Is hoarding a type of positive-leaning mood disorder?
That's one of the tantalizing prospects raised by Randy Frost, one of the first behavioral health researchers to treat hoarding as a serious and distinct dysfunction, and colleague Gail Steketee in their enlightening and perversely entertaining look at the condition.
Through their extensive work with hoarders, the researchers have found as a common thread an inability to anticipate the potential negative consequences of acquiring an object. Hoarders can only imagine the pleasure they'll derive from having the thing, being essentially blind to any concerns about clutter, relationship impacts or other liabilities.
In fact, hoarders are so out of touch with negative feelings that they also vastly overestimate how bad it will feel to get rid of an object once they acquire it. They go to extraordinary lengths to avoid the anticipated distress. Smash 'em together, and you have a perfect recipe for accumulating ever-growing piles of stuff.
Other insights from the book:
- Hoarders have remarkable ability to visually acclimate themselves to their chaotic environments. They only notice the mess when they see others struggling with it, which is part of the reason they seldom invite people in their homes.
- There often are profound social deficits underlying hoarding. Ask a hoarder why they're saving something, and more often than not they'll cite it's imagined use to someone else. (Even though such things seldom if ever get to that person.) Limited in their ability to communicate emotions directly, the thinking goes, hoarders rely on objects as emotional intermediaries.
- If you're running a support group for hoarders, do not have literature to hand out
OK, it took me a while to get around to this 1990s bestseller. And one wonders how relevant portions of the text are, given the major changes over the past decade in the types of psychoactive medications available and especially in the way they're prescribed.
Certainly, the book's central question about the mutability of personality, particularly via chemical adjustment, no longer seems all that compelling or questionable. Of course the personality is malleable, though use of any number of tools. In the case of Phineas Gage, it was an iron rod through the skull that turned him into someone else. Nowadays, a prescription allows for more precision in personality-sculpting. Morality doesn't really seem like a valid concern as much as efficacy -- does it help the individual?
What was more interesting to me in this idea-dense tome was the notion -- and one that largely remains true through the present day, I think -- that psychiatric diagnosis is largely a matter of reverse engineering. You have a drug that relieves symptoms of a certain condition. If the patient responds to the drug, he probably has that condition. If not, look for something else.
Seems like a remarkably crude way to diagnose anything. Imagine if any other part of medicine worked that way. The opthamologist does a little slicing, you can see better afterward, so you must have had a cataract. A surgeon removes your appendix, your abdominal pain fails to subside, so he has to dig around for something else.
How long will it be before a doctor can take a blood draw, make a precise analysis of the person's neurochemical soup and prescribe accordingly?
