Category Archives: Psychology

Is Your Shrink Being Paid to Give You Drugs? The Secret Link Between Psychiatrists and the Drug Industry

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Regular readers of this blog will remember my earlier article on Rebecca Riley, the young girl whose overtreatment with powerful psychiatric drugs may have led to her death.

Now it turns out that some psychiatrists may actually be getting paid by the drug industry to give kids powerful drugs! And this is in spite of an almost complete lack of evidence that these drugs work or are safe for children.

The New York Times has an article called Psychiatrists, Children, and Drug Industry’s Role, and this scary article documents the secretive practice of paying psychiatrists to prescribe certain drugs.

The article documents that more than half a million children are now receiving atypical antipsychotics such as Risperdal, Seroquel, Zyprexa, Abilify, and Geodon. These drugs have never been tested on or approved for use in children!

In Minnesota alone, the only state that requires such reporting, from 2000 to 2005 payments from pharmaceutical companies to psychiatrists soared by six times, to $1.6 million, and the rates of prescribing antipsychotics to children went up by nine times.

And the Times found that the money worked. Those psychiatrists who received more than $5000 from the drug companies wrote 3 times as many prescriptions for atypical antipsychotics than those doctors who got less or no money. Other interesting figures are that the average payment to psychiatrists was $1750, with a maximum of $689,000. (Nice work if you can get it!)

I should point out that atypical antipsychotics are not benign drugs. Side effects can include rapid weight gain that leads to diabetes, and movement disorders such as tics and dystonia, which can lead to a lifelong muscle disorder.

The Times describes one unfortunate girl, Anya Bailey, who was given Risperdal for an eating disorder by her psychiatrist George Realmuto, who had received more than $7000 from Johnson and Johnson, the maker of Risperdal.

Although the drug helped her gain weight, she also developed a painful and permanent dystonia in her neck that now causes her chronic pain and a movement disorder, even after stopping the drug.

And she was never given any counseling for her problems, only drugs!

So what can we learn from this article? First of all, the practice of paying psychiatrists to prescribe certain medications is widespread, but only Minnesota requires full disclosure. We should pressure our legislatures to mandate full disclosure in every state. Write to your state and federal congress and senate and ask them to either ban this practice or to require full disclosure, on the web, by name of doctors, of how much money is given by each drug company.

Secondly, when you take your child to a psychiatrist, you should ask them for a full written disclosure of any money they received in the last few years from drug companies for speaking, or for research. Payments to psychiatrists (and other M.D.’s) are disguised as speaking honorariums or research payments, but when a doctor receives $5000 for giving one or two talks, it is safe to say that they are being paid for something else. If the psychiatrist admits to receiving money, then you should probably find another psychiatrist, as this creates a bias to prescribe that I do not think can be overcome.

Third, you should be dubious about any suggestion to give your child an antipsychotic medication for any diagnosis other than true psychosis. This means that unless your child is actively hallucinating, and delusional, i.e. “crazy” there is no evidence that antipsychotics will help them. For instance, there was only one well-controlled study of the use of atypical antipsychotics in bipolar illness in children, and it found little or no difference between using the antipsychotic and not using it. And most of the children in the group receiving the antipsychotic dropped out of the study due to side effects. A second study by the same researchers found no advantage to using antipsychotics.

Fourth, consider taking your child to a psychologist or counselor rather than a psychiatrist. Psychologists don’t receive money to influence their treatment decisions and use behavioral approaches that don’t have side effects. And there is much more research evidence that supports the use of these behavioral approaches in childhood disorders. Dangerous medications should be reserved for second or third line treatments only. Remember the old saying that to a young boy with a hammer everything becomes a nail, similarly to a doctor whose specialty is giving drugs, all problems become biochemical.

Finally, let’s put pressure on our legislators to outlaw this thinly disguised bribery, which threatens the health of children and adults. Shame on the pharmaceutical industry! And even more shame on psychiatrists, who of all people should be trustworthy and not willing to accept such bribes. I make the perhaps radical suggestion that patients boycott psychiatrists who accept money from drug manufacturers. If doctors can’t earn a decent living without taking payments from drug companies that often have the appearance of bribes, then perhaps they need a new profession. I realize that there are decent, honest psychiatrists who either don’t take drug company money or don’t let it influence them, but I suggest that it may be hard to tell the difference unless psychiatrists employ full disclosure.

Copyright 2007 The Psychology Lounge/TPL Productions

My Afternoon With the Dalai Lama: Lessons and Insights

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I sat a mere thirty feet from his Holiness the Dalai Lama yesterday for 90 minutes. The day April 29, 2007 will always be special to me. It was very magical. Not because of what he said, standard but true Buddhism 101 and meditation practice, but rather his character and his energy. There is a magic about this man, who more than anyone else seems to be completely in his own skin, and truly comfortable in that skin. He laughs, and he smiles, and he just seems unflappable. No pretense. When asked about parenting tips to raise a compassionate child, he laughs, and says, “I am monk. What do I know about raising children?” but then he continues, “Maximum care, maximum affection, and more time is the key.”

His basic message was about happiness. Happiness is mental, not based on people’s situations. Does this sound familiar? Basic cognitive therapy 101, happiness depends on how you think about things. Someone poor and homeless could be happier than someone wealthy and accomplished, depending on their respective expectations.

In the Dalai Lama’s view, happiness also comes from good companionship—friends, lovers, children, and a calm mind. Again, the Buddhists knew something 5000 years ago that modern social scientists are merely rediscovering—the critical importance of social support in mental health. For instance, 40 percent of married people describe themselves as “very happy” versus just 24 percent of single people. Those with 5 or more close friends are more likely to describe themselves as happy.

The fascinating thing about seeing the Dalai Lama is that once I settled down into a calm and meditative state listening to him, something transformative happened. I started to write down some ideas for creative projects, and suddenly words were flowing out of my pen. Anything was possible. I found myself having one of those magical moments that scientists describe as “Flow”. My confidence soared, and I had some important insights into life.

One of these insights was about watching television. I realized that watching television is about having nothing better to do at the moment. Even good television pales if there are wonderful social opportunities or creative ones. We watch TV because we are tired and a little bored. (Of course, even the Dalai Lama watches a little TV in the evenings, as he writes in the Art of Happiness—mostly nature documentaries, and not episodes of “24!” )

Another insight was about purpose. What is your purpose on this planet? What is the main thing you want to accomplish? So much of our striving and actions have no central purpose focus. We just sleepwalk through life. We just fill time. Some of us do it with work, some do it with relationships, some do it with reading, some with television, but all addictions have the same basic theme—how do I fill the time between being born and dying? If we know our purpose, then time fills itself.

The day after seeing the Dalai Lama, I awoke to a strange sense of emptiness. I felt like somehow it was gone: that quiet feeling of confidence, of knowing, of lack of worry. Was it all just a contact high? Later that same day, with meditation, contemplation, and writing I felt like I could get some of it back, so I knew then that my afternoon with the Dalai Lama had led to something real.

Namaste.

Copyright 2007 The Psychology Lounge/TPL Productions

Shopping for Happiness ™

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I’ve been working on a book length project on how to apply the current happiness research to everyday life, and this is an excerpt from that book.

It is said that money can’t buy happiness. This is mostly true. Like most generalizations, though, there are exceptions. What I hope to do in this chapter is to use the happiness research to teach you how to be better at shopping for happiness.

The happiness research teaches us several things. One basic principle is that of habituation, or getting used to things. This unfortunately robs us of joy from new and shiny possessions.

Thus using your hard–earned money to buy that shiny sports car will most likely not result in as much happiness as you anticipated. This is disappointing. After all, what is the point of making money if spending it doesn’t bring happiness?

The happiness research also shows us what tends to make people happy are experiences. This gives us some clues how to spend money to maximize happiness. Instead of buying things, which fade remarkably rapidly in their ability to please us, it makes more sense to use your spending to purchase items that allow you to have experiences you will enjoy. Or to directly purchase experiences that you will enjoy such as exotic trips, unique experiences, or thrills and chills like a parachute jump or bungee cord drop.

Let me give you some do’s and don’ts of shopping for happiness.

In many financial magazines and journals you will see little articles about how much money you can save by skipping the latte at your local café. They run the numbers, calculating one latte per day investing for umpteen million years, invested at 10% interest, becomes some ridiculous number by the time you are 93, perhaps even several hundred thousand dollars. It certainly would be nice to have a spare $200,000 by the time you are 93, assuming you make it that far.

The problem with all these articles is that they ignore what science has discovered about happiness. It really depends how you spend the $3 on your latte. If you spend $3 on a latte just so you can rush in and out of your local Starsucks, jump in your car, and spend your morning commute more caffeinated, then the articles are right. You’d be better off making coffee at home, putting it in a go cup, and investing that money for the long term.

However, if the way you enjoy your latte is by sitting at your local café where you know people, chatting with your table neighbor, reading the New York Times or Wall Street Journal or the local paper, and in general, relaxing and socializing, then this is a $3 very well spent indeed! What you done is to purchase a pleasant and social experience. If you do this daily, you will form a community of sorts, which always increases happiness.

Spending money in order to have satisfying experiences leaves you with memories of those experiences, which linger, and raise your happiness level.

Let me give another example. Someone close to me was living with a woman and he was struggling to find athletic activities he could share with his partner. She didn’t like hiking,  and would complain bitterly when they climbed hills.

Biking was even worse. She was a slow and unconfident rider. He was resentful at how slowly she rode, as it prevented him from enjoying a workout. He also constantly worried about her in traffic, as she had little experience riding, and often would dart out into traffic. She would get mad at him when he rode ahead of her. It was no fun for either of them.

This was a problem. What was the solution? I suggested to them that they spend some money to solve this. What did I suggest? I told him to buy a tandem bicycle. I had seen one on EBay, a recumbent tandem, for about $1800 shipped.

He bought it, and they started to ride together. She would ride on the back of the bike where all she had to do was peddle, and he would steer the bike from the front position. He got a great workout, even if she didn’t peddle very hard, and she was guaranteed to keep up.

It became a very enjoyable activity for them, riding almost every weekend, talking while they rode, and enjoying a pleasant and athletic activity together.

What did my friend purchase? It seemed like he purchased an expensive tandem bike. But in actuality, he purchased a “ticket to ride” or a ticket to a recurring pleasant experience for him and his wife.

Similar examples would be buying backpacking equipment, golf equipment, scuba gear, running shoes, and so on. But it should be something you use regularly. Buying a pair of skis and boots that you only use 3 days a year will not have a significant impact on your happiness level, in fact, in many of these cases it’s better to rent.

For instance, I enjoy scuba. But other than a mask and fins, I own no scuba equipment. The main reason is that I only scuba dive a few days each year, and thus the hassle of buying and owning and maintaining the equipment is not worth the small increment in happiness that my own gear would bring. If I dove frequently I would own my own equipment.

This brings me to another useful principle in shopping for happiness. I didn’t invent this one, my friend Dan came up with this principle. Dan taught me one simple principle for purchasing things. He told me that one should buy the very best in things that you interact with every day.

Again, if I scuba dive daily, I should buy the best equipment I can afford. Or if I am a bicyclist, and I ride daily or almost daily, then it makes sense to spend three, four, or even five thousand dollars on a great bike if I can afford that.

As a result of Dan’s law, I am writing this on my very sleek three-pound Dell XPS laptop computer, which I use almost daily for writing and web-surfing in cafes. At home I write on a three monitor workstation, with a 32 inch monitor flanked by two 24 inch monitors. This is a delicious luxury which I use for many hours each day. As an avid computer user, I think one of the best investments one can make is to buy large flat screen monitors for all of your computers. Especially if you are over 40, and developing presbyopia.

How does this apply to buying cars? Cars are tricky because there are at least three different issues that are relevant: status, function, and add-ons.

The most obvious issue is status. Unfortunately, this is the one that has the smallest and most fleeting impact on happiness. If you buy your car to impress others, they will be less impressed than you expect, even if you buy an outrageous car like a Ferrari or Lamborghini. Secondly, their being impressed will actually give you less happiness than you expected, and you will get used to the oooh’s and aaaah’s all too quickly. Finally, the hassles and owning and insuring and driving a supercar will soon outweigh the relatively small happiness that status brings you. So rule # 1 is don’t buy things for status.

(The same applies for kitchens, bathrooms, televisions, or any other product where you might be torn between shopping for status versus function. If you are buying granite countertops because you like chopping food on granite, that makes sense. If you are buying them so your friends will say “Ooooooh and Aaaaaah” when they come into your kitchen, then your happiness dividends will be much less than you expect. After all, your friends will habituate to your new kitchen, and will stop marveling at its wonders after a few visits. And long before that, you too will have grown used to the “new normal” and lost your initial joy in it.)

Going back to the example of a car, you should be thinking about function. Therein lies the rub. Most expensive cars are not very different in function from less expensive cars. All cars have four wheels, a motor, brakes, and a radio. Heresy! You are thinking. Of course expensive cars are different. But not very much. Once you get into the $20,000 to $30,000 range for a car, you are getting a fast, quiet, and comfortable car that takes you where you wish to go. Above this amount, you are primarily paying for status or for features you can’t use much. Case in point, many expensive cars go very fast. A Ferrari can do a top speed of 155 mile per hour. Cool, right? There’s only one catch. It’s hard to get up to this speed on your morning or evening commute. In fact, you are lucky if you even get up to 45 mph.

So buying features you can’t use won’t increase happiness much, and may even frustrate you. Trying driving a six-speed manual transmission Ferrari in bumper to bumper traffic on the freeway sometime, if you don’t believe me.

Remember I said there were three factors. The first was status which I hope that I have demonstrated has relatively little lasting impact on happiness. The second is function. Function matters somewhat, but what really matters is the basic functions of a car, the ability to drive at reasonable speeds with reasonable comfort and quiet. That’s why convertibles rarely bring people as much happiness as they expect.

Convertibles are really fun about one or two weeks a year. But much of the time it is too hot, too cold, or too rainy to benefit. And convertibles are not very pleasant cars with the tops rolled up. So it makes more sense to rent a convertible for a week or two a year, and enjoy it. Most mid-range cars function very well, and expensive luxury cars have only a few additional functions, and sometimes these functions are more trouble than they are worth. As an example, the BMW 5 series, which has something called an I-drive ™ which is like a joystick that controls the car’s functions. Many reviewers have complained that this feature is confusing and difficult to use, and requires constant reading of the car’s manual.

The third principle of shopping for happiness with cars is the add-on principle. Instead of buying an expensive car, and having no money left over, buy a cheaper car and invest the money you save by customizing and improving the car in ways that will actually increase your happiness while driving.

An example is two items that can have a big impact on happiness. The first is a GPS unit. If you are like my friend’s girlfriend, who is directionally impaired, and who constantly is getting lost and arriving late to every destination, then buying a GPS unit will have a huge impact on your happiness level while driving. She has told me numerous times that buying a GPS was the best thing she ever bought for her car. It eliminated a constant annoyance in her life, for an investment of only about $300. (Or buy a good mount for your smartphone and use that as a GPS navigator.)

The other investment in a car that makes sense is a good sound system for your car. Now if you only drive 5 minutes a day, skip this paragraph. But if you are like most Americans, and you commute a significant distance each day, then it makes good sense to spend some money on adding a great sound system to your car, if it doesn’t have one already.

You will definitely want a way to play all of your favorite music. It doesn’t matter whether that is a way to plug in your Ipod, a CD changer, or some other device. You may also want to consider a satellite radio unit, especially if you like commercial free radio and you like talk radio without commercials. (No one has ever demonstrated that commercials add to happiness levels.) So for the mere $15 a month that it costs, satellite radio may be an excellent investment in happiness.

Once again, neither a GPS nor a satellite radio is very expensive, and they can be just as easily installed in a $15,000 car as a $100,000 car.

I practiced this with older cars for many years. When my Nissan Maxima passed its 15th year, I decided to give it a birthday party, and to improve the car. I replaced the sound system, put new shocks in the front, and added an anti-sway bar to improve its cornering ability. This greatly improved both the driving quality and the experience of being inside the car, and was much cheaper than buying a new car.

In a similar way, you could utilize the add-on principle for a house. Instead of buying a new house, you might focus on improving several areas of your current house, focusing on function rather than status.

I was speaking with a client recently, who loves cooking. She was contemplating a kitchen remodel. She was talking about granite countertops.

I asked her, “Can you cut food on granite?”

“No, of course not,” she said.

“Can you prepare food on granite?” I asked.

“You can,” she said, “but it’s not a good idea. The food can stain the granite.”

“How is a granite countertop going to make your cooking experience more enjoyable? “ I asked.

She thought about it for a moment, and then said quietly, “Well, it probably won’t make it more fun, but it will look nice.”

So I asked her how much the granite countertop would cost. She told me $12,000. I asked her if her budget was unlimited. She said no. Then I said, “Are there any functional items that would make your life easier as a cook? Are there any things you would rather spend your $12,000 on?”

She thought about it, and then she mentioned a special European dishwasher that had two drawers, so that you never had to unload it. And a special type of oven that was costly but worked better.

In the end, she decided to keep her tile countertops, and instead spent the money on high- end incredible appliances that she uses every day.

This was a great example of shopping for happiness. She spent her money on things that would bring her direct joy every day. In general, if you want to spend money on making your kitchen “look impressive”, you’d be better off spending the money on a beautiful painting, or on functional items that you can enjoy every day. Very few people spend time sitting in their kitchen, simply staring at and admiring the granite counters!

Let’s talk about more shopping decisions, and other ways to shop for happiness.

Travel is a great example where shopping for happiness principles are useful. First of all, travel in general enhances happiness. This is because even trips that aren’t that great tend to improve in memory, especially as we tell and retell the stories. Some of the biggest disasters on trips end up making the most memorable stories.

I’m reminded of an infamous bus trip I took while in graduate school, on a hippy bus line from Seattle to Baja Mexico. My then girlfriend and I decided it would be a lark to spend three weeks traveling around Baja on this hippie bus, and off we went. Many disasters ensued, including a middle of the night near head-on crash with another bus which took off the side mirrors on both buses, a trailered boat breaking an axle, falling off the bus, and taking a short and tragic trip across the chaparral, ending up in pieces, multiple encounters with Mexicans who were baffled by this group of Americans, getting off the bus when it became apparent that it was dangerous to stay on the bus, hiking to a deserted beach in the desert, and waking up in the morning to a beautiful experience of homemade fruit salad and skinny dipping, which resulted in every local bee attacking for hours, hiking out from the beach in a hurry as a result, and getting lost in the desert when I proudly said I knew exactly where we were, waking up in the middle of the night in a cheap hotel room only to discover 6 inch roaches trying to drag our food bags away, and then sleeping fully dressed, with blindfolds and the lights on for the rest of a very fearful night!

And these are just the highlights!

This is the stuff of legend, and I have to admit it was one of the best trips of my life. It also brought us closer because we had to cope with all of these disasters.

There are principles of shopping for happiness in travel which many people ignore. For instance, many people will pay more money to upgrade to business or first class when flying. This is generally not a good investment in happiness. (Unless work pays for it, then why not?)

(I should add at this point that these comments apply to people who do not have unlimited financial resources. If you are a Bill Gates or Steve Jobs, you have a completely different set of problems in terms of shopping for happiness, which I will talk about later in a section called Shopping for Happiness Tips for the Billionaire.)

This is not to say that business class and first class are not pleasant experiences. In comparison to coach, they are. The reason why they do not deliver a proportionately higher level of happiness, relative to their cost, is that most airline rides are short. If you are flying 2 to 5 hours, the difference is not very significant. It’s especially less significant if you tend to nap on cross country flights. If I close my eyes, and nap for half of my cross country flight, then I am looking at a 2.5 hour experience in First Class, for a cost of an extra thousand or more dollars. Spending $500 an hour to have a slightly wider seat, better food, and a few free drinks seems like a bad investment in happiness.

The same principle applies to hotels. Many people like to stay in four of five star class hotels, probably because they like the status of doing so. In general this is not a wise investment of travel money, especially if you tend not to spend a lot of time in your hotel room.

If you mainly use the hotel to sleep, then a five star hotel offers very little that a two star hotel does not. As long as the bed is comfortable, and the room is quiet at night, nothing else really matters. A big TV is not important, as you can watch TV at home. A gorgeous swimming pool is also not so important, as you can use the five star hotel’s swimming pool even if you are staying across the street in the two star hotel. Or you can go to the beach, which is free.

There is one exception, though, which is if you plan on never leaving your hotel during your stay. In that case it may make sense to pay more for a luxurious hotel room, as you will get to experience that luxury 24/7. This may have a small impact on increasing your happiness level.

The better way to spend money on travel is to use the happiness research which tells us that status items do not bring much happiness, and that experiences are what we remember fondly. An example of this would be to skip the five star hotel in Hawaii which costs $300 or $500 a night, and to instead stay at the $150 three star hotel. Then invest the difference in buying great experiences.

One day you might spend $200 on renting a pair of jet skis, and have a very exhilarating experience zooming around the coast. Another day you could spend that $200 taking surfing lessons, and renting surfboards. Whether you surf successfully or not, you will have a memorable experience. The next night you treat yourselves to a dinner in the best restaurant in Honolulu, where you run into Barack Obama, who is having dinner with his family at the next table. (True story from 2006.)

Think about travel stories you have told or listened to. Was it very memorable that the hotel room was large or luxurious? No. What was memorable is when you left the hotel and had exciting experiences.

To be continued…

Copyright 2006-2017 The Psychology Lounge/TPL Productions/Andrew Gottlieb, Ph.D.

 Shopping for Happiness ™ is a trademarked term. Trademark 2006, Andrew Gottlieb.

 

The Mind-Body Connection: Depression and Its Effects On Physical Health

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I will return to the theme of happiness in a few more days, but today we will continue with our series about depression, based on Peter Cramer’s book Against Depression, which I heartily recommend to anyone who wants to learn more about depression.

Depression is not just a psychological disease. It impacts the whole body, and especially impacts the cardiovascular system. Depression is one of the strongest predictors of cardiac disease. Even minor depression increase the risk of cardiac disease by 50 percent. Major depression increases risk by 3 to 4 times. For those with pre-existing coronary artery disease, risk is increased 5 times!

You might be thinking that this is no surprise. Perhaps depressed people smoke more, exercise less, eat more bacon, etc. What is surprising is that the numbers in the preceding paragraph are after adjusting for lifestyle and behavior! The raw numbers are even higher!

Why is this? What is the mechanism by which depression reeks havoc with the cardiovascular system?

There are several possible mechanisms. One is through the impact on blood clotting.

Blood clotting is controlled by cells in the blood called platelets. The stickier the platelets are, the more likely you are to develop blood clots, which can lead to stroke or heart attack. Depressed patients have stickier platelets.

Another mechanism is stress. Depressed patients are under constant physiological stress, with excess stress chemicals circulating in their blood. This may raise blood pressure and cause other changes that affect the cardiovascular system.

So what happens if you treat depression? Does this reduce risk of cardiovascular disease?

Studies of antidepressants given after heart attack show a 30 to 40 percent reduction in subsequent heart attacks and deaths.

Antidepressants improve the outcomes after stroke as well. When stroke patients were given either antidepressants or placebo, 66 percent of the antidepressant group survived 2 years, but only 35 percent of placebo group.

Other physical triggers like treatment with interferon for hepatic C and melanoma can also cause depression. In fact, 50 percent of patients who receive interferon will get seriously depressed. Depression in these cases is serious because it can cause the person to stop taking a potentially life-saving treatment.

Antidepressants help even in these cases of drug induced depression. One study found that treatment with Paxil, an antidepressant, reduced depression from 45 percent to 11 percent.

What are the implications of these finding?

  1. All patients who have had a heart attack or a stroke should probably take an antidepressant.
  2. All patients taking long-term interferon treatment should begin taking an antidepressant several weeks before starting the interferon.
  3. Probably most seriously ill cancer patients should take an antidepressant as well.
  4. Counseling that focuses on evaluating and treating depression should be part of any seriously ill medical patient’s treatment regimen.

Copyright 2007 The Psychology Lounge/TPL Productions

All Rights Reserved


Your Junk is My Treasure! The Psychology of Compulsive Hoarding

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Today I am going to write about a very different type of psychological problem, called compulsive hoarding. The Boston Globe had a very interesting article about hoarding. Researchers Gail Steketee and Randy Carlson have a new book, called “Buried in Treasures,” which documents their new approach to treating this disorder.

First of all, what is compulsive hoarding? It’s when you can’t get rid of anything, and can’t put in order what you have, so much so that you end up having difficulties using the spaces you live or work in.

Are you a hoarder? Of course not! But Steketee and her colleagues developed a simple photo test for hoarding . Take a look at these photos, and pick out the one that looks the most like your bedroom. If it is number 4 or higher, then you probably have a problem with hoarding. (Hoarders, it turns out, are very accurate at identifying the level of chaos in their spaces.)

Your official Lounge Wizard, Dr. Psychology took the test, and scored a 2 or 3, which puts him in the normal range, but right on the borderline of hoarding. So this article is close to his heart.

What causes hoarding? It’s not what most non-hoarders think; laziness, messiness, or even depression. Although many hoarders have some elements of depression or anxiety, the core of hoarding is that they have strong attachments to things. They are sentimental about possessions, and often have very intense feelings about them. They tend to be creative, and can think of many uses for objects.

Most hoarders function fairly well outside their homes. They have jobs, friends, and active involvements. Where hoarding seems to impact them is in romantic relationships. The hoarders I know tend to not have long term romantic relationships, which isn’t surprising, as girlfriends and boyfriends tend to want to come over to your house, and for a hoarder than is a painful experience. “Why do you have all of this stuff? Why don’t you get rid of all this junk? I can’t believe you live this way!” are all typical comments they may hear. Needless to say, there are no more invitations after that. Steketee finds that at least 50% of hoarders are single.

So is there any hope for hoarding? One thing that doesn’t seem to work very well is traditional medicines for depression like antidepressants. Although these medicines work well for regular obsessive compulsive disorder (OCD) they don’t appear to do much for hoarding. Traditional psychotherapy doesn’t work either.

Steketee and colleagues have developed a very nice cognitive behavioral model for treating hoarding. They find that hoarders have similar cognitive models. For instance, hoarders have four common fears: 1) missing important information or opportunities, 2) forgetting something important, 3) experiencing loss, and 4) being wasteful. They tend to focus on lost opportunity, so getting rid of a newspaper entails a possibility of losing some opportunity that was in the newspaper. In general, all of their possessions get elevated in value.

Another common issue is needing to keep things in sight. This is tied into the need to not forget anything. “Out of sight, out of mind,” is the hoarder’s mantra. This causes the visual chaos that creates many of the problems of hoarding, since if one just had many possessions, but they were well organized and stored, hoarding would not be a big problem.

So it is not surprising that Steketee’s treatment plan focuses on helping hoarders learn to organize their space, rather than focusing on getting rid of stuff. This is more palatable goal for most hoarders, who know that their space is poorly organized.

The treatment also focuses on helping hoarders overcome the need to acquire things. The rules for acquisition are: 1) immediate need for the object (this week), 2) time enough to acquire and use the object, 3) money to buy it, and 4) an appropriate space for the object. This nips the problem in the bud.

The treatment works, but it’s not a miracle. According to Steketee, it’s not unusual for someone to move from 7 to 3 on a 9 point scale where 1 is neat and organized, and 9 is total mess. But relapse is always a danger, as there is something very compelling about hoarding.

So what is the core of hoarding? Even Steketee and her colleagues are a little baffled about this. As a borderline hoarder who closest friends include some hoarders, I can give some intriguing answers.

Hoarding is about possibility. The thought “I could use this item someday,” is central to the decision to hold onto something. For instance, I have a box of scrap pieces of wood and plastic, which I keep because I might have a use someday. Every once in a while, I use a piece from my scrap box. And that reinforces keeping it.

Or papers. I used to clip articles from papers, thinking I would write about the topic someday. I had many files of articles on travel, psychology, and technology. The technology innovation that has changed that is computers, and more specifically, the email program Gmail. Instead of printing out articles, now I email them to myself. Since Gmail can hold thousands of articles, and with a simple search I can find any of them, I’ve tossed out my article files.

One of the beauties of computers is that even massive hoarding of articles or writing takes very little space on a hard drive. I can hold every email I’ve ever written in my life on a single USB memory stick. So if you are a hoarder of articles, or papers, consider buying a scanner, and using computer technology to hoard more effectively.

Another aspect of hoarding is sentiment. I hate throwing out something that reminds me of a good time in my life, or almost anything that has significant meaning. So I’d never throw away a photograph or a letter from someone I care about. I will throw out cards, though, unless they have a significant written message inside.

And some of hoarding is simply about difficulty in making decisions. For instance, I have too many books. But it is hard to figure out which books to toss. Some rules are easy. A bad paperback novel is easy to toss. But a good novel is tougher; maybe I will want to reread it sometime.

And reference books are still arder. Will I need the information in this book sometime? I try to ask myself realistically if the info is something I’ll need in the foreseeable future, and especially if the information is still even relevant. Thus old computer books are easy to toss, since in the computer world things date quickly.

One trick I’ve used successfully in de-hoarding is to remind myself that one of the advantages of getting rid of things is that you can get new things! For instance, if you go through one’s clothes closet and toss all the clothing that doesn’t fit and doesn’t look good, then you get to buy some cool new threads! The same is true with books. The key is to replace less than you toss.

Conquering hoarding is about psychological growth. Central to the process of growth is letting go of the old in order to make room for the new. New things, new people, and new experiences. Another aspect of de-hoarding is traveling through life less encumbered. That gives you more flexibility to move, and change. The irony of hoarding is that the biggest hoarders I know love to travel. And when they travel, they leave almost all of their stuff behind. And they are perfectly happy living out of a suitcase or backpack, and don’t miss their stuff at all.

Maybe this is really a metaphor for our psychological baggage. Travel light, and leave the junk behind. Throw out old stuff, and organize what you keep. Let go of things, and make room for new things.

Copyright 2007 The Psychology Lounge/TPL Productions