Image (c) www.nathanwinograd.com

Image (c) www.nathanwinograd.com

By Kim Siebert MacPhail

If the statistics that cite “3-5% of the population” are accurate, between 390 and 650 Bedford residents are hoarders.

And while many people in our material world might be worried about a little clutter here or too many pairs of shoes there, that doesn’t mean they’ve got a hoarding problem. Hoarding is not a minor, garden-variety, too-much-stuff issue; it is, instead, a clinically defined condition with, for the first time, a stand-alone listing in the newly published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).

As a May 26 article in the New York Times framed the illness, hoarding is “the self-soothing need to acquire, coupled with a paralyzing inability to discard, that impairs one’s ability to function.” Compulsive hoarding is also associated with the lack of organizational skills, problems with processing and decisiveness, procrastination, perfectionism, self-delusion and avoidance.

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Bedford’s Community Health Nurse Pat Moran knows quite a lot about the issue. Although she’s been working in Bedford for only a year, hoarding is a wide spread problem that has begun to attract a lot of attention. Last year, Moran co-authored an article called, Compulsive Hoarding: Overview and Implications for Community Nurses because, in her line of work, she is often the first health professional to see a client in the home environment and thereby gain an understanding of the living conditions that have warranted Board of Health intervention.

“We get a call because the Fire Department got an emergency call or a [request for well-being visit] they couldn’t get in a house. Or, they got in but there was no path to get through. Sometimes the cat paths that they show on the hoarding programs don’t do justice,” Moran said.

“A lot of times, people don’t call [us before there’s an emergency] because they think that the Board of Health is an entity that’s going to go into a home and just throw somebody out on the street,” Moran continued. “That doesn’t happen. Certainly the code reads that way—we have the authority. But our primary concerns are basic sanitation and safety— basic existence for humanity. We’re not here to tell anybody how they should live, but they do have to have heat, hot water, running water, plumbing….It’s not all or nothing [as in make the house spotlessly neat and clean or you have to leave].

Residents of such homes can deny entry to the Board of Health, although not to emergency personnel, Moran explained. Denying entry can buy a resident time, but Moran stressed that the Health Department provides help and connections to services that most often are sorely needed.

“I’m not going to be looking at something in your pile, as an inspector,” Moran explained. “I want you to be able to get out of this house, I want people to be able to come in to help you, and I want you to be safe, to have all the basics. To have things pulled away from the heating system, so that carbon monoxide isn’t an issue. We bring the Fire Department along sometimes to make sure the heating is fixed and the smoke detectors work.”

As Bedford builds a hoarding task force with a variety of key participants—first responders, building inspectors or code enforcers, church groups, home organizers,  social workers, and hospital staff— there is a strict requirement to respect client privacy.

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“No one on the task force is going to go out into the community and be blabbing about it,” Moran said. “People need to have their privacy protected.”

Moran also noted that the Board of Health will soon have an intern whose job it will be to develop a resource list of people and organizations that will take used items or help individuals work through problems associated with accumulated possessions.

“Who will take my books, who will clean or fix? There are a lot of resources out there. That’s the intern’s starting point. You have to do it in steps.  It’s like any other public health topic; people have questions, like ‘Is mom a hoarder?’ We want to have a public education effort.”

While privacy is important, safety is paramount and trumps privacy when the situation reaches a heightened level. Extreme clutter can lead to unsanitary conditions, increased risks for falls, fires, and illnesses brought on by dust, mold, mildew or vermin. Neighbors can be affected by these unsanitary conditions as well, and the safety of first responders is also impaired when maneuvering within a residence is difficult.

The Board of Health can take a resident to court if cooperation to address the situation is lacking, but the Health office makes every attempt to work with a hoarder before resorting to that option.

While the profiles of those afflicted with hoarding disorder are complex, in Moran’s experience hoarders are not bad people. “I don’t think that hoarding is a mean person’s disease. I think it’s a very lonely disease because they’ve become isolated—no matter what their family situation is. Think about it: nobody wants to come to their house. You can’t sit down. There’s no place for you. The family starts going away, the neighbors start staying away. As people age, friends aren’t around anymore. It’s not fun to be a hoarder.

“We [at the Board of Health] try to make them accountable, we find them as much help as we can, and we try to be understanding. Everybody needs a helping hand, sometimes.”

Some additional articles and a video about the issue of hoarding:

Task Forces Offer Hoarders a Way to Dig Out
New York Times, May 26, 2013: http://www.nytimes.com/2013/05/27/health/when-hoarding-morphs-into-a-safety-hazard.html?pagewanted=all&_r=0

Step Inside the Real World of Compulsive Hoarders
Scientific American, February 25, 2013: http://www.scientificamerican.com/article.cfm?id=real-world-hoarding

Hoarding: How Collecting Stuff Can Destroy Your Life
Time Magazine, Monday, Apr. 26, 2010: http://www.time.com/time/nation/article/0,8599,1984444,00.html
An interview with Randy Frost, a psychology professor at Smith College and Gail Steketee, dean at Boston University’s School of Social Work, co-authors of the book Stuff: Compulsive Hoarding and the Meaning of Things

My Mother’s Garden
MSNBC News http://www.nbcnews.com/id/3036750/ns/msnbc-documentaries/vp/30013661/#30013661
Video documentarian Cynthia Lester returns to her mother’s home to try to help her deal with issues surrounding her hoarding disorder.

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