Should the government help reduce the hoarding problem?

In the January 10, 2010 Boston Globe Sunday Magazine article "When clutter turns to crisis," Stephanie Schorow reports "hoarders’ private problems can become a public nuisance, putting neighbors and firefighters at risk and dragging down property values. Now several Massachusetts cities and towns have decided it’s time to get involved." The Preamble to the Constitution of the United States says that government is create to "promote the general welfare." Does this qualify as an appropriate role for government? According to the article:

No one walking by the neatly trimmed lawn of Shirley’s home west of Boston would see anything amiss. Inside, the small living room has enough space for her son and his friends to gather around the TV for a video game, although the room is lined with plastic tubs stuffed with old board games and toys. The kitchen is another matter; the table is piled high with papers -- newspapers, magazines, documents, letters -- which spill onto the floor. Shirley (who asked that her real name not be used) can’t throw paper away, or not without going through every sheet to ensure it’s not needed. She also has boxes of other belongings that she can’t quite get out the door. She can donate clothes that don’t fit her, but only if her husband helps her decide what to keep.

“It stresses me to get rid of things,” she says. “I think it’s more like memories, like some things have good memories and stuff like that. I think it’s a matter of letting go, you know.” Her words tumble out, scattered and disorganized. “It’s just a weird way of thinking.”

Shirley has a heart-shaped face framed by soft brown locks. She’s a pretty woman but she rarely smiles. She says she desperately wants to get organized. She attends group therapy for people who acquire or keep too much, even though she hates shopping and never goes to yard sales. She doesn’t have to in order to fill her house. American life creates a trail of detritus: old magazines, junk mail, bills, plastic containers, and rubber bands, as well as old clothes and outgrown toys. For Shirley, things just don’t go out the way they come in.

Such compulsive hoarding may strike as much as 5 percent of the US population, according to Gail Steketee, the dean of Boston University’s School of Social Work and one of the country’s foremost authorities on the disorder. In Massachusetts, complaints to public officials about hoarding number 26.3 per 100,000 individuals, according to Steketee’s research. Moreover, hoarding has become pop culture’s trauma du jour. A&E’s reality series Hoarders, which debuted last summer, shows therapists and professional organizers encouraging out-of-control clutterers to allow their spaces to be cleaned up. On the Style Network’s reality series Clean House: The Search for the Messiest Home in the Country, a crew of wisecracking designers and cleaners sweep into garbage-strewn pads and transform them into showcases of style. What these TV shows often sidestep are the public costs of hoarding: These homes are not only dangerous for occupants, they also pose hazards to the firefighters and police who may someday have to rescue those occupants. Junk-filled homes can become eyesores or be condemned, lowering property values in their neighborhoods. Too much accumulation can be traumatic for the family and friends of hoarders, who often see their possessions as more important than their own health.

At least 10 communities in Massachusetts have decided to address these public costs head-on. Gloucester has one of the newest hoarding task forces, launched in 2007, while Newton has one of the first, established in 2003, which serves as a model to other communities in the state and the nation. The task forces are typically made up of public health nurses, social workers, therapists, fire and safety inspectors, animal protection agents, and professional organizers. They want to identify hoarders who are packing their homes with so much stuff that they may endanger themselves and others, and they want to find solutions that don’t humiliate or demean those involved. As more attention is drawn to hoarding, other communities are likely to consider creating their own groups. Because if it takes a village to raise a child, it takes a task force to handle a hoarder.

Bill Burke, director of public health for the city of Beverly, got the call about 11 o’clock on a Friday night in May 2006. An 80-year-old woman had been reported dead in a home where she lived with her 60-year-old son. The police were ruling out foul play, but emergency personnel had found the home stacked floor to ceiling with belongings. The front and back doors were almost blocked, and the responders could barely move from room to room. Neither the kitchen nor bathroom seemed usable. The house was a firetrap. (Firefighters responding to blazes in homes jammed with possessions often call them “Collyer Mansions” in reference to the Collyer brothers, two wealthy recluses who shocked the nation in 1947 when their bodies were found in their rubbish-filled New York brownstone.)

Burke headed to the Beverly home, where he was faced with the difficult task of telling a man who had just lost his mother that he might lose his house as well. The man, an engineer, was pleasant and intelligent. He insisted all the stuff in the house really had value -- everything could be fixed or used.

Burke knew the man could not remain in the unsafe home, but he was troubled at the thought of simply kicking him out without a plan for him to return. So Burke connected with a Beverly social worker; together they became a good-cop/bad-cop team. Burke made it clear to the man that the house had to be restored to safety. The social worker encouraged the man to contact relatives, who helped with cleanup and repairs. Almost exactly a year after Burke’s first visit, the man was allowed to move back in.

“It wasn’t perfect,” Burke recalls. “But you could get out the back door; you could get out the front door. There was access to the bathroom, access to the kitchen. He had a place where he could lay down and sleep. The fire department was satisfied.”

The case struck a nerve. In the spring of 2007, officials formed the Beverly Hoarding Task Force to serve the city and neighboring communities.

On a bright July morning, task force members file into a small room in the Beverly Senior Center for their monthly meeting. Today they will work on a brochure to educate the public about hoarding -- although Teri McDonough, the center’s outreach coordinator, admits she prefers the word “cluttering” or even “over-treasuring.” Participants trade stories and tips. Dawn Boccelli, service coordinator of a Lynn housing complex, is puzzled about a resident who displays “tons” of holiday items -- in the summer. Could hoarding be a result of obsessive-compulsive disorder, she wonders. “I would argue that it defies one diagnosis,” answers Susan Kaplan, who investigates elder abuse and problems for Senior Care, a Gloucester-based nonprofit that helps the elderly to live independently. Experts agree that compulsive hoarding has elements of obsessive-compulsive disorder, but consider it to be a separate condition.

Kaplan talks about her current case: an ailing, elderly woman whose junk-filled home is in danger of being condemned. A utility worker had discovered the house was so filled that egress between rooms was blocked. Senior Care had been alerted; Kaplan was assigned to try to help the woman. Initially suspicious, frightened, and ashamed, the woman wouldn’t let Kaplan inside, telling her, “You’ll report me, and I can’t lose my home.” The woman did agree to sit with Kaplan in her car. “This is progress,” says Kaplan. But does she indeed have to report the woman? No, fellow task force members tell her. Kaplan says she will continue to work with the woman in “baby steps.” She will try to gain the woman’s trust and encourage her to open her doors to a cleanup service. Perhaps she can get the woman into therapy, or refer her for assistance with nutrition and medical care. Kaplan adds grimly: “The whole issue might be moot. She might get sick and die, and the house will be gutted.”

While the term “compulsive hoard-ing” is relatively new, the condition is not. In the 1800s, doctors often diagnosed something called “collector’s mania.” Hoarding is frequently seen as a problem of the elderly or a holdover from Depression-era frugality, yet the mean age of hoarders is 50, and the tendency often manifests as early as age 3, notes Randy Frost, a professor of psychology at Smith College and expert on the disorder. Compulsive hoarding affects both sexes and all economic classes.

“It isn’t merely that a house just has a lot of stuff in it. It is also that people acquire these things in a compulsive way,” explains Steketee, the BU dean. “They don’t seem to have a lot of control -- at least that they can exercise -- about what comes in. Nor do they exercise much control about what goes out.” Steketee and other researchers are developing plans to establish a hoarding information center in Boston, under the auspices of the Boston-based Obsessive-Compulsive Foundation.

As with alcoholism, more people are speaking up about hoarding, says Claudia Schweitzer, a social worker and therapist with the Gloucester Board of Health. “It’s more socially acceptable to say that I or a family member has a problem.” Schweitzer is a member of her city’s hoarding task force, which at a recent meeting discussed displaying photos at a health fair to illustrate the difference between a messy home and a dangerous hoarding situation.

It took years for Jane, a 72-year-old Cambridge woman who asked that her real name not be used, to realize that her home was becoming uninhabitable. She just saw herself as a collector. “As I began to realize I had a hoarding problem,” she says, “I realized I collected everything -- just about everything.”

The word “hoarding” can be misleading. Often hoarders are generous-minded; they believe they are saving or acquiring something in case someone needs it. Others profess to be conscientious recyclers, horrified at a wasteful society. Many find it easy to give possessions away -- they just can’t throw them away. Jane describes herself as a crow that swoops in on shiny objects. “What attracts me, I collect. Rocks. Beads. Glass. Stones. Shoes. Clothes.”

Christiana Bratiotis examined the nation’s growing number of hoarding task forces as part of her doctoral dissertation last year. “There is recognition that mental health alone is not going to solve this problem,” says Bratiotis, now a postdoctoral fellow and project director of BU’s Compulsive Hoarding Research Project. “No one holds the key -- not building inspection nor public health nor animal control nor police and fire.” Rather, the fire inspector should work with social services; the board of health should coordinate efforts with elder advocates. External motivation comes from the threat of eviction, internal motivation from the behavior strategies and counseling provided by the “carrot dangler,” as Bratiotis describes herself.

One approach shown not to work is the tack often employed on the hoarding reality shows. With voyeuristic relish, cameras slowly pan mounds of clothes, broken furniture, rotting food, and empty containers, and then zoom in on the tense faces of hoarders as they watch other people hurl their possessions into dumpsters. Often, at the end of an episode, the hoarder walks into a pristine home. “I loathe [those shows],” Bratiotis says, “because they perpetuate the myth about the solution to the problem. Which is you go in, without the person being primarily involved, and that you clear things out and you bring in new things as if that were the answer.”

A total makeover is “built on someone else’s view of what the house should look like,” Steketee says. It’s far better if a task force determines the minimum necessary to make a home safe and livable and works closely with occupants to ensure they can keep it that way. “Because if it reverts to a dangerous situation, then you have really wasted your time,” Steketee adds.

Bratiotis acknowledges there’s not yet enough data to tell if task forces are effective in the long-term -- the first in the nation was established 11 years ago in Fairfax County, Virginia. But she believes that it’s a model worth pursuing and far more effective than the “clean sweep” of reality TV. Bratiotis is steadfast in her belief that hoarding tendencies can be overcome: “People can reclaim their life in a way they haven’t known sometimes for decades.” Cognitive behavior therapy can help hoarders gradually learn ways to discard possessions or stop acquiring them. Many hoarders find their greatest strength through one another in meetings of Clutterers Anonymous, a 12-step program based on the principles of Alcoholics Anonymous.

Working with a therapist, Jane, the Cambridge woman, has made tremendous progress, but she knows she will never be free of the desire to acquire. “It’s not something you get over,” she says. “It is something you always have to deal with.”

Stephanie Schorow is a freelance writer and the author of four books about Boston history. E-mail her at sschorow@comcast.net. Ann Silvio, a Globe senior multimedia producer, contributed to this report.