Compulsive Hoarding Disorder, Sentimental Clutter, and Healing: A Therapist’s Experience

Oh, honey can’t we get the coat cleaned, there is lint all over it.  

The little girl squirmed a bit in her chair. “But they will have no home if the coat is cleaned,” she told the therapist.

Speaking in Pittsburg in 2007 to a gathering of mental health clinicians from around the country about Obsessive Compulsive Disorder, Dr.Gayle Skeketee, told the story of treating the youngest sufferer of hoarding disorder she'd ever had, age seven. 

I sat in the hotel meeting room, just across the bridge from Duquesne  University that morning, hearing the story of this young girl who couldn’t shed her winter coat in the summer or get it cleaned for fear of harming the lint. It was their home, she believed, animizing (giving life-like qualities to inanimate objects) the fibers and hairs on it.

Dr. Skeketee’s story about the young girl paints a vivid picture of what some hoarders contend with. It is believed two to four percent of Americans have the disorder in varying flavors with its roots in childhood and adolescence.

“My name is Brenda,” the voice, elderly and crackly, said on the phone. “I am thinking, I am a hoarder. And my, uh, daughter found your name. She said you might be able to help me.” 

Because my work bio said I was an OCD counselor, hoarding fell somewhat in my wheelhouse. “I'll be glad to talk to you,” I said.

“Can you come to me?” she asked. 

Surprised, I said I would. Many hoarders, in my experience, put off  inviting therapists to their homes, opting to just show pictures of their troubles. 

Several days later I arrived at Brenda’s house, a small ranch style with a surprisingly well kept front yard. No visible signs of clutter were about. The curtains, stained and yellowed, were closed.

There was an old rusted Buick parked in the driveway near the garage where cobwebs had found a home. I’d neglected getting much information from Brenda, so I was walking cold into her situation. My mistake. 

I knocked on the door. Moments later, the door cracked open, the guard chain still attached. 

“Brenda,” I said, looking down at the white haired, diminutive, what appeared to be octogenarian. 

“Yes. You are Dr. Mcgee?”

 “Not, doctor, just Mike.” She opened the door. I stepped inside to a bolt of cat urine and mixture of something else, possibly vinegar.

Those who hoard animals have Noah Syndrome.The name likely relates to the Genesis story about the gathering of animals for the Arc. 

Animal hoarders are a subtype in the hoarding family. And hard to treat. 

I saw no felines about. But Brenda had other troubles too. 

My nostrils began to sting from the stench, which I tried to disguise the best I could. A covid mask would have helped. Brenda seemed unaffected. She was nose blind. My guess, the cats had the run of the place.  

Brenda jumped right in. “I want to get this cleared up before I go,” she said, gesturing behind her, at a living room of floor-to-ceiling stacks of newspapers, not elaborating on ‘before I go’. “Can you help me?” Her voice was more energetic than on the phone.

Paper cups, dirty dishes pasted in caked-on food, a garden hose, an assortment of hammers and a scattered selection of ceramic curios, lay on the newspapers, all left like abandoned vehicles. A fire hazard no doubt.   

A makeshift narrow aisle separated one large stack from another. Beyond the living room there was a hallway where it appeared more papers were stacked. The floor was hardwood the best I could tell.

Her age, and the severity of the trouble I was witnessing made my answer to her question “Can you help me,” a “No.” But I kept the comment to myself. 

I said, with a light chuckle, “You certainly have a lot of newspapers, Brenda.” Sneeze. 

“Yes,” she said, pointing me to a chair, next to a white stained couch, a likely potty place for her cats. It encroached on the kitchen which was home for more papers, magazines and hard covered books. 

Boxes of detergent, mostly TIDE, lay on the kitchen counter top. Near the sink there was a rack with clean dishes in it.

Brenda sat on the arm of the couch. Oddly, she appeared well scrubbed. Her off-white flower covered dress was clean. Her hair and fingernails were well cared for.  

Another sneeze. Then another. I wasn't sure how long I could last. 

Momentary silence, then, ”Do you take medicaid, or medicare?” 

I told her I didn’t. But I gave her the amount of my session fee. “That’s reasonable. But I will need help from my daughter.”

Another sneeze. I wasn’t making a good impression for this person in distress. “Not to worry,” I said about my fee. 

I asked Brenda the dates of her oldest papers, figuring she kept them due to some personal need. 

People hoard, Gayle Skeketee said, for aesthetic, instrumental or sentimental reasons. The unconscious struggles with loss and loneliness often were at the gut of their emotionality.

“The oldest one goes back to the late 1800s,” she said, nodding toward the back of the living room near a window in dire need of cleaning. “My daddy was a publisher of a small paper and I have all his writings.”

I asked her the name of the paper and town. She said the newspaper no longer existed.  

My thinking, at least about dad’s newspaper, was that Brenda couldn’t part with his papers for sentimental reasons. 

Sneeze. “I am sorry,” Brenda said. "This is very stressful for you. I should have come into your office.”

Another sneeze. “My daughter took all the cats. You're allergic to them. She found homes for them, except for Porridge and Boo. They’re around here some place.”  

I smiled off another sneeze, knowing it wasn’t any allergy to cats, in fact I’d had cats for decades. It was the putrid smell. Brenda’s nose blindness made her oblivious to the rank odor around her. I needed to somehow make a graceful exit, even though I’d just arrived, but leave her with some hope.

Brenda stared hopelessly at the sea of clutter. “I just don’t know what to do.”   

I asked if she’d ever worked with someone about her situation. She said she did talk to someone, once, but she didn’t keep her appointments up with the person. I told Brenda, the trick is to begin with something doable and simple; realizing for a hoarder the simplest task of discarding something acquired, is easier said than done.    

“So, Brenda, for starters, can you make a list of the newspapers which are treasures?” I explained that the objective is to separate items into treasures, trash and things to give away. I guessed Brenda believed all her papers were treasures of some kind. “ I don’t expect you to look at the papers. Please don’t. My guess is you want to keep your daddy’s.” 

She got up. From underneath a stack right in front of us and pulled out a legal pad as if to take notes. “Yes. I can do that,” she said. She looked at the back wall, toward where her father’s papers were. 

Sneeze. “I bet you know where his stacks begin. Make sense?” 

“Oh. Yes. And then am I to call you?”

“Yes. Or, I’ll call you. How about that?”

Sneeze. I was near the front door. I hadn’t taken a gander at all of the house, realizing it was likely as in bad shape as the living room. 

I continued inquiring about her life. The death of husband some twenty years earlier, the father of her two daughters who lived 125 miles away in St.Louis. Brenda herself was a former librarian and once an active reader who entertained her book clubs at her home. She had hoped to one day have her house presentable enough to hold book club meetings again. 

“I think I need to take care of this sneezing,” I said, the stench getting the best of me. 

“Oh, thank you,” she said. 

I opened the door to fresh air, feeling defeated, guilty about my exit. “So, start with that list. Remember this is just your treasure list.” I knew Brenda would need help with making her list. That in itself would be a monumental task. 

She profusely thanked me again, even though my stay was only for a half an hour, apologizing for making my allergies to felines act up. 

I sat in my jeep. I thought I saw her peek out of the curtains. She was likely housebound, another characteristic of a hoarder. Her profile was similar to other hoarders, older, living alone and in dire need of a magic formula to get her out of her fix. A fix for a trauma which had started long ago. 

I didn’t know my next step. 

Several days later, I got a reprieve of sorts. Brenda’s daughter called me and said she had decided to move her mother in with her. Brenda had consented. The daughter said Brenda told her about our meeting and that the family would make sure to take the old papers of archival value along with the two cats.

She said she'd found a cleaning service who specializes in cleaning and clearing out homes where hoarders live. I was cautious of those services because some stormtroop in with little regard for the hoarder’s feelings.   

“I know, you will be sensitive to your mom’s condition,” I said to the daughter. “And make sure she keeps those items which she feels are her treasure.”  

The daughter assured me she would. 

Of the reasons people hoard, I find discarding items which have a sentimental value the hardest nut to crack. Deep emotions are attached to items, which to a reasonable person would seem trivial.

The little girl Gayle Skeketee treated for lint on her coat is now a woman. I wonder if she’d reckoned with her hoarding.

From time to time I drive by Brenda’s old house. The Buick is gone. The yard seems tended to. If she hasn’t passed on, hopefully Brenda is living her days without clutter. And with a few, very few, of those old newspapers. 

Brenda’s name is fictitious.

For more information about hoarding contact: The International Obsessive Compulsive Foundation ( IOCDF).

Maladaptive Daydreaming

What a day for a daydream,

What a day for a daydreamin’ boy,

Now I’m lost in a daydream…dreamin bout my…..,

so sang John Sebastian of the Lovin Spoonful in the 1966 classic hit DayDream. For persons who sang and hummed the tune those decades ago, Daydream carried special meaning, unknowingly so.

While not connecting the song to any mental health malady, today, chat rooms abound with a nascent (coming into existence) disorder called Maladaptive Daydreaming, (MD). 

Defined by The Cleveland Clinic, Maladaptive Daydreaming is “a mental health issue where a person daydreams excessively, sometimes hours at a time. It is seen as an unhealthy or negative attempt to cope with or adapt to a problem.” These daydreams often have elaborate stories and characters. And hamper one’s life in other areas. 

MD shows up with clients who have Obsessive Compulsive Disorder (OCD), ADHD, and Autism. It is important to differentiate mind- wandering and common daydreaming from that of MD. 

According to Eli Somer, an Israeli psychologist, who first coined the term in 2002, mind wandering or common daydreaming is when the brain is in kind of an idle mode, thinking of mundane items. This is not maladaptive daydreaming. All people day dream. Persons who are script writers or those paid to create fantasy, while seemingly creating elaborate stories, don’t have classic MD. 

MD sufferers, however, often have dreams of grandiosity, but do very little to achieve what their dreams wish for. As the above definition notes, persons who have MD can spend hours in their dreams and do so to escape past traumas. In some cases Somer notes, people have a predisposition to MD. 

It is important to be aware of the continuum when the dream crosses over from being useful in creativity to maladaptive.   

“I daydream more when I am out,” a person in a chat group said. ”I might be walking on the city’s trail system and a stranger would pass me and I would immediately start creating this story about him attacking me and me beating him up. And the story would have all sorts of intricate scenes and this would carry me through almost until my walk is done.” 

A key is to ask a person who questions their day dreaming is how much their day-to-day activities are impacted by the dream. 

To get an assessment about the degree of whether one has MD, the Somer, 2016 16-item Maladaptive Daydreaming Scale (MDS- 16) can be administered. The self-report assessment can be downloaded from the internet. 

A first question asks about the propensity for daydreaming to be triggered by music, because music is seen as a common prompt. Music engenders emotions, thus also memories. People who are so poised to daydream can go off into their world from a song.

As a counselor treating persons with anxiety and OCD, I have seen an increase in the number of clients who come to my office expressing mental activity consistent with MD. I don’t jump into any diagnosis.

While movies, news accounts and other stimuli can set off day dreams, an older client I treated who allowed me to change his name, but use his experience with MD, said music very much sends him off. 

“In particular, when I hear the Temptations, Marvin Gaye or to some extent any male singer who I grew up with that gets me going,” Ryan said. “If I listen to a whole soundtrack or sometimes just one or two songs, I’ll dream that I am in front of my high school audience. And I am singing the songs I am hearing. I am the leader of a group and I am wearing sunglasses and all the girls are looking at me, of course falling in love with me.” Chuckles. 

Ryan said once the music is over he doesn’t continue with the dream. But he finds himself listening to song tracks often just so he can go to his dream. “It’s always me, and my group, Paula, David and Donald.”   

A National Library of Medicine research entry about MD notes MD sufferers have elaborate narratives and fantastical stories in their dreams. As with Ryan, sufferers often come back to their daydreams and pick up where they left off. There are references to persons with full blown MD, engaging in it 60 percent of the day. 

MDers can have more difficulty with emotional regulation and could be prone to dissociative disorders; some researchers believe they have higher rates of unemployment, suicidal ideations and sleep disorders. 

OCD and MD are similar in engaging what is called lost-in-the-ritual loop, but differ in the content their mind goes to. Maladaptive Daydreaming can be seen more as a malady where the sufferer takes a pleasant journey into Walter Mitty land when stress occurs. The person self regulates with the dream from anxiety, gets relief, but then the process begins over again when a trigger occurs. In fact, MDers often quite enjoy their dreams.   

When considering treatment for MD, Susan Meindl, a Canadian psychologist, offers some thoughts. It is useful, she says, for the person with MD to consider the emotions which are prevalent in their dreams. 

The dreamer, AKA the protagonist, often has power and is admired by many in their dreams. But being admired and having power isn’t what the protagonist is after, Meindl says. “They want to be beloved.”

My client Ryan likely isn’t looking to be a rock star, but he does appear to have an unmet need for approval from his high school classmates; those years and persons long gone, or simple validation that he is a credible man. 

The dreamer needs to ask, “What am I really feeling?” When a MDer realizes their dream is about unmet emotional needs that insight sheds light on what really the sufferer is wanting. Persons escape to their day dream for soothing purposes from the anxiety, Meindl says.

Somer says, in light of the fact MD is addictive, treatment should relate to that used for addictive behaviors. Because the MD sufferer often likes their dream, therefore, they aren't told to give up their day dream, as someone who drinks alcohol might be. The first step is to limit time spent on their dreams. Mindfulness training is also useful because it trains one to stay in the present.

It is unlikely that Lovin Spoonful creator Sebastian, now in his 80’s, who gave the world the gift of this most prescient piece of music, Daydream, had a mental disorder in mind when writing the lyrics back in 1966. But, his classic work, in part, lays out what it's like to have this disorder, which is certain to be introduced into the sixth edition of Diagnostic Statistical Manual, (DSM). 

A daydream can last long into the night….

or you can be daydreaming for a thousand years….

These resources offer an understanding of MD:

Somer Clinic

my.clevelandclinic.org

casper.com

pmc.ncbi.nim.gov

Solving Maladaptive Daydreaming, a booklet

Reddit

Kati Morton, YouTube 

Parallel Lives, YouTube 

Get Real

Shakendra stuck her hand out to shake, all 5 foot 2 of her and said, “Mr. Gee, you been the best white teacher I ever had. Sorry I been so  bad this year. But… you been real.” 

We both chuckled at the inside joke of being real. During the course of the long school year and in my class made up of adolescents, whenever I’d get too wordy, someone would suggest to, Keep it real. 

Wally Gable, the class loudmouth, would say, “Mr. McGee there you go again talking college. We are bad kids. Don’t you know we need simple words.” 

Ms.Howdy, the school's popular recreation therapist, would join in if my educator self got to be too much, and follow suit, ”Yes, Mr. McGee, can’t you just keep it real.” 

Shakendra and I walked up the hallway. Her bus ride home waited in the small lot outside. As teachers we had hosted an end-of-the-year goodbye barbecue for all the students. We were the outpost school. Our students, some 30, had been booted out of their mainstream for bad behaviors. Most came from fractured families. Their plight and their nature endeared them to us. Underneath their tough veneer, there was a propriety of fairness.

At the door, Shakendra looked up at me. “Shay, you be good,” I said.

She smiled. “I’m going to learn to swim this summer.” 

She joined the other students getting onto the bus. Ms. Dary, the driver, tooted a so-long from her seat. Shakendra waved. I thought she mouthed, You Get Real Mr.Gee. She’d always left out the Mc of my name.

As often as I heard the colloquialism, I couldn’t say for sure what getting real meant. There were several hearty words which come close to describing it.

Honesty always tops a list, implying straightforwardness and a judiciousness in dealing with others.

Authenticity is another. A quick google search brings up being real with the authenticity definition.   

Of course in political circles the big word for being real is transparency. Webster’s defines it as “the quality of allowing light to pass through so the objects behind can be distinctly seen.”    

The word real in Latin is res, for the thing. So then whatever the thing is, be straight about it, genuine, honest, and transparent. It is a term for being upfront with others and oneself. 

 According to The Slang Dictionary, being real was first attested to as early as 1954 in the book, The Huge Season, a book about the Jazz Age.

It appears from a cursory check the saying had its beginning in, ‘American black speak’, then it diffused into Hollywood and by the end of the 20th century into rap. 

Jamal’s 1995 song, Keep it Real, opens with, Crack the bubbly. Don't stop, don’t stop, don't stop.Yo word is bond. 

Other hip hop songs and books have followed with Keep it Real as the title,or in the lyrics. 

Keep it real brings in the whole package. It implies, don’t be all about yourself. Don’t be phony, deceptive or pretentious. It is an aggregate.

Shakendra would have sounded awkward if she’d said to me, “Keep it authentic Mr. Gee”, or "Keep it genuine.” 

Rachel Beohm, a blog writer about life and leadership, says “being real means knowing yourself and being comfortable in your own skin.”  She says honesty and being aware of one’s good points and flaws is a criteria. 

While being real sounds easy to do, Boehm says it’s not. Many people fear rejection about presenting their true self. And finding out the real you takes time and what that means.

In an academic research article entitled To be or Appear to be, the authors contemplated that some persons are authentic and some work hard to appear to be authentic. It’s important to understand the dynamics of this sought-after trait. 

While there’s enough inauthenticity to go around in both political parties, in 2016 the presidential candidate Hillary Clinton said to a black radio announcer that she always carries hot sauce with her in her purse. Her conjecture it seemed was that black people like hot sauce. She was trying to be Real with her audience by identifying with them. The comment didn’t endear her to the voters. 

Something prompts a saying or word into the vernacular. Keeping it real, is an admonishment to behave congruent with your emotional self. 

But why has this saying become part of the cultural speak? And why did it surface in the latter half of the 20th century? 

One theory: Language trends according to happenings of the time. In recent decades the superficiality of commercialism tried to shape identities. Therefore people were thirsty for realness, not depicted by the eat, drink and drive this to-be happy ads. 

A second theory, complimentary to the first theory, is that the American family is fractured; this being more evident in the black and white culture, than the Hispanic and Asian cultures. It is commonplace for sure to blame the failing family for the downturn of civilization. But Being real relates to fundamental values. 

Caregivers shape a child’s sense of self. If there are no caregivers, or they are aloof to imparting what it means to be real, then children learn by and through other means. And these are ad-men prowlers, social media influencers, and peers. 

Shakendra and Wally in my class some 20 years ago were starving for a direction about who they were and could become. They were insightful enough to understand the importance for a person to be true to themselves. But piecing that all together without good, caring support from adults who themselves had any notion about how to get that, made their life topsy-turvy.

Keeping it real was repeated enough in my classroom during that last year. Looking back, I should have done a whole week's lesson on the subject. Perhaps, I too was to blame for not picking up on it way back then. 

I hung up my teacher shield after the class of 2003. And moved into counseling. I never saw Shakendra again. I hope she learned to swim. 

Whenever I hear Get Real, I think of her. And remind myself to head in that direction.

The names in this essay have been changed.