Hoarding

My first internship was very interesting. I was with a mobile crisis team for Gouverneur Hospital in New York City’s Lower East Side. Basically, relatives, friends or even strangers would call us if they noticed that someone was acting bizarrely. And in New York, it took a lot to fall into that category.

Our job was to assess the person. If they were a danger to themselves or others, we arranged for hospitalization at Bellevue. If they weren’t dangerous but needed treatment, we would set up an appointment for follow-up care. And sometimes the person obviously would benefit from therapy or medicines but wasn’t dangerous and declined our offer. In those cases, we would thank them for their time and leave.

The psychiatrist on the team at the time was Dr. Mirjana Blokar. She was a great teacher. Dr. Blokar was a beautiful, elegant woman. She was always dressed and coifed immaculately and in the latest fashion. She had a trace of a Middle-European accent and was charming. (If you’re thinking that I had an unrequited crush, you might be right.)

Anyway, one day we get a call about a woman who would go out on to the streets at night and seem to bring odd things home. The caller noted that there was a terrible smell coming from this person’s apartment.

So, Dr. Blokar, the driver (forgive me for not recalling his name but he was excellent, too) and I went off to visit this woman.

We got to the apartment and immediately noticed the smell. Dr. Blokar knocked on the door and the woman appeared. [Almost all the time, the person did not know that we were coming because we made our trips based on tips from callers.] Dr. Blokar introduced us and asked if we could come in. The surprised woman led us to her living room.

I have never before or since seen anything like that apartment. The woman told us that she had a habit of making nightly trips to the garbage cans on the street corners. She would bring home virtually everything that was in the trash.
trash
The apartment was filled with this stuff. Imagine, briefly if you will, what might be in a New York City garbage can. And she literally had every type of garbage from floor to ceiling. There were narrow paths from one room to the other. I saw what must have been world record size cockroaches at eye level in the mounds boldly looking about for their next meal.

The stench inside the apartment was overwhelming.

The woman asked if we would like to sit on the couch as we chatted. Dr. Blokar gently declined the offer and we remained standing.

As Dr. Blokar conducted the interview, I was sure that this was going to end up in an involuntary hospitalization at Bellevue.

However, as the evaluation progressed, it became clear that this woman did not have a thought disorder, was not psychotic and had no intention of harming herself or anyone else. She simply had a compulsion to hoard things she found on the city streets and in the trash.

To our surprise, her son emerged from a bedroom mid-way through. He also was competent and posed no danger to anyone. He intensely disliked his mother’s hoarding but found that he could not stop her. He did the best he could to look after her and be helpful.

After a while, Dr. Blokar offered the woman an appointment for outpatient medication evaluation and therapy. She politely said no thank you. Soon after that, the meeting ended and we left.

I was confused. Why had we not involuntarily hospitalized her? At the time, I thought that there must be some grounds for that given her irrational habit of collecting garbage and the condition of the apartment. I speculated that since the contrast between Dr. Blokar’s personal habits and this woman’s could not have been more stark, the doctor would be especially prone to take action.

However, Dr. Blokar started explaining the condition of hoarding and its relationship to obsessive compulsive disorder. That day, I learned valuable lessons about psychiatry, the law, civil rights and tolerance for other people’s idiosyncrasies. While this might be a matter for the landlord or the Department of Health to take up with her, it did not constitute a case of psychiatric emergency qualifying for involuntary hospitalization.

I relate this memory here because the Anxiety Disorders Association of America has posted an instructive podcast and detailed informational material on hoarding.

I think you will find it interesting.

Depression Resources from NIMH

While I’m on the topic of depression, The National Institute of Mental Health has a number of valuable resources on depression and its treatment.

The newest one, I believe, is a video. It is aimed at a general audience so that they can “learn about signs, symptoms and research on depression.” The video can be viewed at the NIMH website, click here.

The NIMH also has a fact sheet: Depression: A Treatable Illness.

They also have a pamphlet for men:Real Men Real Depression. Judging by how quickly this pamphlet vanishes from the reading material in the waiting room, you may find it very helpful.

Not to leave women out, the NIMH’s Women and Depression: Discovering Hope is a more extensive booklet than the others mentioned here.

For more information about depression and other mental health topics from authoritative sources, please visit the Links and Search Engines page on my website.

Depression: more on what we don’t know

Time Magazine has an online article titled “Study: ‘Depression Gene’ Doesn’t Predict the Blues.”

The article reviews a recent meta-analysis published in JAMA.

Time’s writers report that “The meta-analysis of 14 prior studies concludes that the so-called depression gene — a variant of a serotonin-transporter gene called 5-HTTLPR — may not be associated with an elevated risk for depression, as many researchers had believed.”

However, the meta-analysis did find that there was a significant correlation between the number of a person’s stressful life events and depression.

The researchers found that “This meta-analysis yielded no evidence that the serotonin transporter genotype alone or in interaction with stressful life events is associated with an elevated risk of depression in men alone, women alone, or in both sexes combined.”

As the Time article concludes:
“So what does this mean for anyone who is struggling with depression? The science of linking specific genes to the disorder is still in its infancy, so no one should worry that their genes alone doom them to a life of sorrow. And while no single treatment works for every patient, there are many — including simple physical exercise or strengthening social relationships — that can help to lift the blues.”

TLC for Depression

Stephen Ilardi, associate professor of clinical psychology at the University of Kansas has a new research program on depression, he calls it TLC. The Daily Kansan reports about in its article Professor develops six-step program to cure depression.
Professor Ilardi says that his research recommends six points.
They are:

  • exercise,
  • omega 3 fatty acids,
  • sunlight exposure,
  • anti-rumination strategies,
  • social support
  • and sleep hygiene.

It is his contention that modern, urban lifestyles deprive us of these six simple factors. One of the results is a higher rate of depression.
You can read more about the research here.

Stress Relievers

Good Housekeeping has an online article 6 Surprising Stress Fixes.

Here are their recommendations:

  • “Strategy 1: Smooch spontaneously…’Kissing relieves stress by creating a sense of connectedness, which releases endorphins, the chemicals that counteract stress and depression.'”
  • “Strategy 2: Take the cuddle cure…holding hands and hugging can measurably reduce stress.”
  • “Strategy 3: Lash out less…Concentrate on the issue at hand and forget about getting even; drop the sarcasm and name-calling.”
  • “Strategy 4: Put the kettle on…people who drank black tea four times a day for six weeks had lower levels of cortisol after a stressful task than those who drank a caffeinated fruit beverage. Research also shows that a substance in green tea leaves, L-Theanine, may shift brain wave activity from the beta waves that accompany anxiety to the alpha waves associated with relaxation.”
  • “Strategy 5: Loosen your electronic leash…take turns with your spouse being ‘on call’ for minor emergencies, and make sure the sitter and the school have his number as well as yours. You may have to retrain the kids, too.”
  • “Strategy 6: Reflect on what you value. When your frazzle level is so high you feel yourself spiraling out of control, a quick way to re-center is to remind yourself of what’s most important in your life.”

You can read the whole article here.

The authors write that these are based on research findings, but they do not provide references to the studies.

Depression and Diabetes Type 2

From WebMD comes the article Depression Raises Risk for Type 2 Diabetes .

It reports on a study done by Julie Wagner, PhD, of the University of Connecticut Health Center.

Dr. Wagner’s research finds that:

“Depressed participants who were not being treated had significantly greater insulin resistance than study participants who were not depressed. But treatment for depression appeared to improve insulin sensitivity, with depressed participants on antidepressant therapy having similar insulin sensitivity to non-depressed participants.”

She concludes that:

“the more depressed someone is, the more cortisol they produce, which leads to more belly fat and more diabetes…(and) Depression may also influence type 2 diabetes risk by disrupting the immune system or levels of serotonin, which helps modulate metabolic function as well as mood…”

Treating depression is important in its own right; but it also helps lower the risk of type 2 diabetes.