For the last three years, I have been working with people, labeled “hoarders,” who have become overwhelmed by their possessions in their homes. This has been some of the most interesting, challenging and thought-provoking work I have ever done. It is also an area that, I think, highlights all of the issues that challenge us in helping people who feel overwhelmed, for whatever reason.
The people I meet have come to realize, or they have been told, that they have a problem with clutter in their homes. They mostly have one thing in common. Nearly all of them say to me, “I have watched those hoarding programmes on the TV, and that is not me!” They are terrified of what they see on their screens, and the very thought of that process happening to them triggers many more overwhelming feelings. My experience is that they are usually right — the people that they see on the screen are not them.
There is always, of course, a reality that centres on people’s relationships with possessions. It may not always be that there is a large quantity of things, as much as it is that there are always things by which the person has become overwhelmed. For some, being overwhelmed can be related to the sheer quantity of the possessions, and the dilemma that comes from fitting them all into their home. More often, however, being overwhelmed is related to feelings of shame, embarrassment, guilt, frustration, anger and a profound loss of self-esteem and self-worth. These feelings are related to issues that have happened in their lives, issues that are then reflected in their specific feelings towards their things.
Each person’s story is unique but there are always life issues, traumas and events that relate to what is happening with their belongings. The people are unique, their situations are unique, and failing to understand and respond to them as such is, ultimately, a failure to really see them. To call them hoarders or to say that they are suffering from a disorder alienates the individual and reduces them to a broad classification, taking them out of the narrative from which they emerged.
When I meet professionals from a range of services they tell me that they have a “hoarder” on their caseload, or that there is a problem with “hoarders”. I am told by experts in the field of “hoarding” that the fact that the DSM V (Diagnostic Statistical Manual 5) has recognised Compulsive Hoarding Disorder in its own right is a good thing as treatment can now be anticipated to follow. I am told that this is a chronic problem affecting up to 5% of the population and that “hoarders” lack insight and are hard to engage, therefore making this work for “specialists” only.
Having met many people now who would be talked about in this way, I wonder what their response to this might be. How would any of us feel? Please imagine someone coming to your home after receiving a referral stating concern with the state of your living quarters. Imagine that they look around your home and ask you about your relationship with your possessions and then diagnose you with a Compulsive Hoarding Disorder. Much like the response from the TV shows, you may (I know I would) tell them that they are wrong and that, while you know things aren’t great, this “disorder” is not the problem. The professional may then tell you, or perhaps they would imply, that you therefore lack insight. Again, as is common and something I think I would do, you might ask them to leave or perhaps never let them back in your house.
After this, of course, the “specialist” may confirm to themselves and those around them that “hoarders” are difficult, lack insight and are hard to engage! This is a professional set up that I have experienced many times throughout my career, most notably when working with people referred to by Assertive Outreach as “hard to engage”. The people I met were not “hard to engage” if you had time to listen, understand and attempt to help them in a meaningful way. However, if you ignore them and try to impose yourself and your opinions on them, they, like anyone else, will resist.
So for people overwhelmed with their possessions in their homes, a familiar process has taken place that distorts what is really going on because the system lacks the ability, or the insight, to look only at the person, their unique situation and their relationships. A familiar irony is that this response often comes from professionals and services that promote themselves as “person centred”. It appears that this approach is so often conditioned upon the person first accepting the opinion of the “specialist”!
What I see is people trying desperately hard to survive the many difficulties that they are currently experiencing or that they and their families have gone through in the past. What is so often the case for the people I meet, as with people who are distressed by hearing voices, people who injure themselves, or people who display many of the other manifestations of distress, is that these reactions are crucial survival strategies that then get medicalised. They feel that professionals are less interested in what has happened to them and more concerned with fixing the immediate concerns that may be distressing to others.
I do understand the arguments and feelings that make people want to classify others, and I understand that people will see someone overwhelmed by their possessions and think that the possessions are the problem. I know that people will meet people distressed by voices and will want to take the voices away. I can see that when someone you care about is injuring themselves, you will want this to stop. Likewise, I can see that profound sadness and crippling worries and fears are tremendously difficult, and we would all wish for suffering to be gone.
However, what I also see when I meet people experiencing all of these, is that the suffering is related to what has happened to them, who they are, how they see their world and what resources they have to overcome what is happening. That the belongings, the voices, the injuries, sadness and worry are understandable responses and often desperate and successful attempts to survive. That the feelings that people have, while painful and difficult, are often an understandable response to what is happening or has happened. That rather than anything being wrong with the person, everything about the way they feel is an adaptation to their circumstances.
So, perhaps if we can acknowledge that these are natural human responses and not symptoms of a disorder, we can just accept and support people, and not call them names and then try to get them to accept the names that we use, reserving labels such as “lacking insight” and “hard to engage” for those who dare to disagree.
If we can employ our natural human skills of love, compassion, and empathy. If we listen, if we are curious, if we accept people and their stories as truly unique, complex and inspiring, if we can marvel at people’s resilience, if we can truly accept difference and tolerate uncertainty, then maybe we can strip away the disorders, we can change the language to words that unite us as human beings, and perhaps then we can be more helpful to ourselves and to others. Perhaps then we can see through the clutter, in whatever form it takes, and see a person.