Stuff (18 page)

Ralph had covered the windows with cardboard to prevent anyone from seeing what was inside, and there were few overhead lights, so even on the sunniest days, the interior felt like a cave. The house was heated with radiators, but there was so much paper, clothing, and other material packed around each one that the house was freezing, not to mention the fire hazard. In the summer, the lack of ventilation made the house unbearable. In the kitchen, the refrigerator door could be opened only partway, and the stove, piled high with papers, had only one working burner. The downstairs toilet did not work. The upstairs one did, but the bathtub and shower were too full of assorted stuff to use, so Ralph showered at the local college pool.

Now Betty faced a dilemma. She knew from working with Ralph on the outside of the house for so long without much success that he would never consent to clear out the inside. If she reported him to the authorities, she could unleash a chain of legal events that might leave Ralph worse off than he was now. But Betty thought that if she did not report him, there was a real possibility that it could cost Ralph his life. She called the city health department. They had seen hoarding cases before, but always in rented apartments, where the housing codes were readily enforceable. The chief of the health department said that there was nothing he could do because this was a private residence.

Betty and her agency did not give up. They enlisted the help of one of the city's health inspectors and kept trying to convince the city to do something. Meanwhile, Betty tried to work with Ralph to clear out the house. After a year of such efforts, with no progress and no action from the city, Betty finally wrote a letter to the city solicitor outlining her observations about the danger Ralph was in. In the letter, she pointed out the city's potential liability. The health department and the city finally swung into action. They pursued an eviction on two charges. The first was that Ralph was running an improperly zoned business. This was stretching it for sure, but the scrap metal he had accumulated in his backyard gave them a basis for the accusation. The second charge was that the house was a fire hazard. This was certainly more justified. The initial order gave Ralph several months to correct the problems. When he failed to do so, the case went to court, and Ralph was evicted. The fire department sealed the house immediately, stipulating that it had to be cleared out, but not by Ralph.

Betty accompanied the sheriff's officers when they served the eviction papers. Ralph didn't seem upset; he enjoyed talking with the officers. The full meaning of their visit seemed to escape him. Betty convinced him to admit himself voluntarily to the local psychiatric ward. He was quite happy in the hospital, enjoying the staff's attention. After some initial confusion about his diagnosis, the doctors concluded that he suffered from OCD and put him on Paxil, an antidepressant. This did little good, and eventually he stopped taking it. Ralph's insurance coverage ended, and he was released. He went to a nursing home to wait for his house to be cleared. He hated the nursing home; it felt like a prison. To make matters worse, he had to share a bathroom with a man who was careless about his hygiene. Ralph's housekeeping not withstanding, he was a fastidious man, and the slovenliness of others upset him.

Meanwhile, Betty and the city were in court seeking a conservatorship for Ralph on the grounds of mental impairment. There was considerable disagreement about who the conservator should be. Betty, who had by then worked closely with Ralph for five years, disliked the idea of appointing a lawyer who did not know Ralph. She was certain that such a person would not gain his trust, and even if he or she did, the lawyer's fees would quickly eat up Ralph's meager trust. The judge and lawyers felt that it was inappropriate to appoint Betty because she was already involved in his life. Despite what had just happened to him, Ralph trusted and liked Betty and felt that he needed her to get through this ordeal. In the end, the judge decided that Betty would be the best choice.

The cleaning, which Ralph was forbidden to attend, took several weeks. Betty did her best to save things of value, though finding them all in the clutter was not easy. The workers removed thirteen dumpsters—the kind used at construction sites, not the smaller variety found behind retail stores—full of stuff. While the cleanout was going on, Betty talked with Ralph about it every day, and it was her impression that he had accepted his fate.

But he was not happy when he returned to his home. Everything, it seemed to him, was gone. Betty's idea of what was valuable apparently did not match Ralph's. The things he wanted to repair, the pictures of his beloved trains, and the parts for his model train setup were all gone. The cleanout, his "trauma" as he described it to me, became a marker in his life, an event against which all others were measured in time or intensity.

When I met Ralph three years after his trauma, he described in great detail how awful it was. As he showed me around his home, every room provoked recollections of things lost—pictures of his trains, the backpack he'd used on his trip to Europe so many years before, and the many things he had planned to use. One especially painful loss was the nameplate for the front door—a brass plate embossed with his father's name that Ralph had taken down to repair. "They dethroned my father's name!" he lamented. As he listed each item, he turned to me and angrily shouted, "Gone!"

To emphasize his point, he showed me a picture he had cut out of a magazine not long after his trauma. It showed an Immigration and Naturalization Service (INS) officer holding a semiautomatic rifle with an angry look on his face. He was pointing the rifle at a terrified Elian Gonzalez, the young Cuban boy at the center of a custody battle several years ago. Ralph had written "the city" in dark ink above the INS agent and "R," for Ralph, above the helpless little boy. In other pictures he had cut out of newspapers and magazines, he wrote short essays stating that the "Confiscators" were evil people who were out to take his house away. The Confiscators were represented as men with guns or menacing cartoon figures. (In a psychiatric interview just after the trauma, Ralph's references to the INS led the psychiatrist to diagnose him as schizophrenic, thinking his metaphors were part of a paranoid delusion. Luckily, the diagnosis changed as the doctors began to understand Ralph's style of communicating by metaphor.) Ralph's fears of being thrown out of his house escalated when seemingly innocuous things happened to him. One day several years after the trauma, a real estate agent approached him outside his home and told him that if he ever wanted to sell it, she would like to list it. The incident left him convinced that someone in town wanted his house and wanted him out. He wrote a lengthy essay, with captioned cartoons, insisting that this agent never come to his house and never mention selling again. He attached her business card to the essay and made numerous copies to show to his friends. The agent was deeply embarrassed and agreed not to bother him again.

After the initial shock of the cleanout, Betty thought that Ralph was adapting well. He began to talk about how nice it was to have a clean house. He invited friends over and even hosted a dinner party for Betty and her husband and some friends. He worried less about people seeing in the windows and generally seemed content.

Even more impressive to Betty, he was more willing to let things go—such as the rusty bucket with the hole in it. She tried to take advantage of the change. For the next few months, she worked with Ralph to clear out his attic. Ralph hated being told what he should throw away. He claimed that when he decided on his own to get rid of something, it felt good. To help him make the decisions himself, they devised a set of simple rules to follow in their work together. Each rule took hours to figure out but in the end saved time.

As they began their work in the attic, where there was no organization and it was impossible to find anything, they established the "trunk rule." Everything in the attic had to be inside one of the many trunks that were there. Other rules evolved over time. The "kitchen rule," which stated that food must be kept only in the kitchen, was developed to deal with mice and insects. (When they had begun, food was all over the house, as were mice.)

Ralph's "utility rule" came from a social worker, Kelly, who had helped him while he was in the nursing home. She was one of the many social workers who had become quite fond of Ralph over the years. Together they devised a scheme whereby Ralph, when faced with a decision about acquiring or keeping something, was to imagine a little Kelly sitting on his shoulder and saying, "If you can't use it right away, don't buy or keep it." This image so tickled Ralph that he planned to take a picture of himself and superimpose a tiny picture of Kelly sitting on his shoulder. When I watched Ralph going through his things with Betty, he frequently patted his shoulder and repeated Kelly's rule.

When making a decision about saving or discarding something, a hoarder often focuses on the usefulness of the item, such as the potential for the rusty bucket, or on the cost of being without the item, such as the information in Ralph's newspapers. Little thought is given to the cost of keeping things or the benefit of getting rid of them. These rules altered Ralph's normal decision-making process. They forced him to consider how objects fit into his life in a more realistic way.

The language Betty and Ralph used to describe their sessions was also tinged with metaphor. Instead of "discarding" or "throwing out" things, they "thinned out" his stuff. This seemed far more palatable to Ralph. He told himself to "prioritize," often with coaching from Betty, to keep his attention focused on deciding about possessions. Like so many others with this problem, Ralph was easily distracted and readily launched into stories about each object. "Be selective" and "Willpower" were other self-instructions he repeated during the sessions I observed.

Ralph said that these sessions were helpful. Before Betty began helping him, he had felt confused when he tried to decide what to do with his things. Now things were clearer to him, and he felt relieved, even happy to work with her. Watching them together, I could tell that Betty kept Ralph focused on "thinning out" when he otherwise would have been distracted by the potential uses of his possessions. Still, the process was difficult for him. An hour into my first session with them, they had worked through a set of videos piled in the middle of the room. He decided to discard some, such as the free videos about buying a condo in Arizona. Betty helped him organize and put away the ones he kept. He was clearly taxed by this activity. He finally said, "I can't think now. It's time for you to go." Betty often gave him homework to complete between their sessions, but he seldom did it. He preferred to work when she was around, and he wanted her to come more often than she did.

Betty helped keep Ralph's home livable. Although it was still cluttered, it posed no health or safety threat. As time went by, however, the thinning-out sessions became more difficult. Ralph grew less willing to comply and began to express more disapproval of Betty. Before one of my visits, Betty had carried off a pile of things they had decided to get rid of, including an envelope with a picture of a train on it. Just how the envelope got into the throwaway pile was not clear, but Ralph was unhappy about it. Maybe he had okayed it originally and was now having second thoughts, or maybe it was a mistake. Whatever the case, he refused to accept Betty's apology or the idea of living without something he wanted. "I don't trust you," he told her. He turned to me and said, "Betty just doesn't understand." For emphasis, he picked up the handle to a garden cart and explained, "I need this for repairs. Betty just doesn't understand. You're a doctor; you understand my psychology."

Ralph's conclusion that Betty didn't understand his attachment to things was unshakable. His refrain continued for the rest of that session and for the next one. Nothing Betty could say or do dissuaded him. When I asked him a question about another part of his house, he did not want to show it to me. He said that Betty would be mad at him: "I need privacy from Betty." Perhaps he had hoped she would come to share his appreciation for things that were used but not used up. When she didn't, he may have given up on her. For her part, Betty accepted the criticism as part of the package, but increasingly it took its toll on her. Especially hurtful were the times he rebuked her in front of other people. Her hope that he would come to share her ability to distinguish useful things from things used up was fading.

But Ralph did show signs of being able to "thin out" on his own. A heavy snowfall over the winter collapsed the roof of his garage, soaking all the papers and other things he'd stored there. The insurance company said that it couldn't authorize payment until the garage was cleaned out and ready to repair. He called me a few weeks later and asked me to stop by and see his progress: he was proud of himself. When he'd first shown me the three-bay garage, it had been packed to the rafters with wood, newspapers, tools, lawn equipment, and junk. He had discarded most of the papers and wood, an enormous amount of stuff in such a short time, even if some of the items had found their way into his house.

Ralph's relationship with Betty continued to worsen until their sessions became battles neither one could tolerate and Betty stopped visiting. No longer employed by the social service agency, Betty was simply helping Ralph as a friend. With her help, Ralph had managed to keep his home livable, if not clutter-free. Without her, his home deteriorated rapidly. When I saw him several years later, Ralph was again in trouble with the authorities. The health inspector had concluded that the pathways were too narrow to allow access by rescue personnel in case of an emergency, and he worried that there might be flammable material near the furnace. No one had been able to inspect the furnace because the basement door was blocked with neatly stacked boxes filled with wood and papers for Ralph's projects.

What's more, Ralph had run out of money. The elder service agency working with him wanted to set up a reverse mortgage on his home that would ensure him a steady income, but the bank required an inspection, impossible to conduct until the house was cleared out. The agency had been to court with Ralph about this problem; the judge had given him a year to clear out his house. At the time of my visit, ten months had gone by with no progress. But Ralph seemed confident that he could make things right: "Come back, Doctor, and see how much progress I can make in a month." I accompanied the caseworker when she visited him a month later. The purpose for the meeting, she told me, was to inform Ralph of the upcoming court date, when the agency would ask the judge for an order of eviction. The agency planned to move him again to a nursing home temporarily so that they could clear out his house.