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The earliest studies linked hoarding behaviors — which have also been referred to as disposaphobia — to obsessive-compulsive disorder (OCD). Hoarding is categorized in the Diagnostic and Statistical Manual of Mental Disorders IV, essentially the diagnostic bible of mental health, as a characteristic of OCD, though plenty of researchers dispute that.
"Hoarding is distinct [from OCD] in many ways," says Randy Frost, a renowned hoarding researcher and professor of psychology at Smith College in Massachusetts. Frost and other researchers are investigating the possibility that people hoard not out of anxiety (which underlies OCD), but on impulse. There are also indications that hoarding, which Frost estimates occurs in roughly 2 to 4 percent of the population, may be twice as prevalent as OCD. In addition, hoarding tends to intersect with other mental disorders, including clinical depression, anxiety disorders, attention deficit disorder, and schizophrenia. These links have some researchers calling for a reclassification of hoarding in the next version of the DSM, due in 2012.
UC San Francisco researcher Carol Mathews works with the MHA and was part of the task force. She has found evidence that certain hoarding behaviors can be passed down through families, which could help researchers build a case that hoarding and cluttering deserves a DSM category of its own.
Sue Jean Halvorsen could have told you hoarding was genetic a long time ago. The San Francisco resident comes from a long line of people she has always referred to as pack rats, including her mom, aunts, uncles, grandfather, great-uncle, and great-grandfather. She says that although she grew up comfortable with hoarding and cluttering, for many years she believed she took after the neatnik side of her family.
"Only in my later years did I become overwhelmed with papers and possessions," says Halvorsen, who eventually accumulated more than 3,000 pounds of books. She needs them all, she says, because she wants them available for reading.
It's common for hoarders to believe that almost everything they come across should be saved for some later purpose, and often those with the financial means will wind up renting multiple storage units rather than discarding anything. Delta Burke, an actress on Designing Women and a self-acknowledged hoarder, admitted last year that she once rented 27 storage units.
One San Francisco hoarder and professor of physics has a home full of gadgets, which he says he began accumulating after slipping into a depression. When his landlord discovered the mess, the professor realized he had a problem, rented a couple of storage units, and joined the MHA's support group. It keeps him grounded, and it's very reassuring to talk with others afflicted with hoarding, he says.
Marlo Tellschow, a clutterer who has been working diligently to clean out her home for the past 10 years, moderates that support group. Her Nob Hill apartment once overflowed with newspapers, flyers, and various other leaflets. She used to feel compelled to save even empty junk-mail envelopes. "My brain would say, 'Well, maybe you missed something,'" says Tellschow, who has also been diagnosed with OCD.
She was one of the few hoarders interviewed for this story who had a home she didn't mind showing off (many hoarders say they are too ashamed to host visitors, much less a member of the press). Though most of her apartment was tidy and free of chaos and clutter, the guest room still contained a large plastic tub of newspaper clippings, calendars, and brochures from the '90s.
She'll get to it eventually.
Standing before Katz, the director of the Department of Public Health, in room 300, health and safety code inspector Mario Oblena is flanked by a nervous Harper on one side and property manager Jordan-Michaels on the other. "I just want to get the room clean," Jordan-Michaels tells Katz. "That's the bottom line."
Oblena explains to Katz that Harper failed a series of health and safety inspections, in the process becoming a human pinball and ricocheting from one service to the next, "with fingers pointing everywhere," he says.
Because Harper is disabled and on Social Security, she should have been eligible for an immediate heavy cleaning, but for some reason an Adult Protective Services worker asked her to obtain a primary-care physician first. Harper missed several appointments because she was hospitalized for kidney failure, and then bounced between Community Behavioral Health Services (CBHS) and SOMA MH, a mental health clinic. According to Oblena, both agencies recommended Harper try the Citywide Roving Team, a case management service that works with clients in 32 SRO hotels. The Columbia isn't one of them.
None of that should have happened, says Aregawie Yosef, a section manager at IHSS, the last-resort cleaning service for people who need it most. Yosef, a cochair of the hoarding and cluttering task force, says Harper's situation speaks to a chronic problem in the city — too much disconnected bureaucracy. "That's why people like her fall through the cracks," he said.
As part of its report, the hoarding and cluttering task force has made eight recommendations, including a streamlined response to hoarding issues, so that one phone call from a landlord or property manager can trigger a support system. It also recommended creating an assessment and crisis team, additional support groups, a physical services roadmap, more training, and a $200,000-a-year "hoarding czar" to oversee progress. All of this would cost the city more than $1 million. The point, MHA director Lyons says, "is to intervene before circumstances become dire and more expensive to the individual and the city."
But considering the Institute of Compulsive Hoarding and Cluttering just took a $20,000 budget cut (which was argued down from $75,000), it seems unlikely that those recommendations will come to fruition. In a recession, people like Harper often receive less help than ever. Often in denial that there's even a problem, hoarders are rarely able to help themselves.
But Harper knew what she had to say. "I'm ready to clean up," she insisted. "I got a storage unit. It's gonna take a few weeks." The director asked her how long it had been since she lived in the room, and she admitted it had been almost two years. A pregnant pause suggested skepticism from all sides, but with this being San Francisco, it shouldn't surprise anyone that Harper got one last shot.
