'TRASH' TREASURED: Experts examine the pathology of hoarding

The clutter and trash blanketing a Moorhead woman's home couldn't hide the irony in a few possessions.

Amid the flotsam of the middle-aged woman's life was "The Power of Positive Thinking," the self-help best-seller about conquering worry and nurturing belief in oneself. And across the living room, atop a teetering stack of periodicals, lay a magazine title that seemed to sum up the woman's approach to coping with worry and self-doubt: "More."

The home held one of the most severe cases of compulsive hoarding Lisa Vatnsdal had tackled with her team. There was a full-size bed with a debris-free sliver only wide enough for the owner to lie down and a stove top cluttered with containers. The woman had died of natural causes, and peace officers had discovered the chaos.

"How can anyone function like this?" Vatnsdal, Moorhead's neighborhood services manager, wondered that day.

Recently, hoarding has been yanked out of secretive obscurity. The media, most famously the A&E reality show "Hoarders," has trained a spotlight on the disorder, just as leaner times have forced viewers to rethink their own attachment to stuff.

Professionals such as Vatnsdal welcome the disorder's higher profile. An aging population and a disposable consumer culture will likely make cases more prevalent. And though these complex cases test public officials and mental health professionals, they hope more hoarders will seek help.

Trash, treasures

Myron Berglund, environmental services manager at Fargo Cass Public Health, has seen narrow pathways boring through 5-foot piles of stuff. He's seen 50 cats amid clawed, shredded furniture.

Deb Williams, a Fargo professional organizer, has seen fortresses of empty cardboard boxes, stashes of long-expired medication, out-of-style clothes that hadn't fit for years.

Mental health professionals debate how to classify such pathological attachment to belongings of dubious value. Once, hoarding was deemed an offshoot of obsessive-compulsive disorder.

"For me, compulsive hoarding is a symptom rather than a syndrome," said Scott Sternhagen, a psychologist at Fargo's Prairie St. John's.

Hoarding, he said, can stem from depression, dementia, psychosis and OCD. Holly Hegstad, a clinical psychologist and North Dakota State University professor, said hoarding might be a separate disorder.

Though hoarding naturally gets worse over time, it affects people of all ages. Berglund has seen it in young professionals: "Some have really good jobs, and people don't realize what they go home to at night." He was once summoned to the immaculate home of an older couple, only to discover stuff piled high in the basement, where their adult son lived.

Just about everyone seems to have a story about a hoarder they know: the room in a big house dedicated to empty cardboard boxes, the purchases that never emerge from shopping bags and the boxfuls they sneak out of a hoarding relative's home in a desperate bid to reclaim living space.

But finding a hoarder willing to talk about the disorder is tough: Hoarders live in deep denial -- or profound shame. The Forum offered anonymity to numerous potential interviews. Still, no luck.

"It can take many months before patients even open up to me," said Hegstad, the psychologist.

But these days, hoarding is attracting new scrutiny. Baby boomers are entering retirement age at a time when Americans are living longer than ever. Past the days of tight-knit extended families, it's easier to retreat into seclusion. And stuff -- cheap, free, there for the taking -- is ubiquitous.

"I always get scared for my hoarders during Cleanup Week," Hegstad said about the metrowide curbside disposal event. "Hoarders always take a big step back."

Breaking the bond

Occasionally, a hoarder will reach out to Williams' Ducks in a Row Organizing, often under pressure from family and friends. Usually, the hoarders hope she can impart order on their packed homes -- without discarding a thing.

Williams, who prefers to work in tandem with a mental health professional, tries to guide such clients through the fraught process of parting with possessions. She concedes she tends to make limited headway. She's seen clients sweat, shake, cry and admit defeat.

"I just simply can't do this," they might say. "It's too hard."

"Think about the possessions you treasure the most, and then imagine some random stranger getting rid of three-fourths of them," said Hegstad. "It's kind of like deciding which one of your children you're going to sacrifice."

Residents have been known to bargain with Vatnsdal when her team tries to intervene. One property owner, whose stash had spilled onto her front yard, zeroed in on Vatnsdal's stylish shoes.

"Maybe, you have too many shoes," the lady offered. "You may have a problem, too."

"My shoes aren't all over my front yard," Vatnsdal countered. "They aren't affecting my neighbors."

Hoarders can balk at letting plumbers or roofers into their homes, and minor maintenance issues over time can claim entire properties. A man who lived in a home with no plumbing once reasoned: "When I was a kid and we went to the lakes, we didn't have plumbing either, and we were just fine."

Generally, city officials only have authority to intervene when hoarding becomes a safety hazard or public nuisance. "They might have 10,000 pairs of shoes and, as long as they're not blocking people's exit, we wouldn't step in," said Kathy McKay of Clay County Public Health.

Moorhead Neighborhood Services calls such cases "intense property maintenance problems," and they call for monthslong teamwork by staff, social services, city inspectors, family and counselors.

City officials try to intervene with both firmness and respect for residents. "Mary, it looks like things got out of hand here a little bit?" Berglund might say.

Lingering cases

Hoarding cases can haunt you, said Vatnsdal. After her team cleaned out the rental apartment of a single mom and contacted social services -- mounds of stuff blocked the heat registers and hallways, and the kitchen sink was so packed with stuff she couldn't see a faucet -- she wondered if they'd done the right thing.

She felt better after she caught an "Oprah Winfrey Show" interview with a hoarder's child, who spoke of having no room to play at home.

"It's something we struggle with here," she said. "What is the right thing to do when the person tells you, 'It's OK. I'm fine living like this.' "

Giving a hoarder's home an extreme makeover is a temporary fix.

"Often, relatives and friends feel cleaning up the place will solve the problem," Sternhagen of Prairie St. John's said. "But if what's going on underneath is not addressed, in a couple of weeks the house will be messy again."

Compulsive hoarders are notoriously reluctant to seek help, and treatment is hard. Antidepressants are helpful only in a fraction of cases. Hegstad pairs cognitive behavior therapy sessions in her office with home visits to help tackle the daunting task of transforming patients' homes.

Progress can be less conclusive than the neat resolutions of reality TV. Still, there are enough small triumphs to make seeking help worthwhile.

"Patients say, 'I can cook on my stove. I can eat at my kitchen table. I can sleep on my bed,' " Hegstad said. "I look at that and think, 'Honey, you still have a long way to go.' But to them, it's real progress."