize or have people into the house or work effectively, and on and on.
Prof. FROST: One of the interesting things that - questions that we get all the time from people is, what's the difference between someone who has a hoarding problem and someone who is a collector? When people collect things, they typically want to display them to other people. And in many ways, if you link this even broader - to a broader notion of materialism, that's a part of the construct of materialism, where people want to present a facade to the world with the objects that they have. But people who hoard are not like that. They don't want other people to see it. They want to kind of keep these things hidden because of the shame they feel when people see their homes.
DAVIES: Let's talk just a little about why people collect stuff. And you have a number of these patients that you've worked with that you've given pseudonyms to, and maybe they collect for different reasons. But do they get pleasure from the things that they collect that make their lives unworkable?
Prof. FROST: Absolutely. It's - one of the most fascinating things about this is to see someone with a hoarding problem while they're getting pleasure from the object. A couple of examples: Once when I visited Irene, we started talking. And all of a sudden, her eyes lit up and she got very excited. And she said, I've got to show you something. And she ran off into the other room, and she came back a minute later with a large, plastic bag filled with bottle caps. And she said, look at these bottle caps. Aren't they beautiful? Look at the shape and the color. In her eyes was such delight, such an appreciation for the aesthetics of these objects. And it's something we've seen in many people with hoarding problems - is this sort of aesthetic appreciation of the physical world that most of us don't have.
DAVIES: Now, in that case, the bottle caps have no particular connection to their lives or people that were important to them. They're absorbed with their physical characteristics. But you also find that there are some people that associate their objects with parts of their lives -become, in effect, representations of who they are, right?
Prof. FROST: That's right. And we find that in the same people. So on the one hand, Irene collected all these things because of this aesthetic appreciation. On the other hand, she collected a lot of the things that she had because of their sentimental attachment. And the attachment went well beyond what most of us have when we are sentimentally attached to an object.
For instance, one day, as we were going through some of her stuff, she came upon an ATM envelope that she'd gotten five years before, some money in it. And she had written on the envelope what she used the money for, and it wasn't anything all that special. And she put it in the box for recycling, and she started to cry. And what she said was, I feel like I'm losing that day in my life. So there's something about that object that seemed to represent that day of her life, and if she got rid of it, she would feel like somehow, she'd - a part of her was now gone.
DAVIES: So this is fascinating. You have some people who collect newspapers because there might be something in the newspaper that might be helpful to them, and they'll save it for years. You have some people who collect things as insignificant as bottle caps because they're fascinated with their physical characteristics. And then you have some people who will keep an ordinary object because they feel a connection to an event or a person. It sounds like there are all kinds of different reasons that people pile this stuff up. Is there a connection that links them all?
Prof. FROST: These beliefs seem to be associated with some peculiar information processing problems - that is, there are some problems with attention - that is, distractibility and sometimes a hyper focus, problems with categorization, the ability to organize things. People who hoard tend to live their lives visually and spatially instead of categorically, like the rest of us do.
So if Irene has an electricity bill, she puts it on top of the pile. And to find it, she remembers where it is in space, rather than putting it in a file somewhere under the category of bills. And the kind of emotional attachments and beliefs about possessions that we see are paired with this kind of information processing problem. That's when we seem to get the problem with hoarding.
DAVIES: We're speaking with Randy Frost and Gail Steketee. They've written a new book about hoarding, called "Stuff."
We'll talk more after a break.
This is FRESH AIR.
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DAVIES: If you're just joining us, we're speaking with Randy Frost and Gail Steketee. They're both experts in obsessive compulsive behavior who've written a book about obsessive hoarding called "Stuff: Compulsive Hoarding and the Meaning of Things."
Let's talk about treatment, because you know a lot about this because you've done a lot of this, helping folks who have come to you, often -and sometimes family members will come to you because they're deeply affected by someone's hoarding problem, and you - people decide to get help. One of the things you tell us is that you don't want to throw things out for the hoarder - in other words, go in while they're not there and just toss stuff out. Why?
Prof. FROST: When people go into someone's home and clear it out, what happens is that they may change the condition of the home relatively quickly, but they don't change the person's behavior, and the behavior is really the problem. Without changing the behavior, the condition of the home will go back to what it was, in short order. We've seen that time and again, when health departments go in and clear people out. What we need to do is, we need to get the person themselves to change their decision-making about what objects to keep and what objects to throw away, and that's why we focus so heavily on it.
DAVIES: And what's the emotional impact when a hoarder finds that someone has come in and gone through their stuff and thrown some of it out?
Prof. STEKETEE: Typically, quite disastrous, unfortunately. And as a cautionary note, I think - not only to the community officers or agencies that are trying to do this, but also, sometimes, to family members who want to do it - it is a very quick way to destroy a relationship. Because if you remember how people feel about these things, it's like ripping something away from them that they care greatly about. It's a disastrous experience for them. So anything we could do to make that a gentler process would be extremely helpful.
DAVIES: So what does work? How do you treat people like this?
Prof. STEKETEE: One of the first things we start off with doing is trying to figure how motivated they are to get over the problem, because one of the things we mention several times in "Stuff" is the relatively limited insight. You know, when they're with us, they feel embarrassed. But in their own home, they're not at all sure they want to get rid of anything. So part of that is helping them figure out what values they have for the future, and what goals they have based on those values. And that can help us sort of set the stage for when they want to back out, or they're afraid to get rid of something, we can always double back to those goals. That's one place we start.
DAVIES: How do you get them to stop bringing the stuff in and accumulating it?
Prof. STEKETEE: That's dealing with the acquiring problem, which is a very interesting challenge in and of itself. A little bit ago, we mentioned the fact that people get very excited about their objects, like the bottle caps. And that actually happens a great deal when people are getting new things, either free things or they're going to the store and looking to - at things they want to buy. They get very, very excited about them. And so part of the challenge there is a little like dealing with an addiction.
Hoarding, in many ways, has elements of addictions like gambling and so forth, where the excitement drives the behavior. It's like a high that people get very stuck on, and it's hard to get over. So we have to help them go into situations. We call them, often, non-shopping trips that we engage in, that help them get over the urge. It actually gradually gets less and less with more and more exposure.
Prof. FROST: It's a little bit like a physical conditioning program, except what we're conditioning is a tolerance for the urge to acquire something.
DAVIES: You know, people who've struggled with alcohol, and who have been sober for years, will not describe themselves as a former alcoholic. They think it's a condition they will always live with. Is the same true of hoarders?
Prof. FROST: One of the people in the book, Paula Kotakis, one of the few people who - actually, not only did she give us permission to use her name, she said: If you're going to talk about me, please use my name, because I want to be out there. I want to be someone who's upfront about hoarding as a problem, and so forth. I asked her if we could describe her in the book as a former hoarder, and she wrote back and said no, because she struggles with it every day. And she wrote a description of her experience just a few days earlier, where she was trying to throw out a used yogurt cup.
And she described the thoughts that she had, that somehow this yogurt cup, when she threw it in the trash bin, would be uncomfortable. And the yogurt cup would feel bad for being the one that got rejected, the one that got thrown away. And it would feel uncomfortable, extra humid -because she put the lid on - and she's thinking, maybe I shouldn't have put the lid on it. And then she thinks to herself, these thoughts are crazy. Why am I having these thoughts? But yet she can't ignore them.
DAVIES: I mean, that letter that she wrote about the yogurt cup was a very compelling thing to read in the book. A lot of people would hear that behavior and say, now, this is delusional. Are many hoarders like this?
Prof. FROST: Quite a few are. And we think there might be a distinction between people with what we consider hoarding disorder, and people who have OCD hoarding - that is, hoarding that's due to obsessive-compulsive disorder - secondary obsessive-compulsive disorder. Now, the thoughts sound delusional, but the fact is that she knew the thoughts were crazy. Now in delusional thinking, people don't know their thoughts are crazy. But she knew that these thoughts were crazy - but she couldn't stop them.
DAVIES: Well, Randy Frost, Gail Steketee, thanks so much for speaking with us.
Prof. STEKETEE: You're welcome.
Prof. FROST: Thank you, Dave.
GROSS: Randy Frost and Gail Steketee are the authors of the new book "Stuff: Compulsive Hoarders and the Meaning of Things." They spoke with FRESH AIR contributor Dave Davies.
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GROSS: You can see an animated dramatization of the way hoarders gather possessions, on our website: freshair.npr.org, where you can also read the first chapter of "Stuff."
Also on our website, we have something interesting related to our first interview: a demo recording of the song "Promises, Promises," featuring the composer Burt Bacharach on piano, accompanying two singers.