92 - Compassionate Decluttering and the Human Side of Hoarding w/ guest Margo Nelson pt 1

When your living space starts resembling a storage unit for sentimental mementos, it might be time to explore the emotional ties that bind us to our belongings. That's exactly what we venture into with the compassionate guidance of Margo Nelson, a psychotherapist with a wealth of knowledge on hoarding disorder. Margo eloquently discusses how hoarding is often misconstrued, when in fact it's deeply rooted in emotional attachments to past memories and future anxieties, leading individuals to find comfort in their possessions.

Navigating the maze of hoarding behavior requires more than a simple tidying up. It's about understanding the person behind the possessions and fostering a supportive environment that's free from judgment. In our conversation, we uncover the creative minds of those who hoard and brainstorm alternative strategies that honor their relationship with their things while promoting a healthier lifestyle. The recent pandemic has brought to light the fragile line between necessity and excess, making this dialogue more relevant than ever. 

As we wrap up, we touch upon the practicalities of living comfortably amidst the chaos, sharing strategies like the 'shoe box' method to help listeners find their ground between sentiment and functionality. Margo's insights are invaluable, not only for those grappling with hoarding tendencies but also for anyone trying to find that delicate equilibrium in life. Stay tuned for our next installment, where we'll be sharing hands-on decluttering tips that promise to bring order to the overwhelming storm of possessions.

Transcript

Speaker 1: 0:51

Welcome back to the Health Hope Harmony podcast. Today, I am joined by one of my dearest friends, margo Nelson. Margo Nelson is a psychotherapist who specializes in hoarding disorder. She graduated with a Bachelor of Science in Art from UW-Madison and a Master of Science in Counseling from UW-White Water, which is how we met. Margo opened her private practice, courage Counseling, in 2017. She works with people who have hoarding disorder, as well as those who are impacted by the hoarding behaviors of a loved one. Her work also focuses on depression, anxiety and grief. Based in Madison, she provides services throughout the state of Wisconsin using virtual services and telehealth.

Speaker 1: 1:35

Because of the length of Margo and I's conversation, I ended up splitting this episode into two episodes. So this will be part one and stay tuned for part two coming next. Welcome, margo. I'm so excited to bring you on the show. Thank you for having me.

Speaker 1: 1:53

Yeah, so Margo and I go way back to 2010. That's what's about, right. I want to say it is yeah, because I don't think we're over close before I got married. That's how I like timeline things. Is it before the wedding? Is it after the wedding? Is it after Anthony? Is it after all these little time markers? So Margo and I went to grad school together and we had been in grad school for a couple of years before we actually had class together and got to know each other and we had mutual friends and people were talking about Margo, this and Margo that I was like I don't know this Margo. And then I met her and I was like, oh my God, I love Margo and since we graduated in 2011, we have kept in touch for the last 12, almost 13 years and, margo, you remain one of my favorite people.

Speaker 2: 2:47

Thank you, Sabrina I write back at you.

Speaker 1: 2:50

You went on somebody else's podcast and shared it on your Facebook feed and I listened to it and I was like Margo is a wealth of information. We need to bring her on the podcast so that she can talk about something that I have little knowledge and skill in treating specifically. So I thought maybe we would start with talking about what hoarding looks like, what we might as like laypeople think hoarding is, and, from a professional standpoint, what is it really?

Speaker 2: 3:21

Yeah, that's a great question. So you can't tell whether or not it's hoarding just by looking at it, because there's a lot of things that look like a hoarded home but that doesn't mean it's hoarded hoarding disorder. There's a lot of reasons that things might accumulate. They might accumulate because there is some sort of physical disability. Somebody is literally unable to physically take out the trash. There might be other mental health disorders happening. There might be too much depression, there might be anxiety, it might be an ADHD issue. There's a lot of things that can be going on that create too many objects in the home.

Speaker 2: 4:02

When it becomes hoarding disorder is when there is a severe discomfort with parting with items that are not useful, functional, sometimes straight up broken and just an excess of things. So if there's somebody who, like you, look at a picture and you're like, oh my gosh, that's totally hoarding disorder and you enter the space and you say I want to clear this out, and they say, oh my gosh, that would be great. Yes, please take out the garbage. Please help me sort through these items and release the clothing that doesn't fit, the clothing that is stained and torn. Please get that out of here. That is not hoarding disorder. That is someone who has lost control of their stuff for some other reason, and those other reasons need attention.

Speaker 2: 4:48

But that doesn't meet the diagnostic criteria. It's when people are holding on to things for reasons that don't necessarily make sense to an outsider. Two main reasons that people hold on to things is because they're holding on to the past or they're preparing for a possible future, and so you have to kind of get in there and find out how somebody reacts to stuff. What makes the stuff important? What does the stuff symbolize to them? Why are they keeping it and how is it being accumulated? How it's being accumulated can definitely be part of whether or not this is a disorder. For example, we all get junk mail. If junk mail is piling up because it kept coming to your house and you didn't have whatever it took to get it into the recycling bin, it's not necessarily hoarding. If you're picking up a heck of a lot of brochures at the grocery store, that might be hoarding behavior. Does that kind of make sense as a difference?

Speaker 1: 5:52

It does, and my brain is looking at this on a continuum. Absolutely so, for, like a comparison, I can feel sad without being depressed. I can have depressed fields and moods without having major depressive disorder.

Speaker 2: 6:13

Absolutely.

Speaker 1: 6:14

And I can feel anxious without having generalized anxiety or agoraphobia or some other anxiety diagnosis, and it fluctuates on that continuum depending on the severity of the symptoms. So people can have hoarding behaviors where we, when these air quotes, collect things, I have a tendency to collect craft supplies or things that I might use in the future for some craft project. Like styrofoam is a big one because it's so bad for the environment that when I come across it I'm like, oh, I can use this in a better way to reduce, reuse and recycle, because we can't recycle styrofoam, right, but I'm not. If somebody comes in and says, okay, we need to clear this out, this is a fire hazard, I'm not going to have a mental breakdown. I can say, okay, get rid of it. How can we do that ethically?

Speaker 2: 7:08

You actually just brought up a really good point that I do encounter. So people will have mild hoarding disorder, like diagnostically hoarding disorder, but not life interfering hoarding disorder. Too much stuff and something happens. There is a loss and they have grief. There is they fell and they broke their hip. There's something that changes. Their ability changes and suddenly what they were keeping on top of enough for functioning, everything just goes downhill and becomes unmanageable and a health hazard. So, staying on top of it when you're able to stay on top of it early interventions it tends not to get better without interventions and it does tend to get worse, as both mental health disorders do get worse with time.

Speaker 2: 8:00

You also brought up a really interesting idea with the styrofoam. Now, if you're willing to get rid of the styrofoam, if it's in any way interfering with your life, that's not a hoarding issue. However, you encounter people that think it's their duty to keep things out of the landfill, and so they'll pick stuff up up the curb because they don't want it to go in the landfill. And whether or not something is in your home if it's junk, it's junk and it doesn't matter if it's in a landfill or in your home You're not actually saving the environment, because once an item has gone from its original state, for example cardboard, can never turn back into a tree. But you do find a lot of environmental motivation among people with hoarding disorder. They do not, as a population, like waste. They want to dispose of things appropriately, to recycle as much as possible.

Speaker 1: 9:02

You brought up some good points and I'm curious and we're not going to diagnose and we're not going to treat on this podcast, because that's not what this is for. But you said hoarding disorder doesn't go away without interventions.

Speaker 2: 9:15

So often hoarding disorder is tied up with some other things. So if somebody resolves their trauma, they resolve their grief. They resolve their grief as a whole of their topic. They get their anxiety well managed. Their depression, their anxiety is in remission. Things can improve when other aspects contributing improve.

Speaker 1: 9:41

And those things don't typically improve without some sort of intervention as well.

Speaker 2: 9:48

It depends upon the cause, Like if somebody is anxious because of a circumstance and the circumstance resolves. I have definitely seen people have incredible improvement in mental health because they changed jobs. So there's just so many factors.

Speaker 1: 10:06

My brain says, oh, that is an intervention, it's just not a therapy intervention that we're doing in the office. You are, of course, correct. Can you share some of the interventions you use with hoarding disorder that maybe you use for without having to actually treat outside of the podcast?

Speaker 2: 10:30

So I always start with creating a relationship. I start working on some other issues that may be contributing. I always say it's not about the stuff. There's grander ideas and thoughts going on besides objects, and so I need to be working with the thoughts and ideas. Eventually, we do work on objects. Whenever I'm working with a client around objects, the client is 100% in control.

Speaker 2: 11:02

A lot of people have difficulty understanding why is this happening? Why are they keeping these things? These things are worthless and they just want to clean it all out. That is horrible. It's going to create mistrust. People will think, well, I'll just sneak it out and they'll never know. Well, if first of all, they probably will know and if they find out, they're not going to trust you again. So it needs to be a slow study process with nothing but love and support and no judgment for the person with too much stuff and the person with too much stuff completely in control. So I start with working with someone, getting to know them, working on some other issues, working on thought processes and how to release objects, and then starting the sorting process of how do we release objects, practicing that and working on that. It is not at all like the shows you see on TV. Please never, ever, treat anybody like the shows you treat you see on TV. It should not be a three day process. It should be a long process where somebody learns new skills, is able to start a different pattern of lifestyles and is able to learn from the experience and resolve some of the issues that contribute. Oh, scarcity is another contributing issue.

Speaker 2: 12:22

People who grew up in scarcity, or even now One of the things that we saw in 2020 is people who had no history of hoarding All of a sudden had 100 rolls of toilet paper. I do not have a history of food hoarding. I don't hoard food. I bought a case of mandarin oranges. That was something that we saw all over the place and even now, one of my friends had bought a whole bunch of dried beans.

Speaker 2: 12:55

People who had never cooked with dry beans were filled their carts with dried beans and within the last year, one of my friends who bought dried beans in 2020 thought maybe I should get them to a food pantry because I don't think I've got to cook them. So people were buying things that they didn't even use because there was such a feeling of scarcity, and people still feel that scarcity to different degrees. For some people they will always have a feeling of scarcity, because for some people the COVID experience was a trauma and one of the things that I'm hoping that came out of the COVID experience is that it helped to create empathy for people who hoard after. Some people who had never experienced scarcity like that experienced scarcity of there's not milk. The store is out of bread.

Speaker 1: 13:52

And when you say scarcity, I'm sure a lot of the listeners already know what you're talking about. But you're talking about this fear of not having enough of whatever it might be, Absolutely.

Speaker 2: 14:06

And there are people who grew up in poverty of various levels and so there literally wasn't enough. I was never at risk of not having enough food, and there were foods that I wanted for a while. They were out of crescent rolls. Why were they out of crescent rolls, I don't know, but there were these weird scarcities and that kind of triggers something in our brain. But people who did not grow up with sufficient items without enough feel that scarcity.

Speaker 2: 14:39

Also, something you see in poverty is somebody will get a new TV. Oh my gosh, the old TV had had these things weird with it. The remote didn't work, so we got a new TV. Cool, but we're going to keep the old TV because it still works a little bit. And if the new TV breaks, we don't have recourse to replace it because there's not enough money to replace it whenever we want. So we should keep the spare one. And my shoes have holes. So I got new shoes. But what if something happens to my new shoes? The shoes with holes are better than having no shoes, and so that's where some of the scarcity comes in, the idea of what if I don't have recourse? What if there's not another one available?

Speaker 1: 15:24

And I think on a biological level that is very much ingrained into human species throughout evolution, of those with resources, those with the ability to access resources are the ones that survive. So it's like this ingrained response to hold on to some of these things.

Speaker 2: 15:48

One of the things, though, that I, when I'm working with people, that I really try to tap into, is, as a population, people with hoarding disorder are incredibly creative. One of the top hoarded items is craft supplies, because it's an incredibly creative population. So I will work with people on. If you didn't have this object, what would you do instead? If you didn't have three microwaves and you were down to one and the one microwave broke, how would you heat up food? Well, let's see, I do have a stove, and my stove comes with an oven, and I have a grill and I have a neighbor. You know there would be other recourses for how you could heat food. Oh, I have a toaster oven. You know, if you have only a toaster oven and a microwave, you can get by without a stove.

Speaker 2: 16:48

I feel like I've gone a bit awry. Ideally, a functioning household has a stove and a refrigerator and all the things to help that, but you can also get by with less. If you run out of coffee cups, you can use a teacup. You can use a tumbler glass. You don't need all of the kinds of glasses. You can drink coffee out of all kinds of different cups.

Speaker 1: 17:17

So it sounds like some of the major or main interventions that you use with clients is building rapport, which is just paramount because we can't go in and make change without having a good relationship and looking at and treating some of those underlying mental health issues, disorders, issues that are going on that might be contributing to the hoarding. And then it sounds like another one you do is a lot of reframing and problem solving.

Speaker 2: 17:49

Reframing and problem solving and building on the assets that the client already has. I think that people with hoarding disorder often get a lot of negative messages about what's going on, and building on those assets can really be helpful. You don't need to reinvent the wheel, you just need to point the wheel in the right direction.

Speaker 1: 18:10

I think that's a great of yeah. You don't need to reinvent the wheel, you just need to make sure it's pointing in the right direction. I kid you not, I just made that up just now. That is awesome. Can we like brand that? That should be like your tagline.

Speaker 2: 18:30

Another thing is you find that people in the population are very generous. A lot of people have accumulated too many items that are actually intended for gifts to give to other people, but then they got lost and the children got older and now you have a onesie for a 12-year-old. The idea of helping people learn to donate, the idea that their items will still be used and treated with reverence, is a very important thing. Like we talked about, as a population they don't like waste. The sentence that echoes from my mom is you get rid of that while someone can still use it, because if you got rid of your VCR 20 years ago, somebody could use it. If you try to get rid of the VCR now, you're going to have to pay a disposal fee. Get rid of it while someone can still use it. Things break down. Clothing breaks down. Clothing evolves. What was a warm jacket 20 years ago, there's different technology now. People want the new technology. Get rid of the warm jacket while someone can use it now, unless you're using it and then please keep it. Oh my goodness.

Speaker 2: 19:44

As a person in Wisconsin, I have what is almost an embarrassing number of jackets, except I use all of them because it's very climate dependent. I have a light jacket. I have a medium-weight jacket, I have a. This is the jacket I typically wear in winter. Everything has gone wrong. It's really really cold jacket. So, as a person who is an expert on hoarding disorder, it may seem like too many jackets, but they do all get used and they do have different, unique functions. That's a thing to think about is does this have a unique function? People accumulate kitchen gadgets like nobody's business. That's where we come back to the creativity pieces. Is there another thing in the kitchen that could serve this function? Is there another jacket that will hold up to that level of cold? Not in my house I don't need three of them, but in Wisconsin I definitely need one of them.

Speaker 1: 20:45

Yeah, speaking of the jackets, that's why I have really liked the ones that come in like a layering set, so that it's got that lighter weight layer on the inside for those cooler days, but then you can put the outer shell on it and now you've got double duty without having to have five different jackets.

Speaker 2: 21:08

Absolutely. Things that serve multiple functions are very helpful to creating fewer items in a home.

Speaker 1: 21:18

Are there things that people tend to have more difficulty with hoarding, or is it kind of independent case specific?

Speaker 2: 21:28

I'm going to say both. I typically try to start working on those basic skills with easier things. Is it okay to get rid of the trash? Is it okay to recycle the magazines that are more than a year old? Trying to figure out what are things that are more easily released, the ephemeral, the sentimental, the acquired history? Oh my gosh, to get those items in the hand Somehow. An object that made it through all the decades, from childhood. That toy is so familiar. You see it, it sets off dopamine in the brain. The idea of getting rid of a toy you haven't touched in 30 years becomes an impossible thought. You really need to work on those skills before you get to the tough choices.

Speaker 2: 22:25

As I sort with people, I typically have a variety of paper bags that are labeled there's trash, recycle, donate and keep. Then there's also a shoe box. That shoe box is for things we're not going to decide on right now because it will completely derail the process. That's going to be letters, postcards, trinkets, pictures. I guess the population I work with tends to be older. There are pictures, there are postcards. It's not all electrical. I know that your generation is a little more electronic In some way. Decluttering computers are a completely different scenario. You're going from having too much stuff to being able to get rid of the things that help the world function. More Typically, having a shoe box of postcards is not what's going to hold your household back from being functional.

Speaker 1: 23:25

You've mentioned that word a couple times functional. Is that a pretty key component in hoarding disorder and when it crosses over into the line of a disorder?

Speaker 2: 23:35

Yes, I definitely encounter people that aren't able to cook because there's too much stuff on the counters. I've encountered people that there are appliances that aren't working but they can't have somebody in to fix them or replace them For the most part, anybody who's going to enter your home for something like a repair. And I've called companies. They say we need a three-foot path. So it's not that they're judging your stuff. They're saying for safety purposes we are not sending our people in there unless there's a clear three-foot path.

Speaker 2: 24:14

So sleeping on a bed that's cleared off, having something go wrong in your bathroom, but you're afraid to tell management of your apartment because you're afraid of what they'll say if they come in and they see what's going on in the apartment when they come to fix a leak. Ultimately, to all apartment owners I recommend check your properties, go in on a regular basis, because that small leak that someone doesn't want to have fixed is going to do some big destruction on property and also it is much easier to work with. This hoard has been accumulating for six months versus this hoard has been accumulating for six years. So I do get contacted by people who own apartments and I always encourage them to be checking their properties before it gets to that level of problem.

Speaker 1: 25:18

I think that's what you mentioned earlier, like that early intervention, yes, and similar with when we treat eating disorders. You know it's easier to go in and treat the problem and the symptoms before they snowball into really big symptoms and problems.

Speaker 2: 25:36

Absolutely.

Speaker 1: 25:38

It's a lot easier to go in and clear off the kitchen counters and start to, you know, organize some of the pictures and postcards and letters before you have 60 years worth of that accumulated.

Speaker 2: 25:51

Absolutely, and one of the drawbacks of the services I offer is I teach skills on decluttering. I teach people how to release objects, how to avoid bringing objects into their home. If you need a really big clean out, as an individual I am not equipped to provide that service. There are people who are equipped to provide that service. They tend to be incredibly expensive and it's an emotionally difficult process. So the earlier yes, earlier intervention is better and I truly believe that interventions can happen at any time. It is never too late to try to create a better situation.

Speaker 1: 26:36

That's it for part one of this two-part series, with Margot Nelson Breaking it down into these two sections so that it stays under that 30-minute mark and you still get to consume all of the information. So stay tuned. Next week, or if you're not listening to this in real time, the very next episode is going to be part two, where Margot is going to share some tips on decluttering.