Stuff (20 page)

Avoidance behavior and a process called avoidance conditioning are in part responsible for OCD and most anxiety disorders. In the case of OCD, compulsive rituals temporarily alleviate the distress associated with the obsession. For instance, checking to make sure the door is locked provides some people relief from their anxiety over safety. Wiping the back of her dining room chair with a towelette gave Irene some relief from her distress about contamination. These strategies don't address the root problem; they simply allow the person to avoid the difficult work of recovery as well as the anxiety produced by the obsession. Similarly, people with panic disorder avoid using public transportation for fear of experiencing panic attacks; people with social phobia avoid speaking in groups for fear of embarrassment. These sorts of avoidance behaviors are reinforced because they allow the person to escape an unpleasant emotional state, such as fear, sadness, or guilt. Unfortunately, the relief is only temporary, and by avoiding that state, the person never learns to deal with it effectively. Before long, the avoidance behavior becomes second nature, difficult to distinguish from the underlying disorder, even for the afflicted person.

Exactly why this pattern of coping develops is not clear. One theory is that some people are unusually sensitive to anxiety and distress, and this leads them to seek extreme ways to avoid or escape it. In one of our recent studies of people with hoarding problems, we found that this was indeed the case: hoarders were unusually sensitive to even small amounts of anxiety.

For Irene, the sources of distress when discarding her possessions were numerous. Discarding a book or a newspaper might mean the loss of important information. Simply making a choice about where to put something was a source of anxiety: what if she put it in the wrong place and couldn't find it when she needed it? This possibility terrified her; it seemed it would be too much to bear, and perhaps it would. Saving things enabled her to avoid feeling upset, but it also prevented her from learning how to tolerate distress. Each time she avoided a negative feeling, she learned how to make herself feel better, albeit only temporarily. The more she did it, the more acute her ability to detect distress became, and the avoidance behaviors occurred more quickly over time. As she rarely had to cope with uncomfortable feelings, even mild distress seemed unmanageable. Over time, Irene learned to avoid even the simplest decisions and slightest negative emotions. This meant never dealing with most of her things, since that would involve difficult decisions and raw emotions. Instead, she just let them pile up. Most hoarders end up here, avoiding even the stuff they collect.

Avoiding discarding also prevented Irene from discovering the true value of her possessions. Less than five minutes after deciding to discard the art history book she had wept over, I asked her how she felt about it. "It doesn't bother me much at all now. For thirty years, I've kept that book. Now I realize it didn't matter that much to me." Had she faced the initial distress over getting rid of the book years ago, she would have discovered then that it meant little to her.

Irene's feelings about me, so similar to Nell's, were part of this process as well. On her first day, as we were making arrangements to get started, she said, "I want to quit. I just thought I should tell you this. I realize I have to do this, but I really want to quit, and I want you to leave." I think the only reason she didn't make us leave at that moment was that she would have felt guilty about our traveling for more than an hour to get to her home, only to have to turn around and leave. For most sessions, Irene had the same reaction when we showed up at her door: "I sort of wished you had forgotten our appointment." Frequently, she thought about calling to cancel, and sometimes she did. We had come to represent the distress she associated with getting rid of things. We were now conditioned stimuli, automatic cues for Irene's apprehension. People in treatment for hoarding commonly show this pattern, and it translates into missed sessions, attempts to postpone or cancel, not being able to work on clearing or sorting, and sometimes dropping out of treatment. Luckily, Irene understood what was happening, and her general affection for people, including us, overcame her conditioned avoidance.

Anxiety is not the only emotion hoarders seek to avoid. Most people, hoarders and non-hoarders alike, attempt to alleviate or preempt grief and sadness. Anyone who has stayed in a bad relationship or a bad job or has delayed breaking bad news to a friend can understand the urge. The difference with hoarders is a matter of scope: the number of sources for these feelings and the intensity of the feelings themselves, as well as the lengths to which they'll go to protect themselves, are unusually great.

Lydia, a participant in one of our studies, is an example of how broad the range of these three elements (source of feelings, intensity of feelings, and avoidance techniques) can be. Her home was a classic hoarded home, arranged for the containment of things rather than people. She had a particular fondness for vintage clothes, dolls, and anything with a pretty picture, and her home looked a bit like a dark and dingy wardrobe warehouse. The piles of dresses and dolls were actually quite spooky. She had plans to clean and refurbish many of her treasures and donate them to the Salvation Army, but she never seemed to get around to it.

As an experiment, she agreed to let me take something from her home and discard it. She settled on a stuffed toy, a yellow swan, which she'd picked up at a tag sale some years before. It was dirty and ragged but had been around long enough for her to feel connected to it. Although she agreed to let me take it and throw it away, before she let me out the door, she took dozens of photographs: me with the swan, her with the swan, her husband with the swan, my student with the swan. Like Debra (see chapter 5), she was trying to preserve her ownership with pictures. As I reached for the door to leave, she insisted on videotaping my departure and narrating the story of the little yellow swan. I learned that this was standard procedure for her. First she inspected an item to make sure it didn't contain anything important, then she photographed it, and finally she videotaped it while telling its story. She couldn't stand to let anything go without such a laborious procedure, designed to avoid the experience of loss. Had she let herself experience the loss, she may have been surprised at how well she could tolerate it, and subsequent attempts to get rid of unneeded things would undoubtedly have been easier.

A few weeks after my visit, I received a letter from her that contained the following poem:

THE YELLOW SWAN

Oh, yellow swan, you are someplace unknown to me.

It was a struggle to say farewell to you.

I would have been glad to pass you on to a friend.

But I took the suggestion of Randy Frost—like a leap of faith.

He told me that it would help me if I threw you away.

I find it hard to believe, but I did it anyhow.

Because that is what our 12-step program suggests.

Randy asked about my feelings. What are my feelings?

Sadness, a longing for your return, a feeling of missing you.

You were with me for so long,

holding my bangle bracelets so nicely on your stately neck.

I used to think you were beautiful.

I remember how delighted I was when you came to live with us.

I guess I am grieving your loss.

I cried at the meeting when I talked about your being discarded,

"like an old shoe."

Rhea said she was "proud of me," but I don't understand why.

Rhea always gives things away to people.

I shall have to ask her why she's proud of me.

Throwing away feels like wrongdoing to me.

Little yellow swan, you are the object of my sacrifice.

You are the symbol of new freedom.

Many things will have to follow in your footsteps for my husband and me

to gain the space we need to live, to enjoy our home, to have our freedom.

In letting go of the old, there will be room for the new.

I enjoyed having you, but perhaps a new family will find you and enjoy you.

Accompanying the ode was a note saying that she thought the experiment had shown her how much energy she invested in the millions of objects in her home. That led her to think that she could do more letting go. In the sentences that followed, however, she described a trip to New York City the previous weekend: "I found myself hoarding the soaps, shampoos, and conditioners from the hotel. The more the maid gave me, the happier I felt. I even asked for the tray they came on as a souvenir." At least she was now more aware of her hoarding behaviors when they occurred, even if more encumbered by her new treasures. I spoke with Lydia a number of times after the yellow swan episode. Six years later, she could laugh about it, but for several years it was a painful memory. Last time I spoke with her, she had made substantial gains in controlling her clutter, clearing out several rooms in her home so that they were livable. It was, however, a constant struggle.

For some hoarders, stopping the avoidance can have a dramatic effect. Recently, we completed a study of the effects of discarding in which we asked people to choose something they had avoided discarding and throw it out. Before, during, and after discarding, they recorded their thoughts and feelings. Most experienced feelings of regret, loss, sadness, or other distress, and most showed a pattern of habituation in which their distress slowly dissipated. One young man was surprised and delighted that his distress went away so quickly. He called three months after the experiment to thank us. He said that the experiment had led him to question how much distress he could tolerate and test himself, and he proudly reported that he had cleared out his entire house.

Avoidance behavior in hoarding is not limited to discarding. It can affect major life decisions and daily routines as well. Remember how Irene coped with her problem with newsstands? She avoided them altogether, crossing to the other side of the street so that she wouldn't have to look at them. She even avoided thinking about newspapers. When I asked what happened when she imagined newspapers she didn't get, she replied, "I could drive myself nuts thinking about all the newspapers in the world, so I don't go there." Janet (see chapter 3) avoided certain stores and even certain aisles in stores because they would trigger her buying.

Buying itself can be an avoidance behavior, because the intense distress and longing for an object that accompanies any attempt not to acquire can be relieved (or avoided) by acquiring it. As discussed earlier, our treatment for acquiring involves teaching hoarders to learn to tolerate the distress they experience at not acquiring something. Several years ago, we organized an experiment after a workshop we gave at the Obsessive Compulsive Foundation's annual conference in Chicago. The conference took place across the boulevard from the second-largest shopping mall in the country. We invited participants in our workshop who had serious buying problems to take a non-shopping trip there and face the discomfort associated with not acquiring something they desired. Each person who volunteered agreed not to purchase anything and to tell us about their thoughts and feelings as they struggled with the urge to buy.

Gail accompanied a woman who was addicted to books—cookbooks, do-it-yourself craft books, mysteries, novels, and, although her own children were grown, children's books. "When they have kids, I'll be able to give these to my grandchildren," she declared. At the bookstore, they found a rack of cookbooks that delighted her. Her eyes lit up as she scanned the titles. At Gail's suggestion, she pulled one out and opened it. It was an Italian cookbook with large color photographs of the food and an appealing, easy-to-read typeface. She found a recipe for a pasta dish and exclaimed over how good it sounded and how easy it would be to make—never mind that she had already reported to the group that her kitchen was so cluttered that she hadn't cooked in more than two years. Her eyes were wide as they bounced over the next few pages, taking in several "wonderful" recipes.

At Gail's request, she closed the book and dutifully put it back, looking disappointed and tearful as she did so. The pull to purchase was written all over her face. She rated her discomfort as 90 on a 100-point scale. She looked miserable but said that she was willing to keep going with the exercise.

The woman and Gail walked toward the entrance to the department store, which took a couple of minutes. At the entrance, Gail paused and asked how she felt. Her discomfort rating was down to 75. They walked to the entrance to the mall. Again she rated her discomfort, and this time, after not more than ten minutes, the rating was less than 20. Gail asked if she remembered the title of the cookbook she had perused in the bookstore. She didn't. Nor could she recall what recipe she'd found so appealing. She couldn't even remember the color of the book jacket. She was shocked. "That's really amazing. I always give in. I would have bought it if you hadn't been here. I can't believe how fast I forgot the book. Wow! I feel fine now. I can't believe it!" Like Irene and her treasured art history book, the woman had avoided the experience of distress for so long that she no longer knew how little value most books really had for her.

This kind of long-term avoidance can have some strange and extreme effects, most notably the "clutter blindness" that Nell experienced. She was a vivacious, lively woman; her days were taken up with work as a private nurse and her nights with church, singing groups, and theater. With all of her activities, she spent relatively little time at home. This is common for people who hoard, most likely another way to avoid thinking about the clutter.

I took pictures of Nell's home on my first visit. It was difficult to do, as is frequently the case in hoarded homes, because the clutter made it impossible to get into position to capture the true magnitude of the problem. Still, the photos were striking: boxes piled nearly to the ceiling, clothes cascading from the piles, and no floor visible. Newspapers and magazines littered most of the home, especially her bedroom. Nell loved to read and reread them, which she usually did in bed. Surrounding her bed and covering part of it were hundreds of magazines and newspapers. Her frequent attempts to organize them were thwarted by her dog and cat, who made a game of sending them cascading across the floor.