09/10/2009

Dear Patti,
My stepbrother and I were raised together until my mother and stepfather divorced. I was 14, Derrick was 12, and when he and my stepfather moved away, I never saw either of them again. I’m now 31 and was recently reunited with Derrick. I was so excited to see him but it became apparent during my visit that something just wasn’t right.
Derrick lives alone, has never married and has a successful career. We met at my hotel because he was reluctant about my seeing his house. He finally conceded and I was overwhelmed that it was filled with newspapers, magazines, old mail and stacks and stacks of books.
He was obviously embarrassed and had to move boxes just so I could sit down. It didn’t seem dirty — his kitchen and bathroom were clean — but all the rooms were disorganized and he had little space to move around. Derrick admitted he has a problem but is unsure where to get help.
He always liked to collect books but says he has developed an irrational fear that he’ll lose valuable information if he tosses anything. Does this mean Derrick is somewhat mentally ill? I can understand how he might want to hold onto things or hide out in the world of books because he did that when we were kids. I’d like to go back and help him clean his house but I don’t want to intrude.
—Carrie 
 

Dear  Carrie,
I’m very happy you’ve found each other and it’s wonderful to hear how willing you are to help him. Your sensitivity in wanting to approach and solve his problem respectfully without seeming meddling or intrusive is wise. Since your relationship has just been newly connected, I’d like to see it strengthened before it’s tested. You don’t want him to perceive you as just trying to “fix a broken relative.”
 
My first concern with the compulsive hoarding you’re describing is how safe and healthy his living conditions are. Is there a fire hazard? Is the weight of books and boxes compromising the floor structure? Is the home a breeding ground for rodents and other pests? How well can he function in his home? How much is his quality of life compromised? Is he socially exiled because he’s ashamed of his habitat? While I wouldn’t necessarily diagnose Derrick as mentally ill based on your observations, hoarders are more likely to be suffering from Obsessive-Compulsive Disorder, Obsessive-Compulsive Personality Disorder and/or Depression. I’d recommend finding a professional psychotherapist trained in working with compulsive hoarders. Depending on the diagnosis, medication might be prescribed if depression, suicidal tendencies or anxiety symptoms are present. Derrick needs to make changes because he wants to and because he recognizes how this behavior painfully limits his life. This is a very difficult behavior to change and he needs to do it for his own sake and not just to please you.
As far as cleaning up clutter and throwing out Derrick’s “stuff,” I’d go slowly. First, he needs to make a conscious decision to stop adding to it. He could make a deal with himself to throw out a similar object for every new item he brings in. After he accomplishes this step successfully for three weeks, he’s ready for you to help him select three fairly small areas he’d like to start with. Examples: the couch, the dining room chairs, a bathroom countertop. With your assistance, he can assess the items stacked on these locations and clear these spaces up (without just stacking them elsewhere). After a month or two of keeping these areas clutter-free, he can go on to new ones. This will take time, but that’s OK because he needs to emotionally and physically adjust to these new habits. He’ll need your calming support when he becomes indecisive, vulnerable, or scared of change. Always remember that Derrick needs your love and faith in him more than he needs a helper or problem-solver.