By middle age, your face tells your life story, and Debra Kricensky has smiled a lot more often than she’s frowned. Most days, it’s effortless. But the first time she entered a hoarded home, she made a deliberate effort to keep that pleasant countenance set: no widening of the eyes, no jaw drop, not the slightest hint of recoil from the mess before her.

Slowly, the homeowner opened up. Once a distinguished banker, he said, he’d been blackballed for refusing to tell a fib. And then his mother got sick and died. And then his wife told him she was a lesbian.

His depression was obvious. So was the drinking—and Kricensky thoroughly understood the need for solace, however self-destructive.

She and the police officer were the first people he’d let inside his home in a long, long time. Squirrels were eating the wires, and an ornately carved mahogany grandfather clock lay toppled on its side in the entryway, denting piles of rubbish. The plumbing hadn’t worked in months, so—?

“I poop in bags,” the man said, shrugging matter-of-factly, “and bury them.”

Kricensky’s own home is orderly and immaculate. She felt an overwhelming wave of sympathy: This had to end. She wanted his place cleaned up so he could stay there and find a little happiness again. So rather than dump a lot of smug advice and run, she rolled up her sleeves, and together, they managed to restore his home to order.

An X-ray technologist by training, Kricensky started volunteering with her subdivision’s neighborhood watch 19 years ago. She’d shown up because she was worried about security—her home had been broken into—but at the meetings, she kept hearing complaints about problem properties: the foul odors that streamed from them; the cockroaches that crawled out to visit the rest of the neighborhood. She couldn’t help but think about the property owners who were living in that hell. Maybe the next time St. Louis County had to issue a formal eviction notice, she could tag along? Sure, she knew she was risking nightmares afterward, bacterial contamination, hantavirus from rat droppings... But she wanted the news of eviction to be paired with an offer of help.

Kricensky was so nonjudgmental, so patient (“More than with my own family,” she admits, sounding a little puzzled), and so consistently effective that in 2006, the manager of property maintenance said, “I think we ought to hire you.”

When Stuff Takes Over

“My ditzy friend reported me,” says Jan [a pseudonym], still annoyed. “She got upset with my house looking the way it was. The firemen and police and a social worker knocked on my door and said if I didn’t open it—”

“We don’t know for sure who called,” Kricensky inserts gently. “Hotline calls are anonymous.”

“I know,” Jan insists. “Anyway, all the social worker did was give me a book for old people” (listing housing options for seniors). “But they got me to her.” She nudges Kricensky, who’s sitting next to her in an orange booth at Denny’s. “She’s one of my best friends now—because she stuck with me.”

Hoarding happens behind closed curtains, and it can stay invisible to the outside world for a very long time—until some sort of crisis brings it to the state’s attention. In this case, it was the threat of foreclosure. “My sister and two daughters made sure to clean me out so the bank wouldn’t seize my stuff,” says Jan. “They waited till I wasn’t there. So I walk into the house and everything is gone.”

She was too depressed to think about moving. But now most of her furniture was gone, so the stuff she’d had piled on the table just stayed on the floor…along with other stuff that would have been crammed into a drawer…and tons of junk mail, because her name kept being sold… “Things were kind of hodgepodge,” she says, sneaking a glance at Kricensky.

“They were…relaxed,” Kricensky agrees.

That was the year Jan lost her job, and her beautiful 3,000-square-foot house flooded with sewage three times, and she fell behind on all her bills, and her car started giving her trouble, and the antidepressants drifted like feathers into the abyss. She sat in a chair most of the day, watching Ellen DeGeneres over and over again, hoping for a chance to laugh.

These days, she’s feeling brighter, hopeful enough to take hold of her life again. She’s been living with her sister—who, she says, also hoards. “We came from a home that was cluttered anyway, because our parents were Depression babies—my mother could get blood out of a nickel—and our generation had the money to buy more.”

Jan collects Lladró, Hallmark princesses, ivory horses, wooden horses, Lenox, Waterford, and Wedgwood but also vast quantities of Tupperware, any plastic jar with a nice lid, and all possible paperwork. “I learned by going back and back and back to court with my divorce that if it wasn’t on paper…” She says she worked for years as an efficiency expert for the U.S. Army: “When I do organize, it’s meticulous, but I don’t do it at all if I can’t do it right. I want perfection.”

Meanwhile, she’s renting four storage spaces, and she’s not even sure what’s in them. (She’s not alone. According to the 2015–16 Self Storage Industry Fact Sheet, there are 60,000 primary self-storage facilities in the world, more than 48,500 of them in the U.S.—roughly 2.5 billion square feet of rentable space. Everyone in the country could fit under that canopy. Almost 10 percent of American households—most in homes with garages, attics, and basements—rent at least one storage unit.

I ask Jan why she hangs on to so much stuff.

“Because somebody gave it to me—my mother or my Aunt Jo, or my sister when she traveled in Europe and Japan,” she begins. “Or it’s my kids’ schoolwork from kindergarten. Through eighth grade. Through college. Or I’m saving things for the church. I save everything just in case I’m going to use it or I can give it to somebody else. We’re a throwaway society. But see, the trouble is, you keep everything because you’re going to do something with it, but you never do it because you’re so busy keeping things.” She pauses. “It’s not an impulse,” she says, her blue eyes steady on mine. “It’s a need. It’s a need to control your environment. A need to control yourself.”

Why Hoarding’s Increasingly Prevalent

For a month, every single time somebody asks what I’m working on and I name the topic, a shadow crosses their face, and they tell me about a family member or friend who hoarded. No way is this disorder affecting just 2 to 5 percent of the population, the longstanding official estimate.

“It’s largely a hidden problem,” agrees Max Zubatsky, assistant professor in family and community medicine at Saint Louis University and an advisory board member of The Hoarding Project. “Individuals don’t seek treatment.” Until a family member or neighbor forces the issue, the person just keeps acquiring. Stuff is private, idiosyncratic. It lives outside the shared economy. People withdraw and stop letting anyone into their home, so there’s no reality check. The clutter creeps up on them, and they just keep managing, swimming like the frog in that simmering pot, not noticing it’s reached a rolling boil. “So it’s underdiagnosed,” Zubatsky concludes, “and we’re starting to see more prevalence, for a lot of reasons.”

We’re a consumer-driven society so glutted in stuff that even our landfills are full. Everywhere you look, temptation dangles, sales and swaps and Freecycle and bulk pickup in city alleys.

And as older adults live longer and stay in their own homes longer, many surround themselves with objects they just might need or can’t manage to sort and discard. They’re lonely and find the stuff comforting; they’re scared and find it reassuring. Their kids then inherit houses crammed with possessions, even as they’re wading through all their kids’ toys and games and gear.

If you Googled “hoarding” in 2011, you would have pulled up about 2.5 million hits. Today, you’ll get 47 million.

The continuum of a hoarding disorder stretches from a “clean hoard,” out of control but not contaminated or infested, to frank squalor, in which people let garbage and rotting food pile up around them. At that extreme, they’re often also suffering from paralyzing depression, dementia, or psychotic delusions.

In between swirl all sorts of variables, from consumerism and childhood influences to neurobiology and personality.

Genes definitely play a role: In an early study of hoarding disorder, almost 85 percent of the participants had a close relative with similar problems. A study of more than 5,000 pairs of twins estimated the heritability of severe hoarding at 50 percent. In families with two or more members who hoard, researchers have found a link to an allele on chromosome 14.

In Stuff: Compulsive Hoarding and the Meaning of Things, pioneering researchers Randy Frost and Gail Steketee write: “One possibility is that hoarders inherit deficits or different ways of processing information. Perhaps they inherit an intense perceptual sensitivity to visual details [that] give objects special meaning and value to them. Or perhaps they inherit a tendency for the brain to store and retrieve memories differently. If visual cues (i.e., objects) are necessary for hoarders’ retrieval of memories, then getting rid of those cues is the same as losing their memories.”

And if that’s the case, then asking them to pitch stuff is like asking them to give up chunks of their past.

The brain’s responses play a role, too: In one study, people with hoarding disorder had lower-than-normal activity in the anterior cingulate cortex, the part of the brain that connects emotions with focused decision-making. Yet when they were faced with the possibility of discarding one of their own possessions, the activity in that part of the brain shot way above normal.

There are other patterns and cross-connections: Some researchers have observed a shortage of the neurotransmitter dopamine in people who hoard; others point to a disrupted serotonin level. Severe anxiety and depression, which also have a neurobiological basis, often coexist with hoarding disorder. So can Tourette’s syndrome and traumatic brain injury.

Just as people who hoard often churn through piles, picking something up and then, unable to sort or discard it, setting it back down again, researchers churn through various explanations. It’s likely that there is no neat solution; that these explanations are all true to some extent, in some instances. In other words, hoarding disorder, true to its nature, has an accumulation of causes, and if there’s an underlying order, it’s difficult to discern.

Traits That Predispose Us

Who hoards? We all do. Some of us hoard praise; some hoard fun; some hoard shoes. But when hoarding becomes a disorder, excess and friendly clutter are weaponized. Over the years, Kricensky’s noticed patterns in the traits that can contribute:

1. Perfectionism that makes it daunting even to begin organizing, because you’ll never have enough time or the ideal conditions.

2. Procrastination that keeps people from completing the projects they dream up or following through to move an object out of the home. Someone might thoughtfully save a kitschy ashtray he just knew his friend Dolores would love—but never give it to her. “The heat of the moment is important to understand,” says one of the therapists Kricensky enjoys working with, Alec Pollard, director of the Center for OCD and Anxiety-Related Disorders. “When you’re tempted to get or keep something, all yourcognitive energy goes into justifying the acquisition. We trick ourselves—and then later realize the trick. They may realize, ‘Oh, Dolores won’t really want this.’ Or Dolores may say, ‘Absolutely not.’”

3. Fear of losing one’s memories. Why does somebody save a cream cheese packet for a quarter-century? “Because it brings back a good memory, maybe a lunch with a friend,” Kricensky explains. “It touches their heart. And if they toss that packet, they’re afraid the memory itself will vanish.”

4. Difficulty focusing and concentrating. Many people who hoard have ADHD, so “they may need more time to make a decision, but at today’s breakneck speed, there isn’t time,” says Denise Lee, a certified professional organizer whose company is called Clear Spaces. “So what do you do? You don’t make the decision. Things pile up because the demands of life have outstripped your ability to cope with them.”

She’s learned to frame decisions in whatever format won’t overwhelm that particular client. One woman shut down at too many choices, so Lee quickly sorted a pile of socks by color and took out two at a time. “Between A and B,” she said, “which do you like?” Even that was a mistake: “Like” opened up way too many paths. So Lee hastily reframed, asking the client what she needs in a pair of socks.

“Well,” the woman said, “to be warm and comfortable.”

“OK, which pair is warmer?”

“Oh, this one!”

Along with indecisive-ness, people who hoard often have real trouble categorizing and prioritizing. It’s as though everything weighs the same—a $100,000 stock certificate, a third-grade report card, a July 1962 National Geographic... Each seems important; it can’t possibly be lumped with others like it. As a result, all the National Geographics don’t live together on a shelf, which would make it obvious that there are three copies of July 1962. Instead, that July 1962 issue is in the southwest-corner pile, 3 inches from the bottom. Lee calls this “sorting by geography.” Memory is spatial, and it’s often uncannily accurate. But the order’s invisible, so other people barge in and mess things up unwittingly.

A Question of Proportion

Kricensky loves the story of the woman who was so sick of her adult daughters’ telling her to get rid of her magazines, she went to the bank, drew out cash, and started sticking a $10 or $20 in every magazine. They piled up higher and higher. When she died, her daughters raced over with a dumpster, eager to clean the place out. They carried out the magazines by the armful. And when the dumpster was too full to drop in a stack, they slung them—and greenbacks whirled free.

They had to empty the entire dumpster.

They counted $10,000.

That woman just liked her magazines—and wanted the last word. But often, hoarding’s motives are nobler: Waste not, want not. Someone might need this. You might need it; you have to be prepared for an uncertain future. You’re responsible for it. It could be worth money someday. These are practical bits of wisdom, corrections to a throwaway society. There’s strong sentiment, a sense that each object carries potential and meaning and memories. There’s also a supercharged ability to imagine a million cool uses for somebody else’s trash. “Maybe,” write Frost and Steketee, “hoarding is creativity run amok.”

Opening a talk about hoarding disorder, Lee holds up a plastic soda bottle top. “Think of all the things you could do with this,” she challenges her audience. Table for a dollhouse? Drinking bowl for a sparrow? A cookie cutter for Yorkie dog treats? People who hoard see potential where others see trash. Aglow with ideas, they pile up future reclamation projects, too many to ever tackle. “Or they have this anthropomorphic relationship with things,” Lee adds. “They believe the thing has feelings, and purpose.” She mentions a client’s cardboard shoebox, which apparently was destined to have a useful life of far more value than temporarily containing a pair of shoes. “By keeping it, they are rescuing it from loneliness, saving it from a landfill.” She waits a beat. “And now the landfill’s their home.”

When the adult children of her clients call, spluttering with frustration, Lee urges them “not to apply logic where there is no logic. This is emotional.” When I ask how she stays so calm, she smiles. “One reason I enjoy working with hoarding is that the people are often very deep. They’re very interesting folks, and they’re thoughtful. Being creative is a good thing. Being frugal is a good thing. With hoarding, it’s all just turned on its head.”

Pollard agrees: “The problem’s not the irrationality of any individual belief that drives their behavior. The problem is the place those beliefs and priorities take in the person’s life. It’s disproportionate. The beliefs are held in such a perfectionistic way that it’s at the cost of other priorities, like family life or having people over.”

But what made those beliefs harden and expand?

Pollard’s a cognitive behavioral therapist, more interested in pragmatic help than speculation. I hammer him with theoretical questions, like a 3-year-old asking, “But why?” and he repeats, “We’re not sure,” slowly draining his ample reserves of patience. Science isn’t very far along in understanding hoarding disorder. “Fortunately,” he reminds me, “a lot of the advances we’ve made in behavioral treatments don’t require knowing the cause,” he says finally. “We’re interested in what maintains the disorder, what keeps it going.”

Avoidance tops that list: “The more they avoid dealing with it, the worse the problem gets, and the more overwhelming it is to even think about dealing with it.” There are also some mind-bending paradoxes at work: Our brains are biased to endow an object with higher value just because we own it. And every time we consider parting with that object but don’t follow through, its value to us notches up a bit. It must be cool, we decide subconsciously, or we would have tossed it.

Procrastination is based in fear and anxiety: What if I need it? What if it’s irreplaceable? What if I’m being wasteful? But beneath that agitated surface lies a deeper fear, says Pollard: “the belief that if you part with this object, your emotional experience will be unbearable.” And because we keep avoiding, we never test that belief—so it never goes away.

Treatment begins with motivational work, Pollard says, “because as a group, folks with hoarding disorder tend to be less motivated and less willing to change. They’re not always suffering; it’s the family members who are suffering.” Once motivated, you identify what beliefs and priorities led to the chaos. Third comes “acquisition control training... There’s no sense throwing things out the front door when they’re still coming in through the back door. That’s a big mistake even Oprah made when she sent the professional organizers in.” The fourth step is learning organizational skills—and only then should a client whip out the sheets, draping large areas to make it possible to focus one manageable area at a time, and begin the actual reorganizing.

Life’s Twists and Turns

After years of this work, Kricensky has learned to accept its paradoxes like they’re Zen koans. She’s stopped being surprised when people are ashamed to let even a repair person into their homes yet adamant that they don’t have a problem. When people so cherish their belongings that they pile them in festering heaps. When people are so eager for control over their stuff, they can’t see that it’s controlling them. When they think what’s crammed into their cars and homes will hide them from the world, and instead it exposes them. Praised to the end of the earth when they clear a shelf—“Oh, that’s beautiful!”—they fill it again the minute she leaves.

Hoarding’s not just about acquisition. It’s about filling emptiness.

And it’s a disorder of excess.

“Say there’s a death in the family,” Kricensky offers. “They want to hold on to everything. One client had two houses, inherited from family members. She had a hell of a life, raised kids on her own, lived between the houses, and now her family was saying, ‘We have to get rid of all this stuff and sell these houses.’ Well, a lot of the stuff in there was hers, and she was so attached to it. It was causing her so much stress, but she couldn’t see that.”

They wouldn’t finish as fast as her family wanted, Kricensky told her client. “Look how many years it took to accumulate. But just think what it will be like when we’re done. You are going to be able to use your stove and your refrigerator. Sit on your couch and watch TV. Sleep in a bed.”

Until now, the objects in the way felt too charged with memory, with love, to just toss them aside. The hoard becomes inextricable from what it represents—and sometimes, from your very self. It’s as though your identity is projected outward, onto that heap of stuff, and tethered there with nylon cables. Throwing something away is like sawing off a piece of your soul.

Displacement—as a refugee or by a natural disaster—can also make hoarding more likely. Lee sees a lot of loss and PTSD in her clients: “In that very vulnerable moment when we’re in their home, they will say things that would not necessarily bubble up in a therapeutic session. And sometimes as we’re digging, I’ll notice that everything on the bottom layer is from 1984, and I’ll say, ‘What happened in 1984?’ and they’ll say, ‘Oh, that’s the year my mother died,’ or ‘I had this terrible accident.’”

So they built a barricade to protect them from pain—and now it’s made them more vulnerable than ever. Or maybe that’s just a poetic attempt to inject meaning into the chaos?

“We kind of throw around this picture of people insulating themselves from the world with their stuff,” Lee observes. “I think from a practical point of view, it’s more that your brain just isn’t working the same way. Some trauma affected the way you look at the world and the way you make decisions. Maybe your self-esteem is low, or your executive function’s a little cloudy.”

Criticism, real or imagined, can also be paralyzing. Lee was helping a client go through stuff in her basement, and suddenly the woman stopped short. “It’s the committee!” she blurted. She’d often hear her mother’s voice in her head, criticizing every move she made—and not only her mother but other women from the same generation—and whenever this happened, she’d hover, unable to decide. With Lee by her side, she was finally able to laugh about it.

Another client kept showing Lee what she called “guilt gifts”—presents from her husband while he was having an affair with someone else. When she found out, she divorced him. Years had passed since. Now she sat back on her heels and said, “I just realized that it’s ever since that messy, horrible divorce that things really got hard for me.”

Lee smiled. “You have turned a corner, my friend.”

Entering a Hoarded Home

Kricensky’s sitting in a booth at Chevys Fresh Mex with Jaime Tiff, who helped her grow the St. Louis Hoarding Help Coalition and now works for SERVPRO, an emergency cleanup service. The women make it through an entire bowl of chips and salsa before they realize that the young man they’re meeting is seated at an adjacent table, waiting for them. Kricensky’s face lights with pure relief. She needs this guy.

Young, earnest, and gentle, Scott Morrow is a licensed clinical social worker who told Kricensky he’d be willing to go to people’s homes. She’d been looking high and low for someone who’d do this. Morrow’s presence would counter her clients’ excuses to duck therapy (no gas money, snow, an achy back…) and prevent them from minimizing the hoard or exaggerating their progress.

When she and Morrow first spoke by phone, though, he said, “Now, Debbie, I’m kind of limited.” Oh, crap, she thought, here we go. Then he continued, “I can only do it evenings and weekends,” and she breathed again. “Not a problem!” she assured him gaily.

“You have to be able to see it,” she says now, carrying her purse and chips and salsa to Morrow’s table and settling in. “Even the judges in mental health court often don’t realize the magnitude. They see this poor older person coming in being picked on, because usually someone has reported them.”

What’s the solution?

“Come to the house at least once!”

I envision a judge lifting black robes, stepping gingerly over that threshold.

“I’d also like to see the courts require weekly visits with a mental health professional,” Tiff chimes in. Without therapy, she says, people slide right back to where they were. Or, if it’s been a forced cleanup, the hoarding worsens as they try to fill that space again.

I mention an episode of Hoarding: Buried Alive about twin sisters who worked in a cake mix factory in southern Illinois. Their home was condemned, so Hoarders put them up in a hotel—and they stacked the room to the ceiling with new purchases.

That reminds Kricensky of her stint on an episode of Hoarders: “The 1-800-Got Junk? boss, a really tall guy, was in the kitchen, leaning up against the sink, and the floor had rotted, and it broke through. Thank God there was metal shelving right below in the basement. All of a sudden he’s standing on it, several feet shorter than the rest of us.”

The stories go on, graphic and wry but not funny; hoarding’s a lousy source for schadenfreude. Kricensky emphasizes the need for tact. “If it’s my first visit, I don’t want to come to the door in a Tyvek jumpsuit.”

They talk about Zubatsky (all three know him; this is a small, tight world) and his point that hoarding cuts across gender, race, ethnicity, socioeconomic standing. The eccentric, impoverished old cat lady is only a stereotype because women live longer and are less reclusive. As for the assumption that hoarding happens at the poverty level, it couldn’t be less true.

“It’s a matter of getting caught,” Tiff says. “Wealthy people can pay someone to maintain the outside of their house, and nobody sees the inside.”

Replacing Relationships

The smell wafted from the house, so pungent, it caught you as you entered the cul-de-sac. There was a fan in the window, but it was so thickly coated in cat hair, it was barely visible. Kricensky drew a deep breath and walked inside, nearly running into a Rubbermaid tub in the hallway with a dead cat decomposing atop the lid. Inside the washing machine, another cat was liquefying.

They ended up taking out almost 200 cats, dead and alive.

“Animal hoarding feels like an entirely different kind of hoarding,” Kricensky says, “but I’ve seen them overlap.” There are also a few core similarities: the good intentions, the impulsive acquisition, the sense of rescuing something from a worse fate, the inability to see the hoarding as a problem—and the speed at which it spins out of control.

In this case, “it all started with a traumatic event,” Kricensky learned. “Afterward, she felt no one was going to ever love her. Then she saw a sign: Free Cat! A light bulb went on. She adopted the cat, and it worked so well, she got another one. And another. And then they were breeding”—and spaying or neutering seemed less and less doable as the numbers grew—“and it got out of control.”

Even love can get out of control.

Kricensky’s matter-of-fact cheer slips a little when she talks about the kids, spouses, and siblings who belittle her clients. Not long ago, she stood there gritting her teeth while a relative said, “You need to get this shit out of here. You live like a pig. Can’t you see how this is upsetting me?”

Oh, she thought, we’re all about you now? What bothers her is the casual cruelty of these remarks, the self-righteous obliviousness to their consequences. “A lot of times I have to undo what the family has done to them,” she says. “I become their ally, because I just keep focusing on the positive. And it’s the truth. These people are so kind, so intelligent. They’re not bums on the street; they’re highly educated. And they have not always lived like this. I’ve seen photos of their houses before.”

Lee’s just as defensive of her clients. She makes it a point to talk to spouses ahead of time, because if they’re not going to be supportive, the project’s doomed. One woman cleaned out a small space—a long-awaited triumph—and her husband blurted, “Well, yeah, but what about the rest of this stuff?”

“He was really frustrated, too,” concedes Lee—and maybe a little panicky. Hoarding’s a stubborn phenomenon, and it’s scary: You can’t even wait for the person you love to hit bottom. They’re cushioning their own fall, suffocating so slowly, they don’t care. And speaking your mind too bluntly can make the problem even worse.

“In our culture,” Lee says, “there’s this idea that shaming is the way to institute change, when in fact, shame’s on the same circuit as the reward system, neurologically. When that’s engaged, behavior is reinforced.”

Kricensky can be dismissive of professional organizers. In a hoarded home, they’re out of their depth, and their pretty shelves and baskets sink fast. But a few, like Lee, have mastered this.

One because she had no choice.

Growing Up Inside the Hoard

Mandy Manley’s easy to talk to, ready at any moment to laugh at herself or cry for somebody else. She calls her company Skeleton Key Organizing, “because that’s the key that unlocks every room in your house.” Her motivation? She grew up in a house packed floor to ceiling.

“If a friend came to pick me up, I’d make sure I was on the porch ready to go,” she says. “I didn’t even want the door open, because you could see it. We had our windows covered. When I got a little older, if a boy wanted to pick me up for a date, I’d walk down the street and have him pick me up at a different address.”

At first it had been fun going with her dad to “estate sales, garage sales, yard sales, any sale. It was treasure hunting. But then his mother died, and soon we had what people call deer paths,” narrow openings to navigate between the piles. I carved out a little reading cave, like an igloo, with clothes draped over the top.” Back then, there weren’t any reality TV shows, and no one talked about “hoarding.” Kids used to take pictures of her dad’s hoarded car—complete with a spice rack on the dashboard for fast food—and post them on Facebook.

“It didn’t make me not love him,” she says. “I just knew: I will never live like this. My mom was miserable; she just kind of shut down. She’s very social, but they didn’t have many friends. There’s a sense of hopelessness that sets in.”

Manley lifts her coffee cup halfway, then sets it down again. “Some people think, ‘Oh, they’re as happy as a pig in a sty,’ but they are not. There’s anxiety that someone will get in and steal their things. They’re ashamed. Depressed. No one would say to someone who was alcoholic, ‘Why can’t you just not drink?’ But this is also a chemical difference in a person’s brain. We make them feel terrible about it, and those bad feelings lead directly to them obtaining more things because it feels good; it’s soothing.”

Why are we so quick to condemn this particular phenomenon? We know that germs and bugs and rodents can make us sick. That part’s primal. But why does even a clean hoard trouble so many of us?

Maybe for the same reason Marie Kondo’s sparks of joy have sparked a craze: We’re all overrun with stuff. Our closets are crammed, our basements filled with tubs we forgot to label.

I ask Manley why seeing it magnified makes us nervous. Her dad held on to stuff. He loved history, she says. “Some of it’s documentary. It marks the passing of time. Significant events. Or people remember where they were when they saw that. They worry that if they get rid of the object, they’ll be dishonoring the past. Even a gift they don’t like—it’s ‘How could I get rid of that? Aunt Bessie gave it to me!’ And so it stays, even after Aunt Bessie’s long dead. Out of some sense of false chivalry, they hang on to things. And then they die, and all the stuff’s trashed or sold at auction anyway.”

Her dad also thought his books, magazines, CDs, coins, and stamps would increase in value. “He might’ve even thought that someday he was going to set up a museum,” she says. “It never happened. It never was going to happen.”

Why do so many good intentions fall by the wayside? “Too many ideas. That one idea was great, but pretty soon, it’s buried, and you’re overwhelmed; you don’t know where to start. I tell my clients, ‘Try not to let the buying outpace the doing.’”

Manley isn’t convinced that spatial mapping is at play as the piles build up: “When stuff’s creeping up the walls, pretty soon it’s just, ‘Where’s a hole the size of this thing?’”

I ask about something else that puzzles me: the number of unopened packages in many hoards. She nods. “I call it the dump and run. You might go to Target for trash bags to start cleaning, and then you see something on sale, and the cashier says, ‘Ooh, you got a good deal,’ and you drive home and the sun’s shinin’ and the birds are singin’”—she’s from Kentucky, and the soft twang returns with emotion—“and then you open the door and realize you have nowhere to put it. And all the good feelings melt off, and you get that warmth of shame in your face, you can hear your heart beat, and you think, ‘Oh my God, I’ve made it worse. I’ve made it worse again.’ So you drop the bags and go do something else.”

How does she manage doing this work? Doesn’t it trigger too many memories?

“I definitely feel their anxiety,” she says. “My chest gets tight when I enter their home, because I feel the pain of them saying, ‘You’re the first person I’ve let into my home in 12 years.’ But I want to take the pain I experienced and turn it on its head. I want to be the person who didn’t judge—because that’s the person who’s going to help.”

▸ A DISORDER ALL ITS OWN

It wasn’t until 2013 that severe hoarding emerged as a psychiatric disorder in its own right. Until then, it was a subset of obsessive-compulsive disorder—a mistake now painfully obvious. At least twice as many people have hoarding disorder as have OCD, and studies have shown that 80 percent of them don’t even meet the criteria for OCD. Its compulsions are driven by fear or anxiety; hoarding’s more like addiction, its negative emotions punctuated by a thrilling little burst of endorphins at each acquisition. Genetic studies of hoarding and OCD show a different pattern of heritability. Brain scans show a different pattern of activation. Medications that work for OCD do nothing for hoarding disorder.

When severe hoarding was given its own section in the Diagnostic and Statistical Manual-5, Debra Kricensky compared the criteria to her own experience:

Acquisition of objects that are not needed and, in most people’s opinion, have little or no value. Like the used tissues, old receipts, and sticky peppermints one client used to dump out of her purse and save. She had stacks of these boxes. “We sure could make some progress if we went through these,” Kricensky ventured. No dice.

Persistent difficulty parting with these objects and severe distress at the thought of discarding them. One day, a dumpster driver called Kricensky’s cell and said, “She won’t let me take the dumpster.” Sighing, Kricensky said, “Put her on the phone.” The woman had found a box of teabags she wanted in the discard pile. Alarmed, she was now insisting on combing through the entire dumpster. Kricensky wasn’t entirely surprised; a previous client had ordered a dumpster emptied right back into the house. That time, Kricensky needed a few long, calming breaths. “You were with me when we made these decisions,” she pointed out. “Well,” the client said, “I changed my mind.”

Homes with rooms that were no longer functional. One woman was so excited when she saved up to buy a new stove. “I’m going to bake cookies!” she told Kricensky—who was staring at the niche from which the old stove had been removed, now packed solid with objects, newspapers, containers of partially eaten food, and filth.

Lives that were no longer functional—or were sharply endangered. “Psychologists will tell me, ‘You can’t make somebody get rid of their stuff,’” Kricensky says, “and I say, ‘Well, we have to make them if they want to live in their house. It’s a fire hazard. There was one up in Spanish Lake, the guy’s living room was so full of books and magazines, they were blocking the front door. His gas stove exploded, and the firefighters couldn’t get in.”