Hoarders

Lots of patients and friends have been talking about these reality shows featuring various hoarders. Intrigued about how hoarders are portrayed in these shows, I sat down with Hubby and watched an episode.

I have been to homes like that. I have had patients who lived like that. As an intern, there was a severely depressed woman who came to the hospital nearly mute. Initially, she only said yes and no. As she improved, more social issues came about. While she was hospitalized, her neighbors called Code Enforcement and her dwelling was pronounced uninhabitable. They found over a dozen cats, and rats, and gerbils, and of course, the usual feces and garbage. My co-intern and I were incredulous. When we asked her, "So, um, how many cats do you own?" She thought she had two. She also thought she had about half a dozen of rats and gerbils in cages. Well, according to the authority, they were DOZENS and these animals roaming. To this day, I have no idea how there were cats and rats running around the same property?! A lot of times, these homes are made aware to authorities because of fire hazards (can you imagine an apartment full of papers burning?) and of course, health hazards.

I also completed this rotation where I went to people's homes to evaluate competency. Basically, is there anyone upstairs to manage the estate/health of the said person, and if there is no one upstairs, and if it is a 'psychiatric reason' (generally, it was all psychiatric reasons,) I then filed paperwork and requested a judge to pronounce the said person to be incompetent. Once that is in place, then a conservator gets involved and theoretically, things will get better. As you can imagine, people really don't want to be conserved. There was a woman in a fancy neighborhood who refused to let us in, we called the cops and she still refused. Without a warrant, one could not go in. (Perhaps she was really with it?!)

There was another lady who lived in this neighborhood that I would love to live in, and apparently, according to the social worker who had been there previously, had no electricity, no water, no heat, and was full of garbage. This elderly woman was never home when we stopped by- we thought she was just sitting in the dark behind the door.

Then there was this family with a very strong psychotic gene, that resided in this very, very, very fancy neighborhood, where a home easily could fetch 5 million bucks. Yet it was so incredibly dilapidated.

Of course, on the other spectrum of the socioeconomic range, a man and his three adult sons lived in this trailer along the coast. It was absolutely disgusting. The toilet had not worked in a very, very, long time and was, well, brown. There was food, of all ages, everywhere. Surprisingly, there was a computer, albeit surrounded by lots of empty boxes from Amazon. The poor elderly man was taking a nap with his CPAP for his sleep apnea, and man, that CPAP was loud! Anyway, turned out, he was competent and he was aware of the mess.

Then things can get freaky at these home visits. Thankfully, a social worker typically already made a connection so I never had to go in 'blind.' There was a lady who 'collected' tarantulas. Her house had floor to ceiling full of stuff: mailings, circulars, letters, newspapers, crap. She did manage to form aisles through it, so one could get from the front of her residence to the back.

It is my opinion that there are two types of hoarders: ego syntonic hoarders and ego dystonic hoarders. Whereas ego syntonic hoarders like it, and must keep up with it, ego dystonic hoarders tend to also suffer from depression, anxiety, psychotic disorders, and do not like how they are hoarding. In general, ego dystonic hoarders are more easily 'treated.'

I was struck by several things for the episode I watched. First of all, these psychologists sound really, well, dumb. They keep saying the obvious. "Let's encourage her. It is ok, I am here to help you." Definitely not a useful portrayal for what a psychologist can do in these situations.

Secondly, some of these people really need to be medically treated for their underlying disorders. Surprisingly, that was not an intervention used in the episode I saw.

Thirdly, I think hoarding really speaks to how isolated people can be in our modern society. So often, people start hoarding behaviors after life circumstances change: after kids move out, after a spouse dies. Sometimes, I think, the prevalence of our psychiatric illnesses would decrease if people lived in more secure communities, where people got in on each others' business, with care and kindness.

Anyway, I think TLC and A&E ought to hire me as an 'expert.'