She conquers the clutter: Ottawa's Elaine Birchall has written the book on hoarding

Elaine Birchall, photographed in a client's home, is an Ottawa social worker and hoarding consultant who is sought after internationally. She has written a book, Conquer the Clutter: Strategies to Identify, Manage and Overcome Hoarding. Julie Oliver / Postmedia

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Ottawa social worker Elaine Birchall can tell you all about people who keep way too much stuff, how you’ll know if you’re one of them and what to do about it.

There are a lot of misconceptions about hoarding, starting with the one that those who hoard are survivors of the Depression or other deep deprivation.

Not true, says Birchall. While there is such as thing as “adaptive hoarding” — people who acquire and save things because they know they’ll need them — the other kind is “maladaptive” or compulsive hoarding. Whatever that person intended to do with all those things, that has broken down.

“Some of the nicest people I know are people who hoard,” said Birchall, the founder of the Canadian National Hoarding Coalition, who has since trained mental health professional health professionals across North America. Her book, Conquer the Clutter, was published this month.

One of those is Lucy, an Ottawa woman who ended up the “curator” of the possessions of seven family members after they died and couldn’t bear to part with any of it without “total anguish.” That included seven sets of china.

“Every piece of china had been passed own to me in a custodial manner. And I was to hold it in the same esteem,” said Lucy. “I got to the point where I couldn’t deal with it.”

Birchall has worked more than 600 people who hoard. Her book, Conquer the Clutter, includes examples of interventions and therapeutic plans for some of the clients she and her “clutter coaches” have worked with.

Spoiler alert: It’s not always happily-ever-after. Lucy is now down to four sets of china. “It’s a work in progress,” she said.

Birchall was hired as a social worker with Ottawa Public Health in 2002 and tasked with continuing the research the municipal agency had started about a new type of referral. “No one quite understood what it was. It felt different. Ottawa Public Health wanted to know what they were dealing with,” said Birchall./

She went into private practice in 2007 and founded Birchall Consulting to work as a hoarding behaviour and intervention specialist.

Hoarding affects so many municipal departments — fire, police, bylaw and public housing, to name a few. “It was a lot bigger than anything we ever imagined. I was getting calls from the fire marshal’s office in Toronto. Hoarding has a direct correlation to homelessness and the risk of homelessness,” she said. “Not every hoarding situation is that severe. But it is a compulsive disorder.”

About 15 years ago, researchers believed that one or two per cent of the population hoarded. It used to be considered a syndrome of obsessive-compulsive disorder, but became a distinct disorder in its own right in the DSM-5, the diagnostic manual of psychiatric disorders, in 2013.

“Now we’re talking about five or six per cent. But that can’t be accurate. I can’t go anywhere without someone self-identifying as hoarding, or telling me they’re worried about someone. Even if it’s only five or six per cent, we need better research,” said Birchall.

There are three paths that put people at higher risk of hoarding behaviour. One of these is genetic. Research shows that 84 per cent of people with obsessive compulsive disorder who hoard have a mother, father, sister or brother who also hoards, said Birchall. “Then you add the power of modelling behaviour. When children grow up in a very cluttered, chaotic environment, they either react with extreme minimalism or they can’t find the skills to simplify their lives.”

The second path is having a high-risk co-morbid factor like depression, social isolation or an addiction. It makes it more difficult for people to manage.

The third path is for those are even mildly disorganized, then becoming vulnerable and overwhelmed. It could be a major event, like a death in the family or a health crisis, or a series of smaller events. Sometimes people acquire and save things to soothe themselves. In other cases, they compartmentalize their lives. “They go to work and pretend that everything is fine, but they go home to a hoarded house. There’s a whole section in the book on online shopping,” said Birchall.

Birchall decided to write Conquer the Clutter because she believes those who struggle with such a private, personal challenge as hoarding disorder have credibility. “I wanted a legacy of the last 18 years of what I had learned professionally, and what I had been taught by my clients.”

Among them was a couple who decided to surrender their three boys to child protective services because they could not declutter their house to make it safe. Sometimes even the threat of official intervention isn’t enough motivation to change.

“The most heart-wrenching situations are those when people know that they are not able to resolve the problem,” said Birchall.

She often gets asked about Japanese organizing guru Marie Kondo’s method of “tidying up.”

“The method of choosing things that ‘spark joy’ is a recipe for disaster for people who hoard. For them, everything sparks joy. There are people who are really motivated by her method and they’re able to maintain it. These are not people who hoard. I had a client who could organize her underwear drawer, but could not apply it to the rest of her home.”

In order to change, people have to change their relationship with their things, so they don’t use them to cope with something else, said Birchall. She challenges her clients to face their fears, beliefs, fundamental values, things that they had been taught as children and their sentimental attachments to their possessions.

“The younger people are when they start the hoarding behaviour, and the longer they engage in the behaviour, the harder they will have to work on their mental processes. At a minimum, I believe people can learn to manage and understand what their triggers are and avoid those triggers. It’s like a diet. Sometimes that chocolate cake is going to look really good. The trick is to know yourself and respect yourself,” she said.

“If you have a one-thing-in-one-thing-out system, then you’re not in danger. But some people can’t discard things. We’re not organizers. I don’t do the cleanup unless the person engages in a counselling relationship. I don’t shame and blame.”

Lucy has been working with Birchall for years.

“There was no shame or condemnation, unlike the (Hoarders) TV show. They go in, they blitz it, and they don’t deal with the underlying issue,” she said.

Lucy has no family to inherit the things that have been entrusted to her. Her way of letting go has been to donate her things, but to choose the charity.

“It was a matter of letting it go in stages and not be torn up about it.”

(Conquer the Clutter, co-written with Suzanne Cronkwright, is available through Birchall Consulting, through next month, and Chapters Indigo in the Ottawa area.)

The five different subtypes of hoarding:

1. Indiscriminate hoarding: These people acquire different kinds of stuff and hold on to it until they are discovered and persuaded to reduce their collections. Given enough time and without treatment, indiscriminate hoarders create personal and public health and safety hazards.

2. Discriminate hoarding: These people accumulate things they see as attractive and valuable. They see themselves as collectors.

3. Combination hoarding: Valued items are mixed up in piles with unimportant things. These people often fail to discard everyday items such as food containers, garbage, newspapers and unused furniture.

4. Hoarding in Diogenes syndrome: Often called “senior squalor syndrome,” this is a situation featuring extreme neglect, domestic squalor and social isolation as well as apathy. These people are often suspicious and paranoid about public officials.

5. Animal hoarding: These people have so many animals that both human and animal health and safety are compromised.


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