Tuesday, 1 May 2012

Diogenes Syndrome, Hoarding – or Merely an Avid Collector?


I know it's in here somewhere

There was an interesting article in the Guardian a week or so ago about hoarding. The article described the lifelong difficulties that Jasmine Harman has had with her mother. As she said in the article: “I literally couldn't get into her house. There was so much stuff in the hall that the front door wouldn't open properly and then, if you did manage to squeeze yourself in through the tiny gap, the whole place was piled high with junk. You could barely stand upright and most of the rooms were completely inaccessible."

The article refers to Paul Salkovskis, professor of clinical psychology at the University of Bath, who makes an interesting analysis of this problem. He says that about 1% of the population have hoarding issues to the extent that it dominates their lives.

According to Salkovskis, hoarders fall into one of three categories. “The first group, around 25% of the total, are people with what might be termed "obsessive compulsive hoarding": their problem is harm avoidance, because they fear things could be contaminated and worry about contaminating others if they get rid of them. The second group, who make up about half of all those affected, are deprivation hoarders: they have been through a period of massive deprivation (for example, war, displacement or another sort of loss) and they hoard because, having lost so much once, they feel a need to hold on to possessions in case catastrophe strikes again. The third group… are sentimental hoarders. They have been damaged by unpredictability and possibly even neglect during childhood: for them, possessions have become more reliable than people and they invest in them accordingly.”

I’ve written a couple of times on this blog about the problems of hoarding (here and here). It can be called Diogenes Syndrome or domestic squalor syndrome, but hoarding is probably the best description, since it avoids unduly medicalising this phenomenon.

According to the Blogger statistics, which I avidly read, my blog posts on this subject interestingly receive by far the greatest number of page views; these posts continue to receive dozens of page views weekly. I also regularly receive comments and emails on thethis subject which indicate the anguish that having a neighbour or relative displaying this behaviour can provoke.

It is clear, therefore, that many people throughout the world make searches on these topics, and this must mean that many people have personal experience of people with this problem and want to find some sort of solution.

AMHP’s are fairly often asked to assess people under the Mental Health Act who are living in extreme conditions of clutter or squalor, and reaching a decision that takes full account of an individual’s right under the Human Rights Act to their right to privacy (Article 8) can be very difficult.

The HRA states “Everyone has the right for his private and family life, his home and his correspondence”. However, this is a conditional right, as the Act goes on to say:

“There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.”

A balance therefore has to be struck between the individual’s right to privacy in his own home, to live as he or she wishes, and the rights of the wider community in terms of public safety and others’ right to have their freedoms protected.

The AMHP, as well as having to take into account the effects on the individual of their hoarding habits, and the effects on relatives, carers and those who live in their vicinity, also has to be satisfied that the person is suffering from a mental disorder of a nature or degree which warrants their detention in hospital.

This is where it gets really difficult.

In the article about Jasmine’s mother there is no suggestion that she needs to be in hospital; it is also far from clear that she is suffering from anything other than an obsessive/compulsive disorder. The article does identify a talking treatment for her mother, which according to the article is having some beneficial effect.

I will state for the record here that I have a close relative who is a hoarder. I dread visiting her home and would never accept anything cooked in her kitchen. I have attempted on several occasions over the years to clear up and declutter the house. Not only is she remarkably ungrateful and ungracious when I have done so, but she manages to restore the house to its default state of chaos within weeks.

However, although she is now in her 80’s, not only does she show no signs of dementia, but she shows no signs at all of any diagnosable mental disorder. She is not depressed, she is not psychotic – she just likes to buy stuff, and doesn’t like to throw anything away.

I have learnt to let it be. If, one day, she spontaneously tells me that living like that is a bit of a nuisance, and would I help her sort things out, then of course I would. But that time may never come, and I have to live with it.

As Jasmine says in the Guardian article: "People so often say, why don't you just get a skip and get rid of everything. Don't they think we've tried that? It's not the answer. Unless you address the deeper issues, the hoarder just goes out and buys a whole lot more stuff to replace what has gone."

It has been my experience as an AMHP that people presenting with excessive hoarding rarely have a clearly identifiable mental disorder – they just have a behaviour which most people find baffling or personally unacceptable. And that is not sufficient to detain someone in hospital against their will.

Many people collect things. Some people spend all their spare money on collecting stamps, or bone china, or books, or horse figurines, or obsolete computers or tractors, or even more outlandish objects. There’s someone in the Guiness Book of Records who has the biggest ball of string. Other people might be interested in these collections, or amused, or intrigued. But they don’t demand that these people be incarcerated in a psychiatric hospital.

Whatever I say, AMHP’s will always be called on to make judgments about such behaviours. In the end, however, it is still necessary not just to identify the existence of a significant mental disorder (other than “hoarding” or “Diogenes Syndrome”) but also to make an assessment of the severity of the impact of the behaviour on the person and others affected by their behaviour.

If that can’t be done, then we have no option but to respect their privacy and leave them to get on with it.

2 comments:

  1. The problem arises if you have to share a home with a hoarder. Whatever their mental health is like, yours will certainly suffer - they monitor your rubbish and accuse you of throwing things out if you attempt to tidy up - they are very controlling and insenstive to the needs of others, they love their stuff more than they love you....It is heartbreaking

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  2. 4 JULY 2012

    Dear Masked AMHP


    There used to be a saying "Let and let live".

    I am aware that some people are overwhelmed by "mess" which other people do not regard to be a problem at all.

    The problem seems to come when one set of people moralise over the "rightness" of a person's actions and that this is then a short step to being deemed mentally incapacitated because they do not share the same opinions as the assessor.

    I believe that the MENTAL CAPACITY ACT 2005 SECTION 44 is not fit for purpose because millions of people who care and support their friends and families might suddenly be accused of a crime of preventing a person from doing an action that is "not in their best interests" when they knew or had reason to believe that the person was incapacitated mentally - even if only temporarily or momentarily.

    Surely this is insane as Kate Blunsdon a senior Counsel has cautioned prosecutors beware in her important and seminal document which can be seen online via a Google Search.

    Thank you very much for bringing this to the public's attention.

    Best wishes

    Rosemary Cantwell

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