Imagine a house somewhere on the Island; on the outside it looks just like other homes in the neighborhood, but inside is a different story. A sea of food containers covers the kitchen floor. Empty cereal boxes neatly line the oven. In the garage the only indication of a car is a rusted decal peering out from beneath a mountain of boxes. In the living room a waist-high pile of newspapers dating back three decades looms above a panorama of detritus and endless more unmarked cardboard boxes.
An elderly person lives here. Imagine then that there are other houses like it on the Island.
Last month Island officials invited Dr. Christiana Bratiotis of Boston University to speak at the Oak Bluffs library on the hidden but very real problem of compulsive hoarding. Ms. Bratiotis is the author of The Hoarding Handbook, set for release by Oxford University Press in 2011, and the four-hour training and information session was an eye-opener for many in the audience.
“To me it has probably always existed but we just didn’t know what to name it,” said Ann Wallace, executive director of Island Elderly Housing. “It’s just recently that we’ve realized how devastating it is to people’s lives, and to families’ lives.”
The meeting was originally intended for health and safety officials as well as social workers, but was attended by many members of the general public as well, underscoring the pervasive and hidden nature of what is slowly becoming accepted as an illness.
“What interests me is that there were people sitting in that room that I didn’t recognize,” said Edgartown health agent Matt Poole. “I suspect they were there because they knew someone, or they wanted some information on something that was happening outside of their work that they had encountered. Those are the ones that are most ready to receive help.”
Momentum from the meeting is expected to carry over to Jan. 6 when the newly-formed Martha’s Vineyard Hoarding Task Force will meet to begin an initiative that seeks to unite social workers, EMTs, police departments, boards of health and elderly services to try to tackle what can often seem an intractable problem.
Hoarding has been defined by psychologists as the “acquisition of, and failure to discard, a large number of possessions that are useless or of limited value.” The illness is frequently accompanied by depression, missed work and financial problems. The traditional picture of the hoarder is an elderly pack rat or reclusive cat lady, but hoarding can in fact start as young as age 12. Often the problem is masked by a lifetime of support structures and accommodating loved ones. When those support structures fail or disappear, especially among the elderly, the problem can explode. At its extremes the problem can include squalor and animal hoarding; in her talk Ms. Bratiotis was not short on details. But for most family members of hoarders, the problem is as mundane as an endlessly-increasing supply of trinkets and clutter. Ms. Bratiotis described clients with collections of 5,000 grocery bags and 200 pairs of pants. Once a patient left a short but dire message on her answering machine:
“Hi, Doctor Bratiotis, I just picked up seven vacuum cleaners, call me back, bye.”
On the Vineyard such problems typically come to light through third parties.
“A lot of the cases that we’ve gotten were a result of a referral from . . . somebody who went out to fix a furnace or deliver gas,” said Tisbury health agent Maura Valley. “They’re good about calling and saying, ‘Look, we saw this and we think it may be a problem.’ ”
Referrals include Islanders who have not left their homes in decades, or no longer go to the dump. When the town receives such a referral, the course of action is often ambiguous.
“If I just go knock on someone’s door and say, ‘I’m the board of health, let’s get working on cleaning your house up,’ they might say, ‘Thank you, I’ve been waiting for decades for you to come and this is the opportunity I’ve been waiting for, ’” said Mr. Poole. “Or the other 99 in 100 are going to say, ‘I don’t have a problem, thanks for your offer. Bye, bye.’”
Ms. Valley agreed. “Where is that line between it being a public health issue and just somebody living the way they want to live?” she said.
Even in cases where a person is willing to throw away the trash, it is often not the same as addressing the problem.
“If you clear it out it will come back one-hundred-fold and faster than it accumulated in the first place,” Ms. Bratiotis warned at the November session. In Edgartown the highway department has had to clear out a houseful of trash from the same address multiple times.
At the Woodside Village elderly housing complex in Oak Bluffs, yearly inspections of tenants’ rooms help identify warning signs of compulsive hoarding, which is rare there. Still problems sometimes arise and can threaten safety.
“One of our big concerns is when people start stacking things on the stove top, and we’re just terrified of the fire hazard,” said Ms. Wallace.
“There have been cases at the tenants’ request because they’re tired of us telling them to move this stuff, they say can you just unhook my stove, I don’t use it anyway, I just use the microwave,” added Island Elderly Housing service coordinator Ann Baird. She said sometimes a maintenance person will go in to repair a broken refrigerator and find upon arriving that the fridge no longer works due to the fact that it is filled with so much food.
All who are involved with the issue agree that the most important aspect of tackling the problem is the mental health component. Hoarders collect objects for the same reasons that anyone else does — either the objects are sentimentally valuable, functionally valuable like a hammer, or intrinsically valuable like chinaware. When the natural impulses grow pathological, it becomes a problem. Sometimes hoarding is rooted in hardship, as with many people who lived through the Great Depression. Others simply find extraordinary comfort in their possessions.
“We need to learn exactly the right language so we don’t offend,” said Ms. Wallace. “It’s like either this is your junk or these are your possessions. To start the conversation we need to say that your paper towel rolls are your possessions.”
In her talk Ms. Bratiotis said the most effective way of treating the problem is a highly sensitive approach, but one that still challenges sufferers and engages them in practicing throwing things away. It can be a lengthy process fraught with setbacks and relapses, sometimes accomplished only through a network of family members, town employees and social workers — the very kind the Vineyard is trying to establish with the newly-formed task force.
“If we could get a group of people who really understand this issue and what is needed to try to resolve it, I think that would be really valuable,” said Ms. Valley.