A number of years ago, I had a job where I made home visits to formerly homeless people who’d obtained permanent housing. It was part of a subsidized housing program put on by the U.S. Department of Housing and Urban Development. The idea was that people who were the most vulnerable out on the streets should be placed, relatively quickly, in apartments of their own and then surrounded with case management services (e.g., home visits from people like me) to ensure they didn’t return to the streets. Prior to entry, potential clients in the program had to meet certain criteria, one of which was that they had to have some kind of diagnosable disability.

Hoarding is and should be treated as a mental disorder. (Photo: Ali West, Flickr)

Quite often, within the subset of the general homeless population that this HUD program served, the diagnosable disability was a mental health issue. Depression, post-traumatic stress disorder, schizophrenia, and on and on. But, and I’m not sure of the correct word to use here—"interesting," perhaps, or maybe "fascinating"—the most interesting/fascinating clients for whom I provided case management were two separate single men, both of whom dealt with hoarding behavior.

As I understand it, there’s still not a consensus within the mental health services community as to whether hoarding behavior is its own illness or whether it’s actually a fairly specific form of obsessive-compulsive disorder. I bet there are pretty compelling arguments on both sides. At least judging from these two particular men, what was clear to me was that there were no easy answers, no magic medication or talk-therapy that could provide a tidy cure, or even that could make the problematic features of the illness easier to deal with.

The hoarding behavior, at least for these two men, was egosyntonic, a fancy word that means, to the ear of a layman like me, they couldn’t tell anything was wrong with what they were doing. The accumulation of items at such an out-of-control pace, with no corresponding discarding of anything, was in sync with their perception of how they functioned best within the boundaries of the world. In fact, the hoarding behavior was so locked into each of their personal values systems that to ask either of them, "Why don’t you get rid of this stuff?" was akin to asking, "Why don’t you cut off your own arm?"

It would only be wild speculation to say where the hoarding behavior came from in each of their lives, what its causes were, why these two men behaved in the ways they did. I’m not sure there’s a consensus on the causes of hoarding behavior among the experts, either—psychological, biochemical, spiritual, probably some combination. I know that one of the men had a tragic upbringing, an upbringing that involved abuse of some kind. So it would make sense to me that he hoarded because he was familiar with how it felt to have things taken from him. Innocence, perhaps, most significantly. The behavior was symbolic, on one level, of just how important it was to him to never again be stripped of something he held dear. With the other man, I just don’t know.

It’s also interesting to note how the hoarding behavior differed between these two men. One was sort of the stereotypical hoarder, like somebody you might see on an episode of "Hoarders." His apartment was filled with newspapers and clothing in haphazard floor-to-ceiling stacks. Things were stuffed into garbage bags and seemingly thrown into the apartment with no rhyme or reason. There was no place to sleep or sit down. The other man collected things and arranged them neatly, and arranged them differently on different occasions. One time I visited him and he had magazines laid out on the floor in an order, as if he were setting them up to sell them at a flea market. The next time I came, the magazines were gone. He kept a collection of ceramic lighthouses displayed on his windowsill. There were toilet paper tubes, none with toilet paper on them, stacked in a neat pyramid. What they had in common was that both of their apartments were so filled with things that they were mostly unusable, at least as habitable living spaces.

If nothing else, the hoarding behavior of these two men highlights the complexities of the human brain to me. I, for one, take for granted how, on a daily basis, this incredibly complicated organ inside my skull allows me to drive a car, interact with other people, digest my food and experience happiness. But when there is something slightly off within the brain, just one little thing—too much or too little of one chemical or another, a slight deformation of this part or that part—a person can exhibit behaviors that society’s mainstream would call bizarre.

Probably it’s the things we don’t personally understand that we label "bizarre." The tangible result of these two men’s illness, what everybody could see, at least, looked very strange. No doubt about it. Accumulated things overwhelming an apartment to the point where the apartment can no longer function as an apartment is a very strange sight to behold. My constant challenge as case manager was to see the two men as adult men, each with their own hopes, fears and goals for their lives. What I wanted to say, each time I visited, was, "Look, just take care of this mess. You’ll be better off"—but it just doesn’t work that way. 

Paul Luikart is a writer whose work has appeared in a number of places over the years. His most recent book, "Animal Heart," is available now from Hyperborea Publishing. Follow him on Twitter. The opinions expressed in this column belong solely to the author, not Nooga.com or its employees.