What’s “hoarding”? Well, the DSM-V includes hoarding in its section on obsessive compulsive disorders. There’s OCD, which is a pattern of behavior and inner experience, and there’s OCPD (Obsessive-Compulsive Personality Disorder), which includes that pattern, but also extends to deep-seated and pervasive concerns with order, regularity, and tight control. You exert unnecessary and excessive control over variables you can actually affect, like neatness or punctuality, but your opportunities to do so are often subject to other variables beyond your reach, like the weather, traffic, or other people’s actions. This brings plenty of episodes of frustration, when highly charged efforts at maintaining order get interfered with by unpleasant surprises from outside. The irony is that someone suffering from OCD or OCPD is exercising what can look like a heightened personal mastery over their immediate environment, but it’s actually a type of helplessness: they cannot control their relentless need for control.  

OCD tends to start in childhood, but like most personality disorders, OCPD usually (not always) shows up a bit later, in adolescence or early adulthood. Hoarders typically don’t have OCPD. They don’t care much about order; their environments tend to be chaotic, and they often hold onto broken or incomplete items without repairing or maintaining what they insist might someday come in handy. Their problem is classified next to OCD because it’s a maladaptive behavior pattern they can’t regulate, with a thinking style that’s distorted to legitimize it. Of course, this fits addiction, too (so does disordered eating), and compulsivity is part of addiction—especially behavioral addictions that aren’t drug use, like shopping, sex, or gambling. Psychological diagnosis and “nosology” (the part of our science that divides human troubles into discreet categories) are not entirely scientific, and plenty of books (here’s a favorite) rightly criticize the Diagnostic and Statistical Manual of Mental Disorders for the limitations of its ever-changing categories (a more nuanced and humane approach has produced the Psychodynamic Diagnostic Manual, or PDM, by Vittorio Lingiardi and Nancy McWilliams). We do need some way of talking about what ails people; imprecision is inevitable; and imprecise terms are far better than none.  

Like many ailments, hoarding occurs on a spectrum of severity. It can be a light nuisance, a serious problem that impinges on one’s life-possibilities, or a severe mental affliction with potentially dire implications for physical health. Like some other conditions, it’s a distorted version of some natural and necessary mental functions. In the deeply ancient world, long before civilization, people generally kept almost nothing, or only what they could carry. When the Paleolithic (“Old Stone Age”) became the Neolithic (“New Stone Age”), the first settlements were established where people lived for an entire season, or even year-round, storing food and artifacts. Evolutionary psychology of this sort can easily jump to mistaken conclusions, but it seems likely that somewhere along the line it became adaptive to try and hang onto stuff that might be useful later on. A temperament that disposed people to a more retentive attitude became partly heritable—despite the fact that it could also cause trouble, like plenty of other genetic traits. Even if OCD were entirely DNA-based, which it isn’t, activating it would still require a releasement mechanism in the form of a lived experience. Such mechanisms are usually traumas of one kind or another, having to do with some kind of scarcity: food insecurity, inadequate love and affection, episodes of being robbed or cheated—all these can make someone err “on the safe side” by keeping too much stuff.  

Obsessions are a cognitive thing, with affective (i.e., emotional) dimensions, manifest as intrusive repetitive thoughts, preoccupation with certain themes or figures, or recurring words that take up too much mental space for no good reason. Compulsions are behavioral; often they’re involuntary rituals, involving repetitive counting, arranging objects in spatial patterns, or “checking” again and again that one really did lock the door or turn off the stove, far beyond the point where you’ve already secured that important information. There’s usually some misery in it, along with efforts to conceal the problem. Hoarders rarely have people over to visit, because shame is usually involved—unless the person is oblivious to other people’s judgments, or to their own disorder, two features of more severe presentations. If you suspect you may be hoarding, it’s likely a good thing that you’ve got the perspicacity to be concerned.  

It’s a lot easier to deal with hoarding when it’s got other meanings to it besides the traumatic, maladaptive ones. If you’re a collector—of art, musical instruments, rare handmade tools, antiquities, autographs—you may manage to sublimate the underlying anxiety into a life-enhancing fascination with some aspect of culture that speaks to you. A “philatelist” collects stamps, a “numismatist,” coins. Book collectors may be captive to their enormous holdings, and being only human, they don’t have the necessary centuries to read every book they own—but come on, it’s the cumulative wisdom of the world on those shelves, not, say, a hundred pairs of shoes (ok, I’m a bit of a bibliomaniac myself). Then again, hearing a balanced, articulate shoe collector hold forth about his or her favorite specimens might be interesting enough to earn a guest’s instant respect. There’s something cool about a passion that builds expertise and a refined capacity to appreciate the larger meaning, history, and design of what appeals to you, however esoteric it might be. But there are limits. 

When there’s no unifying theme to the possessions, when they’re not in good shape, when their owner can’t find anything, and the space is cluttered to the point that the room is hard to cross without knocking things over, when dust is a major issue, when acquiring and retaining things has crowded-out self care, sociality, and financial prudence—and above all, when there is no joy in having all this stuff, well, that’s obsessive-compulsive hoarding disorder.  

Aristotle recommended “the golden mean,” the sweet spot between the extremes: “nothing in excess.” It may seem odd that people who endure opposite insults like “neat freak” and “slob” will find their problems listed on the same pages, but remember the horseshoe metaphor? The extremes have more in common with each other, than with the center. Dante put the Spendthrifts and the Misers in the same circle of the Inferno, where they taunted each other forever, shouting “Why hoard?” and “Why squander?” That’s also the soundtrack of the hoarding experience whenever it’s time to try and escape it: the first question is your exasperation at all the junk you’re living with, but as soon as you pick up any single item of it and try to throw it away, the second question kicks in.  

Let’s linger on that a moment. You’ve just picked up one of your hoarded objects… an extra audio speaker, a bundle of obsolete cords, a chipped tureen, the wrong-sized pair of old new shoes you never got around to listing on eBay. You’re holding it in your hands. The pleasure of keeping it is only a very brief moment of relief at not having to part with it. But the pleasure of removing it lasts, because you keep noticing the cleared space you freed-up by releasing it. Suppose you hang onto a belt sander for eight years because you might have a carpentry project one day. Then you get fed up, or you’re given an ultimatum by a lover or a landlord, and finally manage to fetch $40 for it on Craigslist. A week later, your favorite aunt Facetimes you out of the blue, about the wooden stairs at her place—how they keep giving her splinters, and they need “a coat of varnish or something.” Waves of self-reproach come flooding in from your inner tyrant: How could I let myself give up that sanding machine, after keeping it for eight years! Now I need it! I knew this would happen. The people who urged me to get rid of it were wrong! Now I’ll have to spend a hundred dollars to buy another one! 

Persuasive as that mighty voice may seem, it doesn’t know the whole truth. And the part it does know, isn’t helping you. Sure, you could buy a new sander, but you’ve just learned that the need for this tool arises about once per decade. And for under $40 per day, you could rent one and be rid of it when the job is finished. Look around the living room, the garage, the storage unit. Of all the objects you see, what percentage of them have suddenly come in handy the way the belt sander just did? Wrapping paper will get reactivated on holidays, and candles are a good hedge for a possible blackout. But the extra speakers, the orphaned USB cables, the chipped tureen? Almost no foreseeable scenario will turn their lost importance back on again, and what you see when you look at them is stagnation, anxiety, and reluctance to govern your own affairs without excessive fear of being caught without a tureen, just in case a soccer team drops by with five gallons of soup in a bucket. Giving up that belt sander was a victory. It turned out you could’ve saved some money by keeping it, after all. But there would have been value in getting rid of it years ago, to enjoy the freedom of choice, and the decluttered living space, its absence would afford you.  There are hidden costs to hanging onto things you don’t need now, even if there’s a chance (and there’s always a chance) you might need them in the future.

Suppose you do throw out some usable item, and some years go by. Then the phone call comes, announcing a sudden occasion to make use of what you sold, or gave away, or threw out so long ago. Suppose there’s no option to rent a new one, and no cheap replacement waiting for you on some website or a thrift shop. If you want to do the project, you’ve got to spend $50 that you could’ve kept if you’d only continued hoarding the thing. Well, consider the $50 a small fee you pay for those years of being unencumbered by the thing.  

We know some of the neural correlates of Hoarding Disorder, and there are medications that can be useful components of treatment. While there’s currently no 100% effective psychopharma for it, HD often occurs with depression, so any successful treatment for that mood issue can alleviate HD, sometimes significantly.  

If you believe you may have a milder degree of trouble with hoarding, it may help to watch some of the documentaries and reality TV shows that have been made about cases much worse than what you’re contending with. That can make unpleasant viewing, but it can jolt you into firmer resolve to make some changes.  

An excellent psychodynamic treatment approach for OCD in general is George Weinberg’s book, Invisible Masters.  

Some cultural resources that may help anybody who needs them include Swedish “death cleaning,” which builds on the truism that “you can’t take it with you,” and Japanese housekeeping, which emphasizes an elegant minimalism.  

If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Licensed in NY, NJ, TX, and CA. www.drjameyhecht.com

If Winter comes, can Spring be far behind? – Shelley

Seasonal affective disorder (or S.A.D.), also known as the winter blues, affects “0.5 to 3 percent of individuals in the general population,” according to MedlinePlus. But it also “affects 10 to 20 percent of people with major depressive disorder, and about 25 percent of people with bipolar disorder.” So if you’re already suffering with a mood disorder, the shorter days and colder weather may be making it worse. There is, of course, a subtype of S.A.D. that’s less severe but more common. Things seem flat, cold, and remote, instead of enlivened and eventful.

From mid-February, it may feel like Spring is a long way off, regardless of what the Groundhog says. But Daylight Savings Time begins on March 12th this year, rain or shine, cold or mild. That’s less than a month away. Hang in there! And if you’re struggling with your mood, call for an appointment today, at 917-873-0292.

When a young person presents with both addiction and failure to launch, there is almost always a pressured tension between the patient and his or her family, especially those who control the pursestrings and pay for the therapy. The twenty-something’s journey (out of addiction and deferral, and into adulthood) should be distinct from his relational process with his family. In fact, it may even be psychologically necessary for him to move forward without having reached a stable accord with them. That way, he can be sure that his progress is not mere compliance. As that progress yield concrete results---especially, paying more of his own bills---he can be more confident that it isn't mere defiance, either. 

Compliance and defiance typically have been the poles between which the patient has been running back and forth for years, inside a family system which is stuck in that pattern. His compliance seems to be movement forward into adulthood, so long as most of what he complies with happens to be good advice, and reasonable rules, that come from exasperated elders who may well love him. But compliance is never really as good as it looks, because it's not autonomous, so it is not sustainable; it builds resentment that comes out sooner or later.  His defiance appears to be much worse, of course, because it's often full of hostility, self-destructive, anti-social, risky, and debilitating. 

Part of the reason this pattern is so terribly stable and hard to break up, is that the family's response to the young addict's defiance is usually a call for a return to compliance, this time a new-and-improved compliance that will last. That never works, because even if he does produce a good lengthy chunk of compliance, it's still mere compliance.  The solution is, in most such cases, to bring in a therapist whose client is not the family, but the patient himself. That way, the patient can continue doing the only two things he knows how to do, but in a whole new way which will permit him to learn new skills: he defies the family, and complies with the therapist in a genuine, collaborative search for what the patient (himself/herself/theirself) actually wants from life.

Why is that compliance somehow better? Well, between the patient and the therapist there is no personal history of being hurt, or betrayed, or robbed, or worried half to death. The professional is not burdened with guilt or regret about the past of the patient and his family. So she or he can afford to keep the patient's interests central, striving to collaborate with him on a viable path to a good-enough life (good-enough in the patient's own terms), at the heart of which must be a kind of guarded friendship between the struggling young patient and Reality. 

This is the same Reality which he has avoided for so long, languishing in addiction and the related un(der)employment. For him, Reality has been a place of failure, shame, and fear. Changing that is not easy, even with professional help. By the time such a patient arrives in the therapy office, he may have been to rehab, only once or many times. Depending on the nature of the addiction involved, recovery might be the first order of business; sometimes it has to come second or third. The choice (or the cycle) between abstinence and harm reduction should be respected, in accord with the specifics of the case and the values of both patient and therapist.

When something has been stable---even something toxic and annoyingly stable, such as a particular dynamic in a family system; a particular role for a particular person; any ongoing relational process that's been around for a while, even if it's one that truly sucks---its replacement by something better is still a big change. And all big changes, good or bad, are losses of the familiar. The good big changes are also gains, sometimes far bigger gains than the loss involved. So when a young person is coping with addiction and "failure to launch," and he or she manages to change and become successful-enough, sometimes the family gets upset---even though this good development is exactly what they've been pulling for all those years. It's new and it feels strange and people aren't sure how to respond to it.

And from the patient's side, as the therapy gains traction his capacity to manage his own affairs may be growing at a different rate than his capacity to deal with his family in ways that remain timely, kind, and effective for the pursuit of his own interest. Again: the patient's ability to cope with reality may be growing somewhat faster than his ability to deal with parents or other attachment figures in good-enough ways, enough of the time. Those older adults should try to keep these two capacities distinct in their minds, even though they are closely linked. Yes indeed, a guy who can keep a job ought to have the relational skills to manage his family elders without too much emotional noise-making. But as a therapist I can report it's extremely common for people of all ages to regress into childhood self-states when they deal with their parents---especially when purse strings are involved; or when there has been a divorce; or when there has been bereavement in the early death of a parent; and when addiction has been the main coping mechanism for a long time. If the patient acts messy with his folks, it doesn't necessarily mean he's still being messy out in the world.

In general, as far as good things go---things that might flow from the family to the patient, in recognition of his recent achievements---timing is important. It may be fine, and even lovely, for his family to use words and gifts to celebrate him for going straight after he manages to do so. But such things should never be mentioned beforehand, nor set up as an incentive. It has to be a free gift, at the right time, not too soon and without any strings attached. Of course, when therapy has just begun and addiction is still active, that's still a distant concern.

Compliance and defiance look and feel very different. Ultimately, both are forms of captivity to the cycle they form together. The way out is a genuine alliance between patient and therapist, in which it's made clear that there is a world---vital, interesting, unpredictable, sometimes friendly, and not impossible to join---beyond the one that has proven so painful and boring. Sometimes, the first hint of this lies with something outside the problem which can illuminate it: literature, or religion, or science and nature, or politics---it doesn't matter what the source is, so long as the patient gets the news (eventually, and as soon as possible) that, as Shakespeare's Coriolanus says when he leaves his mother: There is a world elsewhere.

If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Sessions are available in-office in Park Slope, Brooklyn, and remotely in NY, NJ, TX, and CA.