Local law enforcement, code enforcement and animal control experts have known about the problems of animal hoarding and object hoarding for a long time. But excepting the sporadic attention given to the issue here and there in the professional literature, the mental health community is relatively new on the scene. As such, it is still investigating and catching up on why people hoard.
Hoarding was initially regarded as an exotic subtype of obsessive-compulsive disorder (OCD). But given that it contains parts of several other Axis I conditions without clearly fitting within any of them, plus has features all its own, there is growing consensus that hoarding might be a distinct disorder.
The psychological study of animal hoarding in particular is a fairly recent development. Gary Patronek initiated this study through his work at Tufts University in 1997, completing a groundbreaking initial data collection from participating animal control agencies nationwide. He used a convenience, non-randomized sample and analyzed submitted inspector reports collected from agencies that cooperated with him. About the same time, the Hoarding of Animals Research Consortium (HARC) formed in Massachusetts. It brought together an interdisciplinary group from psychiatry, social work, veterinary medicine and law enforcement, as well as others dedicated to “exploring the problem of animal hoarding to find more effective and humane solutions for this very problematic and poorly understood behavior.” The group collaborated over a 10-year period and eventually published a community intervention manual after a major symposium in 2006. The group’s website (tufts.edu/vet/hoarding/index.html) remains its primary means of communication. Today, HARC’s goals are to eliminate stereotypes, raise awareness and stimulate research among all concerned parties.
The mental health team involved with HARC put forth a working model of the relationships between a broad array of early childhood issues and genetic and environmental factors that produce disordered attachment patterns and/or Axis II traits that further impair relationships. Together, these inadequate attachments and faulty structures of personality form such a massive deficit in resilience that as the person reaches adulthood, he or she is ill equipped to handle life stressors. This situation eventually gives rise to hoarding behaviors. HARC posits that hoarders attempt to repair the self via their relationships with animals, but these individuals are ultimately foiled by some crisis or trauma that causes them to become even more overwhelmed. Their coping deteriorates further, including their ability to care for themselves and the animals (see model attufts.edu/vet/hoarding/abthoard.htm#A3).
Although this model is good so far as it goes, it only considers animal hoarding, and much more needs to be fleshed out. For instance, what are the intermediary steps in turning away from human attachments and turning toward animals? Does the behavior start to manifest early and, if so, how? What accounts for some hoarders retaining social ties as their collecting worsens? What is the role of trauma or loss in a hoarder’s life?
The loss connection
My opinion is that the roles of unresolved loss in general and traumatic loss in particular need further inspection in connection with hoarding. The mismanagement of a single major loss or clustered losses along life’s way could represent a turning point that makes either object hoarding or animal hoarding go active. This is not to say that loss is omnipresent in all cases, but it is present in enough instances to merit further attention. A recent interview I conducted with Kathleen, a recovering hoarder, speaks to this point.
The woman shared that her first and second husbands died nine years apart, both of natural causes. She had remarried knowing about her second husband’s health problems. Still, she wasn’t prepared when she came in one day to find him dead on the floor. She could tell now, looking back from nine years’ distance, that symptoms of depression had settled in shortly after the second loss. She walked around like a zombie most of the time. She started neglecting routine cleaning and stopped taking out the trash. As things piled up, she just left them there, lacking the energy to deal with them.
During that time frame, her sister also died, and the woman’s hoarding patterns escalated to more serious levels. Friends and neighbors told her she needed to clean up her place, but she turned a deaf ear. By that point, she admitted, well-meaning interventions without any administrative force were easy to turn aside. Still working, she was already good at maintaining a public front while restricting access to her private life. Unchallenged, she discovered the self-medicating effects of buying things for herself. Yard sales, dumpsters and dollar stores became her unholy trinity.
“Thirteen pairs of pajamas make no sense except to someone who is feeling abandoned, empty and in dire need of an emotional boost,” she said. Each purchase or acquisition provided her that much-needed boost. “That’s the way a hoarder thinks,” she explained. “It just generalizes to all sorts of other things.” Recalling all the accumulating piles, she thoughtfully reflected, “I guess when you think you have nothing else, you think at least you have your stuff.”
Normal grief is a hard enough process for a healthy person to navigate. According to George Bonanno in The Other Side of Sadness, grief is an oscillation between loss-centered thinking/feeling (reminiscence, longing for the loved one, reviewing memories) and forward-centered thinking/feeling (planning for a changed life, forming new relationships, moving). Most people oscillate to varying degrees throughout the first year or so, then gradually taper into less intense and less frequent oscillations. Bonanno notes this alternation is good because unremitting loss-centered thinking and feeling would be too much for anyone to bear.
With this in mind, I speculate that some people, perhaps because of the resilience deficits noted earlier or perhaps through the simple misfortune of being hammered by several major losses, go through one loss too many, causing something to go wrong with how losses are processed in the mind. They can neither integrate painful life experiences nor easily oscillate between pain and more pleasant states. All of this happens in a more destabilizing way than occurs with other complicated grief patterns — a way that disrupts multiple areas of functioning such as memory, attention, planning, categorization, judgment and reality testing. They experience a slowing of cognitive processing, which impedes decision making.
As hoarding develops, other changes take place, too. According to Randy O. Frost and Gail Steketee in Stuff: Compulsive Hoarding and the Meaning of Things, hoarders develop an elaborative processing style based on having maximal choices and preserving every imagined opportunity. They reify objects and animals. Reification is the error of regarding an abstraction as a material thing and attributing causal powers to it. Hoarders attribute safety, security, control or any other traits they find comforting or desirable to either inanimate objects or animals. Through repeated avoidance, they escape stress for the moment but reinforce inordinate fears of change and further loss concerning things most of us would consider everyday transactions. Certain other features, such as the aggressive acquiring mentioned previously, take on a life of their own, much like an addiction, particularly process addictions such as spending, gambling and food, some of which often are comorbid with hoarding. In any respect, what we are learning is that hoarders seem to manifest an intolerable existential pain, an abiding sadness, a sense of abandonment and, as their illness manifests into its active phase, a sense of perpetual defeat.
An extreme protest
The mind always has another card to play even in such dire circumstances, so it mounts an equally strong, equally extreme protest against this pain and the threat of future loss. By engaging in behavior that is the opposite of losing — having or hanging onto things — the individual is soothed. If nothing is thrown out, the individual reasons, then nothing will ever be lost again. Or, in the case of animals, especially if one has many of them, the person never has to face a loss leading to aloneness ever again. These inner tactics can be projected onto current relationships and used as a bargaining chip. Hoarders sometimes will resist change until they get an ironclad guarantee from others that they will help or stay with the hoarder, particularly in cases in which the person’s hoarding or other issues have driven relatives away.
One 69-year-old hospice patient had lost two husbands, one through a divorce and the other through death. She was estranged from her only daughter, who lived in a distant state and refused to come see her. The patient was dying of lung cancer that had spread to her chest. She lived alone in her mobile home, a recluse from her neighbors, and received visits only from her hospice workers. Well into the late stages of her illness, she continued to collect cats, regardless of her inability to care for them. As with many hoarders, she talked about them as “her life.” Her belief that the cats needed her was at least partially a delusion; many of them were neglected to the point of starvation and had learned to forage for themselves. But they gave her life meaning, which she frequently asserted.
I noticed this stayed at the level of an ideal in her mind. Curiously, she spent little time petting, holding or relating to any of the cats. She would dump food in their dish in a rather detached way, and only occasionally would she speak to any individual cat as it passed through the house. It was as if simply having them there was enough. At a deeper level, they were her insurance policy against having to part from anyone dear to her or having to suffer rejection ever again.
She recounted having once fallen to the floor with chest pains and said the cats had organized themselves to revive her, standing on her chest, licking her face, intuiting her needs. She fantasized they would be there like that for her until the end, seeing her off as she passed from this life. She straightforwardly asked her hospice caregivers to bury some of the cats with her, presumably dead or alive. She focused her loyalty and desire to be with these animals far more intensely than she had done with any person she had ever known.
Seen in this light, hoarding is the perfect solution. It is a tactic to have and to hold onto something forever. It is a strategy that effectively erects a buttress against frozen grief and further devastating loss. When someone finally forces the issue and the sheriff or animal control officer takes over, the whole house of cards comes tumbling down. The presence of delayed frozen grief, possible additional loss (through animal removal, necessary euthanasia or enforced cleanup), intense shame and existential panic all reassert themselves in an abrupt manner. It is a very tricky passage for first responders to manage because brittle hoarders may feel as though they have no remaining resources — that their life is, in effect, over.
More study needed
This is a very limited sketch of the possible role of frozen grief in the development of hoarding. This article has not dealt with other dynamics, such as the hypersensitivity to judgment, the distorted projections onto authorities, the continued problems with honesty and compliance, the anger related to thwarted control and the frank sociopathy and exploitive cruelty that can surface across a variety of these cases. These elements are just as important to investigate and illuminate. As the authors of the HARC project stated, we are just at the beginning when it comes to understanding hoarding. A rigorous scientific collection and study of cases is needed to more accurately identify important key variables and the relationships among them that begin to explain the continuum of hoarding phenomena. As the study of key variables proceeds, we may be able to fine-tune the effective and timely interventions currently taking place in some locales, thereby helping more hoarders earlier in their process.
We continue to face some significant obstacles in addressing hoarding, however, including widespread public stigma. At the same time, societal values concerning the sanctity of one’s home and our rights to privacy and self-determination combine to make this population very hard to identify until late in the progression of the illness. This fits the agenda of the hoarder and hoarding families very well because they become extremely adept at hiding their behavior. Typically, cases tend to come to light at their nadir, when the person and his or her lifestyle have deteriorated so severely that they demand attention. Consequently, very little is known about the onset and earlier phases of the disorder or its comorbidity with other disorders.
For every hoarding situation that comes to light, there may be an equal or greater number that go undetected because of uneven reporting procedures from community to community. As multidisciplinary teams such as the one at Tufts multiply across various communities, and specifically as they organize themselves to do research, there is great hope of learning more about, and therefore dealing with, the hoarding disorder more effectively.