Syllogomania

Gerontology is the study of aging and its associated problems. In the gerontology research literature, the hoarding of rubbish is referred to as “syllogomania.” (Sylloge is Greek for “collection.” ) Syllogomania is widely regarded as one marker of self-neglect among the elderly, along with poor personal hygiene and squalid living conditions. In the early 1960s, two British gerontologists described seventy-two cases of what they called “senile breakdown syndrome.” The cardinal features of this syndrome, which they believed to afflict only the elderly, included severe deterioration in both personal hygiene and living conditions, often accompanied by hostility, isolation, and rejection of the outside world. A common feature of these cases was syllogomania.

Somewhat later, another British gerontologist coined the term “Diogenes syndrome,” after the ancient Greek philosopher Diogenes of Sinope (fourth century B.C.E.), who was reputed to have traversed Athens looking for “an honest man.” Diogenes rejected most social conventions, preferring a hermetic existence and eschewing any form of luxury. For a time, he supposedly lived in an olive oil barrel rather than a house. His indifference to his living conditions probably led to his name becoming synonymous with domestic squalor. However, Diogenes showed no inclination toward syllogomania. In fact, the Cynics, the school of philosophy typified by Diogenes, believed that happiness could best be achieved by living without possessions.

The Diogenes syndrome includes poor personal hygiene, domestic squalor, and syllogomania. (Other names for this syndrome include “senile recluse syndrome,” “extreme self-neglect syndrome,” and “social breakdown syndrome,” although all of these names portray the condition inaccurately, as the syndrome is not restricted to the elderly and involves more than self-neglect or social inadequacies.) More recently, gerontologists have begun to refer to these symptoms separately rather than as a syndrome. The term “severe domestic squalor” has been suggested to distinguish it from neglect of personal hygiene and hoarding, both of which can occur without squalor. In fact, Daniel displayed two of the three Diogenes syndrome features—domestic squalor and syllogomania.

For many years, gerontologists believed that the Diogenes syndrome resulted from other problems, such as schizophrenia, dementia, or frontal lobe damage, and in fact nearly half of the cases do. But more than half occur in the absence of these disorders. The Diogenes syndrome is not related to income or intelligence. It may be precipitated by life events, such as the death of a caregiver or a serious illness, but these events don’t cause it. One theory holds that certain personality characteristics, such as suspiciousness and obstinacy, may be the bedrock of the syndrome. Daniel had both of these characteristics, but most striking was his lack of awareness of any problem associated with his behavior.

Complex Thinking

Though identified as geniuses early in life, neither of the brothers was able to finish college. Alvin complained that his mind was “too difficult to navigate.” He went on, “It’s like a tree with too many branches. Everything is connected. Every branch leads somewhere, and there are so many branches that I get lost. They are too thick to see through.” He said his thoughts came so rapidly and spun from topic to topic so fast that he couldn’t keep things straight. He likened it to an old episode of the TV comedy show I Love Lucy in which Lucy and her friend Ethel work in a chocolate factory picking chocolates from a conveyor belt and putting them into boxes. As the conveyor belt speeds up, Lucy and Ethel fall behind. As it continues to accelerate, chocolates collect everywhere, resulting in chaos. The mess resembled not only the twins’ minds but each of their rooms as well.

Jerry echoed Alvin’s description in a note he sent me.

I think somehow this “paper” situation is like an embarrassing secret—normal people cannot fathom or understand this predicament or overwhelming situation. Also, keeping my important stuff (driver’s license, credit card, garage key card etc.) together is a real daily feat! My head has so many spinning plots and my dreams at night are turbulent and unsettling—Everyday I wonder if I will ever have freedom from chaos.

Alvin’s experience of getting lost in the complexity of his thoughts is common among hoarders. At first we thought that people who hoard might be more intelligent than those who don’t. Although that is probably not true, hoarders do appear to think in more complex ways. In particular, their minds seem flooded with details about possessions that the rest of us overlook. Irene frequently commented, “I’m a detail person, not a big-picture person, but I’ve been saving the details for so long, I need to put them together.”

The complexity of thought extends beyond possessions. A curious commonality among people who hoard is how they talk on the telephone: they leave long, rambling, almost incoherent messages filled with irrelevant details. My voice mail records up to six two-minute messages. Often it is filled with messages from a single caller, such as one woman who contacted me recently. At the end of two minutes, when the machine cut her off the first time, the woman still had not gotten to the point of her call. She called back and repeated half of what was in the first message. She described her background and how she thought she might need help, then told a story about a comment her brother had made regarding her collecting. She argued with herself briefly about exactly when he had made the remark, concluding that it had been about Christmastime. That was the year her mother burned the turkey and it snowed on Christmas Day. The machine cut her off again. In her third message, she apologized for the first two and launched into yet more details about her life. She left her phone number just as her time ran out. She never asked a question or asked me to call her.

Dr. Sanjava Saxena, a University of California, San Diego, psychiatrist who studies the neuroscience of hoarding, described this tendency as giving “a twenty-minute answer to a twenty-second question.” People who hoard often speak in overly elaborate ways, including far too many details and losing the main themes, as with Daniel’s tangential stories … It seems as though they are unable to filter out irrelevant details. Each detail seems as important as the next. People with hoarding problems can’t sort them out or draw conclusions from them. Alvin tried to explain his predicament this way: “Everything is compelling, like it’s attached to something else. I can’t interrupt the stream of things without ruining it.”

This might explain the problems with decision making that accompany hoarding. Even making simple decisions such as ordering from a menu can be excruciating. Alvin showed me a wad of twenty ties in his room. He said, “I have trouble deciding which of these ties to put on in the morning. I could spend all day just deciding that." Jerry reported similar problems: “If I’m going away for the day, I have to pack six or seven sets of clothes. I can’t decide what is too much.” Alvin recalled his mother having similar problems. When the boys were young, their parents booked a cruise but nearly missed it when their mother couldn’t finish packing. Their grandmother came to the rescue once again and did the packing.

In one of our research projects, we compared people with hoarding problems to people with other mood or anxiety disorders and to people without any kind of emotional problem. We found that most of the hoarders reported frequent childhood experiences of distractibility, attention deficits, difficulty organizing tasks, failing to finish projects, losing things, being forgetful, and talking excessively. All of these are symptoms of attention deficit hyperactivity disorder (ADHD). As adults, the hoarders displayed even more pronounced symptoms. Also as adults, they described a tendency to avoid any work that required sustained mental effort. Jerry is a good example of someone with this problem. He spent almost no time trying to organize his things because the intense effort required and frustration from getting confused caused him to give up. “Everything I do is so hard. I have to think about it so much,” he complained.

We recently conducted a study of relatives of hoarders that revealed the harmful consequences of growing up in a hoarded home. We found that the effects varied depending on the age of the child when the hoarding began. Children who lived in a hoarded home before the age of ten were more embarrassed and less happy, had fewer friends over, and had more strained relations with their parents growing up than did those whose parents’ hoarding began later. As adults, they were more likely to experience social anxiety and stress and continued to have more strained relationships with their parents. Children who spent their early years in a cluttered home held more hostile and rejecting views of their parents than did children whose parents’ hoarding was not apparent at that time—but even the latter group expressed a very high level of hostility toward their parents, higher even than that expressed by the relatives of people with other forms of serious mental illness. It is clear that the negative effects of hoarding stay with many of these children for a lifetime.

Children with hoarding parents find ways of coping with the problem. Ashley became the protector, ignoring her own needs. A woman from one of our studies, the middle daughter in a family of six children, described elaborate rituals the family adopted to deal with her father’s rage at losing things. When her father couldn’t find a newspaper article he wanted from the thousands of copies of the New York Times cluttering the house, he became belligerent and insisted that the family search for it. As his distress grew, her mother concocted a plan to calm him down. She organized the children to chant to Saint Anthony, the patron saint of lost items, while they searched:

Saint Anthony, Saint Anthony please come around
Something’s lost that can’t be found.

They chanted in unison faster and faster as they searched. Although they never found the article, the chanting seemed to ease her father’s distress.

Besides the emotional costs of growing up in a hoarded home, children of hoarders bear the responsibility of figuring out what to do with an aging parent who is living in such unsafe and unhealthy conditions. Most children are frustrated and angry after years of unsuccessful attempts to get their parents to do something about the problem. At the same time, they love their parents and are worried about them. Conflicting feelings of love and resentment put the children in an impossible position, and understanding a parent’s problem does not change the condition of the home. One woman on the COH [Children of Hoarders] Web site wrote about how her mother died in squalor, leaving her scarred by shame, guilt, embarrassment, and anger. She advised, “I don’t care what the cost for the rest of you whose parent is still alive and living this way, WHATEVER IT TAKES, have an intervention.”

One of the challenges for this research will be to distinguish what is positive in hoarding from what is pathological. We wonder whether the attention to the details of objects indicates a special form of creativity and an appreciation for the aesthetics of everyday things. In the same vein, empathy with the physical world expands life’s horizons and can give meaning by connecting us to the world and one another. More than anything, hoarding represents a paradox of opportunity. Hoarders are gifted with the ability to see the opportunities in so many things. They are equally cursed with the inability to let go of any of these possibilities, thereby ensuring that few of the imagined options can ever be realized. Hoarding seems to be a symptom of both positive and negative capacities among those who are so blessed and afflicted. With luck, researchers will be able to sort out this paradox and to help people take advantage of the opportunities and jettison the costs.