Abstract
Interest in hoarding behavior has intensified, as it works its way through DSM-V deliberations and treatment models. Meanwhile, both documentarians and fiction writers have embraced accounts of individuals with disposophobia and romanticized versions of the Collyer brothers, the Hermits of Harlem. In this article, I examine the range of media and professional attention given to hoarders and their problems and then focus on a potential role for forensic mental health professionals. The psycholegal problems of hoarders include health and zoning code violations that evolve into criminal charges, civil commitment, questions of animal cruelty, landlord-tenant disputes, divorce and custody evaluations, testamentary capacity, and child-neglect charges.
As a child in mid-century New York, I heard my mother and my friends' mothers admonish, “Clean up your room or you'll end up like the Collyer brothers!” Okay, I guessed, I would not want to be like them, whoever they were. As it turned out, the Hermits of Harlem1 had captured the imaginations of New Yorkers as iconic hermits and hoarders holed up in a Fifth Avenue home. Most famously, over decades they had filled the huge brownstone with possessions, newspapers, and just plain junk. After their deaths in 1947, over 130 tons of material was removed. There was so little of value that the few auctioned items fetched only $1,800.2
So packed was the home of Homer (aged 64 years at death) and Langley (aged 61) Collyer that the interior was a maze of tunnels, many booby trapped to satisfy Langley's fear of intrusion. Langley, a failed concert pianist and Columbia engineering graduate, would go out at night dragging a carton by a rope, collecting things. Homer, a lawyer, blind and crippled by arthritis, was entirely dependent on his brother. In the end, Langley was crushed to death by debris triggered by one of his booby traps, leaving Homer to starve to death. Running the story as page-one news for weeks,3 the media fueled a frenzy of interest after Homer's body was found and a search for Langley4 revealed that he was buried 10 feet from where Homer had died.5 Not cleaning one's room in the 1950s, then, was to be headed down the slippery slope toward a Collyeresque outcome.
The brothers were sons of an eccentric gynecologist, Herman Collyer, who canoed to work from Harlem to Bellevue Hospital, and Susie, from a patrician Hudson Valley family; the parents were first cousins. The brothers lived at 2078 Fifth Avenue from 1909 to 1918 with both parents and then with their mother until her death in 1929. By themselves for the next 18 years and largely oblivious to the significant demographic change in Harlem, they lived in a self-contained world of books, pianos, memorabilia, and Langley's imports. They stopped using the telephone in 1917 and gas and electricity in 1928; it simplified their lives, Langley explained.1 Never publicity seekers, they were outed as hermits by Helen Worden Erskine, a reporter for the World-Telegram, in 1939, and were never far from media attention thereafter. Langley blamed Worden for the hounding,2 which made his junk collecting more difficult. About 16 newspapers and magazines provided source material for Franz Lidz's book, Ghosty Men.2 The joint obituary in Time Magazine also focused on their hermitage and inscrutable outcome: Homer Collyer and his brother Langley grew up just before the gas chandelier, the camisole and the Prince Albert coat vanished from the American scene. Their father was a well-known and wealthy Manhattan gynecologist, their mother an educated woman who read the classics aloud to them in Greek. They were fondly reared; they were trained to be gentlemen & scholars. Homer became an admiralty lawyer. Langley went in for engineering and developed a talent for the piano.6
Although they were persons of interest to police, utility companies, and banks, they were never brought to the attention of anyone in psychiatry or mental health.
Eccentrics, hoarders, and hermits have continued to provide a source of fascination and entertainment, especially when they are famous—for example, Howard Hughes. How we regard them in society is not a simple matter. When they are persons of means, they fall on the eccentric end of the sliding scale of public perception, whereas a poor-plus-squalid formula would fall on the end reserved for those deemed dangerous to self and others. In this review, I will explore some of the permutations of eccentricity, in particular individuals whose domestic habits cause legal problems.
Parsing Syllogomania
Is hoarding an adaptive trait gone haywire? The question of why hoarding behavior has become a cultural meme or manifestation of an archetype deserves serious study. Cross-species analyses suggest that it may be hard-wired in humans; humans and pack rats may share evolution-shaped traits.7 Indeed, there may be evolutionary pressure to accumulate goods,8,9 especially following psychological trauma.10 During wartime, fear drives hoarding behavior, but it is considered to be antisocial, not a sign of sickness. Because there is no consensus about nomenclature or diagnostic criteria, there is little value in speculating about prevalence, although emerging research suggests that hoarding is not rare.11
Hoarding is usually referred to as compulsive hoarding or syllogomania, thus begging the question of nomenclature. Nevertheless, there is a differential diagnosis that may be critical in determining the individual's freedom, especially when the behavior is intractable and infringes on the rights of others. The multifarious presentation of repetitive behavior has raised concerns about lumping obsessive-compulsive disorder (OCD) with the anxiety disorders in general and with hoarding in particular.12–15 Excessive acquisition (for example, compulsive shopping, or “shopaholism”) and the inability to part with things (disposophobia) are the surface dynamics of the clinical entity. The relative inability to organize oneself or to make critical decisions reveals the overlap of hoarding and attention-deficit disorder.16 The DSM-V work group is considering including hoarding within an OCD spectrum; its bedfellows include OCD, body dysmorphic disorder, Tourette's disorder and tics, trichotillomania and compulsive skin-picking, and stereotypic movement disorder.17 There is some evidence that the components of the spectrum sort differently in men and women.18
In addition to the OCD-spectrum model, other conditions enter the mix of hoarding dynamics. These include depression, schizophrenia, dementia, developmental disability, odd personality traits, poverty, and ordinary collecting.19 My first encounter with the problem came via a request to help a couple regain custody of their five children; the woman was the focus of concern. The family was in public housing, and workmen noted external disrepair in their living quarters. The housing authority obtained a court order to inspect, and severe clutter was discovered. The children's services social worker was called in on the theory that danger and neglect were evident amid the messy habitat. The woman's oddness had already been noted elsewhere—for example, in her decision to home-school the children and in her resisting immunizations. The children were removed and sent to the maternal grandmother. Meanwhile various clinicians diagnosed conditions in the woman such as schizophrenia, Asperger's disorder, and paranoid personality disorder. Psychotherapy was court ordered, but she had no subjective symptoms, and no treatment plan could be developed. The matter was resolved when the family agreed to declutter. What struck me was that the phenotype of oddness and cluttering caused such alarm within the social agencies. I had yet to discover how widespread the problem had become.
Media Portrayals of Hoarders
In addition to a growing body of literature on hoarding,20 there have been three stage plays (St. Germain M: At Home with the Collyer Brothers. Typescript provided by the playwright by personal communication, September 26, 2009; Saltzman M: Clutter: The True Story of the Collyer Brothers Who Never Threw Anything Out. Typescript provided by the playwright by personal communication, October 15, 2009; Ref. 21), a historical work,2 and two novels22,23 based, to various degrees, on the lives of the Collyers. Most of these creative works have little grounding in fact, using the brothers as Rorschach cards. For example, consider Richard Greenberg's Author's Note for his play The Dazzle: “The Dazzle is based on the lives of the Collyer brothers, about whom I know almost nothing.”21 It is nonetheless impressive how, so many years after death, the brothers remain a fount of fantasy. Meanwhile, television has had a field day with portrayals of the mentally ill, such as Monk, the obsessive-compulsive detective on Monk, or Tara, the host personality of a woman with dissociative identity disorder on The United States of Tara.24 Surely, hoarding would be a ratings magnet. A documentary, Packrat,25 concerns the fathers (both hoarders) of the filmmaker and cinematographer, and the impact of their behavior on their families.
Several dedicated television specials26 or series27 have focused on the multiple psychosocial and clinical problems of hoarders. Episodes of Hoarders on A&E TV involve studies of two hoarders and their families. Most of the individuals have homes loaded with trash and clutter, making for unsanitary and unsafe conditions. As the stories unfold, we see them in their squalid habitats, often in a state of despair or anxiety—no insouciant repartee of the fictionalized Collyers. They are exhorted by family and visited by professional organizers, teams of junk haulers, and psychologists. Although their stories are spectacle-cum-education, the editorial attitude is not one of schadenfreude. There is no attempt at differential diagnosis, and medical labeling is eschewed.
Many of the hoarders are highly anxious during the inventorying and decluttering process, but are greatly relieved to regain an uncluttered residence. The interventions, while not uniformly successful, are conducted sensitively, showing professionals acting creditably. Apparently, television shows such as Hoarders have raised awareness, leading to identification of the problem, for example, in Oklahoma.28
The subjects of Hoarders run afoul of domestic conventions and, because they are not hermits by choice (although they are ashamed to have visitors), their odd habits have negative effects on others. For example: Steven's apartment is packed with trash and his bathroom with excrement, putting him on the verge of eviction; Jill has rotting food but cannot distinguish it from the edible; Paul has violated a town ordinance and faces jail time; Missy's son Alex has mimicked his mother's condition and has been hoarding toys, raising the question of neglect; Patty and her husband (who has considered divorce) have had their children removed because of the unsafe conditions; Paul cannot part with tools and manuals and has alienated his family; and Jennifer (a compulsive shopper) and Ron (a hoarder) have overflowed their home with things they do not need, forcing them to have meals in bed.
Some but not all of those shown on Hoarders have had successful interventions, in the form of decluttering, reorganizing, and cognitive therapy, often administered by hoarding psychology researcher and author Dr. David Tolin and colleagues.16 Alongside the popular fascination with abnormal behavior are a robust self-help movement and the advent of professional organizers. The self-help component includes numerous books on decluttering and organizing, targeted less on persons with mental disorders than on the chronically disorganized. Many communities have Clutterers Anonymous groups,29 and several have Children of Hoarders meetings and websites.30 Certified professional organizers often visit the subjects on Hoarders. They often serve as buffers between the hoarder and the court, which is responding to disgusted neighbors. There is a professional group of organizers with about 4,200 members, the National Association of Professional Organizers,31 who work mainly with persons who are chronically disorganized, but also with compulsive hoarders. The National Study Group on Chronic Disorganization serves as a resource for the public and professionals.32 Some of the Internet sites contain links to legal services, especially in regard to landlord-tenant relations and health and dwelling code violations. For example, the Mental Health Association of San Francisco adopts the premise that the behavior in question is a disability, which is the preferred legal stance.33
The Collyer brothers differed from the hoarders on television, in that they were from a privileged class, lived in an ego-syntonic hermitage, and were able to stay a step ahead of the law. This romanticized view runs through the fictional works based on them. They accumulated objects over decades, but the contemporaneous media portrayal focused more on the hermitage aspect.1 The enduring popular image, however, was about clutter. Homer, the former lawyer, blind and arthritic, made a decision to stay home, while Langley made nighttime excursions to retrieve junk. Their decades-out-of-style clothing and Langley's highfalutin speech cemented their reputation as eccentrics, but there was no talk of their being frankly psychotic. In one of the stage plays (Clutter: The True Story of the Collyer Brothers Who Never Threw Anything Out.), author Mark Saltzman intimates shared delusional disorder (folie à deux). In other works, notably E. L. Doctorow's recent novel,23 the brothers are pathologically nostalgic in a world populated by objects and a parade of 20th century characters (gangsters, hippies). In the novel, Langley is portrayed as suffering from the effects of World War I combat, which is consistent with a trauma-related dynamic,10 but fictional. There is scarcely a suggestion of serious psychopathology, let alone a need for forensic intervention.
Hoarding in the News
When someone's hoarding has an impact on the health or quality of life of the neighbors, there is police or welfare agency involvement. Consider the following snippets from The Washington Post: Last month, in San Jose, Calif., police entered the home of 70-year-old Floria Jacobson after neighbors complained her house gave off a disgusting odor. The house was brimming with more than 25 tons of rotting garbage, infested with maggots, mice and rats. Charged with violating state laws on storing refuse, Jacobson argued that most of the heap was books and clothing she was saving.
A few weeks later, San Jose police discovered a second residence overrun with trash. “There were paths going around to the various parts of the house,” said Sergeant Bud Davis, who investigated the makeshift dump where the William Bennes and their three children lived. California authorities uncover a couple of similar cases every year, Davis says matter-of-factly. “These people felt they had a right to live that way” (Ref. 34, p C5).
Sometimes cluttered homes pose a lethal threat to residents, family, and neighbors. In 2001, a 92-year-old man living amid massive clutter in New York City had to be rescued from his burning home; his 60-year-old son was burned seriously.35 Hoarding in urban apartment buildings poses a special threat: “More than 150 firefighters battled a three-alarm fire yesterday in an apartment in Sunnyside, Queens, packed floor-to-ceiling with debris that the building's superintendent called ′a warehouse of junk'” (Ref. 36, p B3). Other times, the danger is associated with untreated psychosis: A Bronx man was found barely alive in his own apartment, buried under a mountain of books and magazines, fire officials said. Patrick Moore…was saved by neighbors who heard him screaming, authorities said. The neighbors…said Moore, described as in his early 40s, had been stuck under the literary pile for two days and appeared dehydrated when he was pulled out. “I heard him moaning for a couple of days, but he talks to himself all the time, so I didn't pay him any mind,” [a neighbor] said [Ref. 37, p 14].
During a three-month period in 2006, 10 Collyer-type stories were picked up by a news service.38
Dementia and Diogenes
It has long been understood that individuals with dementia often become shut-ins, living in squalor. They lose the ability to assess critically what is of value, resulting in the accumulation of trash and objects. Many communities have hoarding task forces, usually with a geriatric focus. Several years ago, New York City convened a task force on hoarding, with academic support from Weill Medical College of Cornell University.39 The proceedings of the group included compulsive hoarding, animal hoarding, and aspects of dementia. The Dane County (Wisconsin) task force framed the problem succinctly: Everyone working in Adult Protective Services and Elder Abuse and Neglect Offices knows that referrals of people who hoard will be simultaneously amazing and confounding. Can a person possibly be both legally competent and living on top of three feet of a mix of garbage and newly purchased gifts, trinkets, and food? Or living in an apartment or home in which all but one small corner of one room is totally filled? Or living amid a few dozen pets and their waste?40
The post-Collyer fascination with eccentric hermits was the subject of Erskine's 1953 book, Out of This World,1 which included transcriptions of interviews with Langley Collyer. He had seemingly rational explanations for his lifestyle and habits, which, in their entirety, bordered on the delusional. Being the son of a physician living amid thousands of medical books, Langley would have one believe he acquired medical knowledge osmotically. He treated Homer's blindness with a prescription of 100 oranges a week. The accumulated newspapers, Langley explained, were for Homer when his eyesight returned.
Noting the number of cases of elderly shut-ins with bizarre habits, Granick and Zeman41 collected news clippings from 1942 to 1959. Like Erskine, they focused on hermitage, noting clutter as an associated feature among 105 recluses aged 56 to 105. Because they did not focus on hoarding, their working formulation, far from OCD, was “that [recluses] are persons with either latent or overt schizophrenia who have successfully avoided treatment and whose behavior has, for the most part, been such as to elude institutional care” (Ref. 41, p 651). Most of the subjects had substantial estates and many kept their money at home. The stashing of money at home had forensic implications in two areas: first, that such persons could become easy prey for criminal attacks; and second, that the ambiguity surrounding their competency could result in testamentary chaos.
In 1975 in The Lancet, English clinicians described the condition as the Diogenes Syndrome, after the ancient Greek cynic who chose to live in poverty.42 Despite concern over a possible misnomer,43 the label has persisted. In the 30-case report, the subjects, aged 66 to 92, included men and women who had been hospitalized for acute illness and self-neglect; only two were civilly committed. More recently, there have been cases in which a guardian has been appointed.44 Although dementia must be high on the list of differential diagnoses, there remains the possibility that the hoarding or cluttering behavior can be attributed to pre-existing personality traits.45,46
Animal Hoarding
Among the most notorious of hoarding types is animal hoarding, described as long ago as 1960 in the report by Granick and Zeman.41 They noted the potential threat to community health, since harboring many cats and dogs causes proliferation of vermin. Several years ago, a shocking instance of pet hoarding was uncovered in New York State: “A dog lay dead and disemboweled on the ground. Dogs were feeding on it. Feral cats were roaming around in the woods. Rats had infested the home where dog feces were piled three feet high on the floors in some rooms. A thick smell of urine hung in the air.”47 News reports of “cat ladies” and the like are abundant.
Because such reports invoke pathos, the perpetrators are often viewed as cruel rather than sick. However, there are several psychopathological models that could explain the behavior. These include delusional disorder (special ability to communicate with animals), early dementia (along with hoarding of inanimate objects), addiction, zoophilia, attachment deficits, and OCD.48 The hoarders, when apprehended, face criminal charges that may include animal cruelty.49 The charge of cruelty is ironic from the hoarders' point of view, since their subjective dynamic is abnormal attachment to pets. The Hoarding of Animals Research Consortium is a resource for this problem.50 Forensic mental health evaluations may have a role in determining whether these individuals are eligible for programs to divert them from criminal justice or for civil commitment.
Discussion
We love the story of the Collyer brothers because they were counterculture eccentrics who defined the terms of their existence. Compulsive hoarding, as it is portrayed on television, fascinates us, too, most likely because it takes everyday behavior to an extreme and offers the sufferers the possibility of redemption. News reports of elderly shut-ins living in squalor, cat ladies, and fire-trap rescues are harder to accept and often evoke public outcry. Beyond hoarding task forces and social-services interventions, there is the possibility that mental health services will be brought to bear. When the situation evolves into questions of civil rights and freedom, forensic opinions may be used to assist courts and agencies in determining dangerousness and the likelihood of recovery. The following points illustrate the potential interface areas between hoarding and forensic psychiatry.
Health and Safety
Hoarders, whether in high-rise apartment buildings or in rural settings, can violate laws by littering, creating hazards, and creating a noxious environment. They face eviction, fines, and even imprisonment. Those in apartments often face eviction proceedings. When hoarders cannot comply with court orders, they risk contempt of court. Forensic assessments may be helpful in mediating these situations by reframing the problems as the result of behavior over which these individuals have little control. Though they may not be legally insane, their disability can be understood, perhaps temporizing the proceedings until a solution can be found. Although there is no specific psychiatric condition to explain animal hoarding, the differential diagnosis is broad and would be a reasonable indication for a forensic assessment. If hoarding is countenanced as a disability for Social Security or Americans With Disabilities Act purposes, assessments would be necessary.
Children, Families, and Domestic Relations
Individuals who have lost control of their habits and environments have difficulty maintaining a suitable home for children. When word gets around a neighborhood or apartment house that a family is living in extreme clutter, social agency evaluations are triggered. In extreme situations, termination of parental rights could ensue. A possible scenario, suggested in one of the Hoarders episodes, is for the nonhoarding spouse to seek divorce to gain custody. A forensic assessment can aid in the overall understanding of the degree of psychopathology, if any, and the parameters for restoration of a safe home. Even without the problem of child abuse/neglect, hoarding can drive couples apart. In some situations, the hoarding is fueled by compulsive shopping, which, in turn, can lead to substantial credit card debt and the threat of bankruptcy. In cases of divorce, a forensic assessment may be needed to determine fitness for custody.
Civil Commitment and Capacity Assessments
The inability to care for oneself, in conjunction with mental illness and a risk of danger, is often sufficient for at least an emergency commitment. The presence of serious psychopathology is ambiguous in the case of hoarding, especially when the behavior is construed as an OCD variant. Because of the reactions of others to the effects of hoarding, there is a possibility that hoarders will have their freedom revoked unnecessarily. On the other hand, if major psychopathology cannot be assessed, hoarders will be permitted to live in horrific conditions. The situation may evolve, as it did in the older adult sample of the original Diogenes subjects,42 into medical emergencies or voluntary hospitalizations. Forensic assessments can help to sort out dangerousness on the basis of mental illness versus an eccentric lifestyle taken to the extreme. There may also be a role for forensic analysis of testamentary capacity, since many hoarders have sizeable estates. Similarly, an assessment of general capacity would be of value when there is a question of guardianship.
Footnotes
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Disclosures of financial or other conflicts of interest: None.
- American Academy of Psychiatry and the Law