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I’ve worked with hoarders living in houses filled with rotting food and dog feces, and hoarders living with dozens of animals running all over the house. I’ve helped hoarders let go of their beloved collections of handbags, handguns, and dead rats. The truth is that some recover, and some don’t. Hoarding is a serious mental illness, and sometimes “recovery” is a relative term. But I have learned what the challenges are and how to address them. I have seen what the critical elements of success are for any hoarder, and how those elements can combine to give a hoarder the best chance at de-cluttering.

I can help families and others working with hoarders maximize the hoarder’s chances for getting and staying clean. It’s a long and arduous process, and I will explain how to stay patient and positive for the months, and sometimes years, that it takes.

The key is hope. As long as everyone involved believes that the hoarder’s life can get better, it truly can.

Because some of the stories I tell in this book are deeply personal, I have changed the names and identifying details. Some are composites, but all of the stories are true.

1

WHAT IS HOARDING?

Margaret is a classic, stereotypical hoarder who had clearly given up years ago. Living in a threebedroom, double-wide trailer home in rural Idaho with too many dogs to count, she had been without electricity or running water for years. The floors were damp with brown muck. Decomposing trash was piled up to five feet high, through which narrow walkways gave limited access to each room.

In the kitchen, flies swarmed the windows and clung dying to a strip of flypaper hanging over the sink. None of the appliances worked except for one microwave that had been stacked on top of a broken one. All of the appliances and cabinets were smeared with unidentifiable black and orange gunk. Dust and cobwebs covered the walls and hung from the ceiling. The bathrooms were just as bad. A bucket of murky water sat next to the toilet, to pour into it for flushing.

The dogs had clawed and chewed away the bottom half of each bedroom door, and they ran through the house and romped wildly on the beds, rubbing their dirty fur around on the bare mattresses. The few chairs were scratched and chewed.

The smell was overwhelming—a mix of urine, rotting food, and dog feces. It was hard to have a conversation over the constant barking. Brown smears coated the walls and windows, and the sagging ceiling had completely fallen in places.

Margaret was a large woman of an indeterminate age, with messy hair pulled back in a ponytail. Every day that we were with her, she wore the same permanently stained T-shirt and shorts, which didn’t cover the open sores on her arms and legs. She never smiled or even made eye contact with any of us. She didn’t seem to care that she lived in conditions worse than in many third-world countries. Margaret is what most people think of when they think “hoarder.”

But there was a time when Margaret wasn’t much different from two of my other clients, Brad and Ellen, a middleclass couple raising three small boys in a pretty suburban neighborhood. Ellen was a typical frazzled mom, who got her daily exercise chasing after the kids. Brad was a mellow guy, with dark hair and a little bit of a paunch under his button-down and khakis. The whole family was clean, well dressed, and friendly.

Their house was cluttered—but not the stereotypical place that one associates with classic hoarders like Margaret. There were piles of clothes, toys, papers, and mail that looked like someone meant to get to them a few weeks ago but had gotten distracted.

The telltale sign of hoarders-in-training: The piles were in every room.

Brad worked with computers, and he had saved a lot of his cast-off electronic equipment in the basement, thinking someone might use it one day. Ellen had been a teacher and had kept many of her old supplies and now-outdated workbooks.

Ellen was having trouble keeping up with laundry, with stacks of dirty and clean clothes on the chairs and