ABOUT 15 YEARS ago, I received a desperate phone call from a woman named Irene. She had found me by contacting the Obsessive Compulsive Foundation and asking for someone who might help her with her hoarding problem. Irene was 53 and had just separated from her husband. She had two children—a 13-year-old daughter, Julia, who was away at boarding school, and a 9-year-old son, Eric, who lived at home. Her husband, an engineer, had been after her for years to get rid of her clutter, which waxed and waned but never went away. Finally, he told her to clean it up or he would leave. She couldn’t, so he did. Now she was worried that she would lose her children, in the upcoming divorce, because of the conditions she lived in.

I spotted Irene’s home immediately after my 90-minute drive from Northampton, Mass. Despite its commanding view from atop a hill, the house was dark and gloomy. Overgrown trees and bushes hid much of it from the street. Its paint was peeling, and its fence needed mending. A car parked in the driveway was packed with papers and clothes. I had brought along a student assistant, Tamara, and as we walked toward the house, we could see boxes, newspapers, clothes, and an assortment of unidentifiable objects pressed against the windows.

We knocked on the front door but got no answer. We found a side door and knocked. Something stirred inside the house. Behind us, a door to the garage opened, and out stepped Irene, slightly overweight and rumpled, with straight brown hair and a friendly smile. She introduced herself with a nervous laugh and invited us in: “You can’t get in that way. You’ll have to come through the garage.”

Inside the garage we found a narrow path—through a chest-high jumble of boxes, tools, and bags—to the only door in her house not blocked by debris.

IN IRENE, IT turned out, we had found an extraordinarily articulate and insightful subject. The foreboding exterior of the house belied her personality. She was friendly, bright, and engaging. Like other hoarders Tamara and I came to know, though, she was tormented by her situation and demoralized by her inability to do anything about it. While she was happy to see us, she worried that she was wasting our time, since her problems were of “no consequence to anyone but me.”

In reality, the chances are that all of us know someone with a hoarding problem. Recent studies of hoarding put the prevalence rate at somewhere between 2 percent and 5 percent of the population. Moreover, the boundaries between normal and abnormal behavior blur when it comes to hoarding. We all become attached to our possessions and save things other people wouldn’t. The passion of a collector, the procrastination of someone who hasn’t taken the time to put things away, the sentimentality of someone who saves reminders of important personal events—all these are part of the hoarding story. Why do certain people go too far?

Some researchers have posited that people with hoarding tendencies form attachments to possessions instead of people. The social psychologist Erich Fromm claimed that a “hoarding orientation” leads to social withdrawal. Hoarders, he suggested, are remote and suspicious, preferring the company of objects to that of people.

Irene, however, defied this categorization. She had a wide circle of friends, and it was easy to see why people liked her. She laughed easily and was often amused by the ironies of her plight. One day, as she pondered why she had saved a newspaper ad for new tires, she fell into gales of laughter when she noticed the headline: SAVE THIS AD. As Irene came more and more to seem like a model subject, the classic definition of hoarding as a socially isolating syndrome appeared to be flawed. One of Irene’s favorite things, she said, was to make connections between people with mutual interests. Unfortunately, her gift for seeing such connections was a factor in her keeping virtually everything she acquired.

Irene was well educated and had a wide range of interests. She seemed to know something about almost every subject, and she had a story to tell about each possession—most of them remarkably detailed and engaging. One day she found a piece of paper with a name and phone number on it among the pile of things on her kitchen table and excitedly recounted its history: “This is a young girl I met at a store about a year ago. She’s Hawaiian and had such wonderful stories about Hawaii that I thought Julia would like to write to her. They are about the same age. She was such an interesting person, I was sure Julia would enjoy getting to know her.” Her face lit up at the prospect of making this connection. “But Julia wasn’t interested. I thought about writing her myself, but I never did. Still, I don’t want to get rid of the contact. Julia might change her mind.”

I had met few people who were as interested in the world around them as Irene, though I later learned that this attribute is fairly common in people with hoarding problems. As Irene talked, I could see the way her possessions formed the fabric of her life. The advertisement for the tires led to a story about her car, which led to a story about her daughter wanting to drive, and so on. A piece of the hoarding puzzle seemed to be falling into place: Instead of replacing people with possessions, Irene was using possessions to make connections between people and to the world at large.

DURING THAT FIRST visit, Irene gave us a tour of her house. We moved through each room on “goat paths” (a term well-known in the hoarding self-help world)—narrow trails, not more than a foot wide, where the floor was occasionally visible.

The dining room was the worst room in the house. Every surface was covered, and the clothes, containers, books, and newspapers climbed above my head. In the kitchen, a pile of unwashed dishes balanced precariously in the sink, and the countertops were strewn with containers, piles of pens and pencils, bottles of pills. Only a small corner of the kitchen table was visible, about the size of a dinner plate. One very small corner of the couch in the TV room was also clear. That was Irene’s sorting spot. She reported that she sat there for at least three hours every day trying to sort through her papers, but the pile was growing steadily despite her efforts.

Irene was apologetic to the point of tears about her situation. Yet despite being able to talk generally about the irrationality of her behavior, she had difficulty changing the behavior. When faced with deciding whether to discard a 5-year-old newspaper, she could not see the absurdity of keeping it. “I know I am smart and capable, so why can’t I manage my stuff?” she asked. “I see other people do it. Why can’t I?” In the beginning, I had no answer for her. But as we learned more about her and her home, the pieces of a new theory about hoarding began to develop.

MOST DESCRIPTIONS OF hoards include piles of worthless and worn-out things. Initially, the clutter in Irene’s kitchen seemed consistent with this model—expired coupons, old newspapers, plastic forks and spoons from fast-food shops. But mixed among the empty cereal boxes and old newspapers were pictures of her children when they were young, the title to her car, her tax returns, a few checks. Once when I had convinced her to experiment with getting rid of an old Sunday New York Times without first looking through it for interesting or important information, she agreed but said, “Let me just shake it to make sure there is nothing important here.” As she did so, an ATM envelope with $100 in cash fell out. This illustrated something important. Irene’s clutter contained a mixture of what seemed to me both worthless and valuable things but what was to her a collection of equally valuable items. She described it herself one day as we worked through one of her many piles: “It’s like this newspaper advertisement is as important to me as a picture of my daughter. Everything seems equally important; it’s all homogenized.”

Early on, we asked her to sit in her sorting spot in the TV room and show us how she worked. Irene agreed, and began by picking out a newspaper clipping from the pile. It concerned drug use among teenagers and the importance of communication between parents and teens on this issue. The clipping was several months old. She said she intended to give it to her daughter as a way of initiating a conversation about drug use. However, since her daughter was away at school, she would have to wait until she got home. She said she would put it “here, on top of the pile, so I can see it and remember where it is.” She then picked up a mailing from the telephone company offering a deal on long distance. She said she needed to read it to tell whether she could get a better price on her long-distance plan. She put it on top of the pile so that she could see it and wouldn’t forget it. She followed a similar logic with the third item, and about a dozen more. The clipping about drug use was soon buried: The result of all her effort was that the papers in the pile got shuffled, but nothing was actually thrown away or moved to a more suitable location.

This behavior is so common among people who hoard that we have given it a label: “churning.” The churning we saw in Irene’s TV room was driven in part by a simple problem with making decisions (a dysfunction that may reflect common problems with how the brain operates in people who hoard). With each item Irene picked up, she failed to figure out which features were important and which were not, in the same way that she struggled to distinguish important from unimportant objects. Moreover, she thought of features and uses most of us wouldn’t. When she picked up a cap to a pen, she reasoned that the cap could be used as a piece in a board game. She couldn’t throw it out until we had talked through whether this was a reasonable purpose for the object. The same problem arose with a piece of junk mail from a mortgage company. She couldn’t get rid of it until she figured out what was really important (or unimportant) about it. Sometimes she could decide to throw things away, but often the effort to make the decision was simply too much, and things went back on the pile.

ONE OF THE great challenges in helping a hoarder is distinguishing what is positive in their behavior from what is pathological. More than anything, hoarding represents a paradox of opportunity. Hoarders are gifted with the ability to see the opportunities in many things. They are equally cursed with the inability to let go of any of these possibilities. When I began working with Irene, a crucial goal was to teach her to tolerate uncertainty regarding unrealized opportunities.

Irene and I eventually worked out a filing system for her papers. In the beginning, she could tolerate very little of the work I asked her to do. “Can we stop now?” she asked just five minutes into our first treatment session after she had discarded one scrap of paper. But she persevered, and worked very hard for the next year and a half to clear out her home. Each step brought her more of a normal life. When her kitchen table was cleared, she and her children started sitting down to eat together. When her whole kitchen was cleared, she resumed cooking. By the time we stopped working with her, the majority of her home was virtually clutter-free. And it remained so for a number of years—until her son, too, went away to school. Then she started hoarding again.

Excerpted from
STUFF: Compulsive Hoarding and the Meaning of Things by Randy O. Frost and Gail Steketee. Copyright © 2010 by Randy O. Frost and Gail Steketee. Used by permission of Houghton Mifflin Harcourt Publishing Company. All rights reserved.