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10/06/2004

Super Savers

Last week, we attended a Friday afternoon concert of the New
York Philharmonic Orchestra featuring Lang Lang, the
acclaimed 20-year old Chinese pianist. Our concert group
typically spends the morning at the Metropolitan Museum of Art,
located on 5th Avenue at about 81st Street, on the east side of
Central Park. Normally, our bus driver crosses through the park
on a street that takes us to 5th Avenue just a few blocks north of
the museum. This time we had a new driver who didn’t take that
road because he saw a sign indicating low clearance and he
didn’t trust the height measurement he was given for our vehicle.
Every road through the park north of that one was blocked off
and we ended up in Harlem.

We finally crossed over to 5th Avenue at about 110th Street and
arrived at the museum a half hour later than usual. At the time, I
didn’t realize that we had been close to 5th Avenue and 128th
Street, site of the infamous Collyer mansion. Which brings us to
our topic for this week – compulsive hoarding. The October
issue of Discover magazine has a short, 2-page article by Mary
Duenwald titled “The Psychology of Hoarding”. The article had
pictures showing rooms and closets cluttered with clothing,
boxes, papers, etc. in total disarray. The clutter belonged to an
older New York City woman, who found it difficult to move
around the apartment due to the mess. A poll of community
service agencies that deal with older clients in Manhattan
indicates that about 10 percent of them hoard things to such an
extent that it becomes a problem.

Could I be a compulsive hoarder? We’re vacating our premises
at UMDNJ Robert Wood Johnson Medical School and I’ve spent
many hours throwing out books, papers, journals, etc. that I
haven’t touched in years. It’s the same thing at home. We’re
considering downsizing and the most daunting challenge is to
decide what treasures to throw out. I’ve spent days shredding
papers that should have been retired years ago.

However, after reading the Discover article, I decided that my
hoarding problem pales when compared with those of cases cited
in the article. Take a recluse named Moore, who lived in a 10-
foot by 10-foot Manhattan apartment. For years, he just kept
piling up papers, catalogs, magazines and other reading material
he got in the mail. When I say “piling up”, I mean it was from
floor to ceiling! Finally, late last year, the hoard overwhelmed
him and he was actually buried standing up! It was two days
before his landlord heard his moaning and pried the door open
with a crowbar. It took firefighters and neighbors half an hour
just to dig the fellow out of the debris and get him to a hospital
for medical treatment. I checked the story and found a news
release dated December 30, 2003 on sfgate.com stating that
Moore was on public assistance and was selling magazines and
books on the street for money.

But let’s return to that once luxurious 3-story Collyer mansion at
5th Avenue and 128th Street. Langley Collyer was an admiralty
lawyer and brother Homer had a degree in engineering. Born in
the 1880s, they lived in the mansion with their mother. After her
death, they found themselves in a decaying neighborhood filled
with poverty and crime. They secluded themselves, boarded up
the windows and turned off the gas, water and electricity! They
got water from a park and heated the place with a little kerosene
stove, on which they cooked their meals. They began hoarding
things, partly to use in booby traps and to block up the entrances
to their home. Homer went blind in 1933.

On March 21, 1947, police were told there was a dead man in the
house. I found a detailed account of what followed on the Web
site tripod.com. The police couldn’t get in the doors or windows
on the ground floor and finally gained entrance through a
window on the second floor. There they found Homer’s body. It
took 18 days before, after removing tons of junk, they found
Langley’s body less than ten feet from his brother. The body
was covered under bundles of newspapers, a suitcase, and three
metal breadboxes. Police theorized that one of the booby traps
had collapsed on him as he was crawling through the maze to
feed his blind and paralyzed brother. Langley suffocated and
Homer, without food, died of starvation.

Workers took out well over a hundred tons of junk, including
such items as a horse’s jawbone, pianos, lots of outdated phone
books, a dismantled car, to name just a few oddities. These guys
were not only compulsive hoarders, they were really weird! The
mansion was condemned and turned into a parking lot.

Compulsive hoarding isn’t a rarity in the animal world. Today, I
see the squirrels in our neighborhood digging holes in our lawn,
storing acorns, nuts, etc. in them and covering them up for future
retrieval. Some birds hoard bits of food in thousands of places
over a wide area. Other birds hoard stones, piling them up to
impress potential mates, who apparently consider the number of
stones a sign of the ability of the male to provide and store
sustenance. Obviously, these examples of hoarding serve useful
and even life sustaining purposes. Could human compulsive
hoarding be an example of an inbred instinct gone amok?

Typically, the compulsive hoarder likes and enjoys what he or
she is hoarding and may also envision different uses for the item
in the future. A key factor in compulsive hoarding is indecision.
The hoarder can’t decide whether to throw the item out or keep it
and opts to do the latter. However, as a hoard builds, the normal
person makes a decision to throw out some things before a hoard
becomes life threatening. Is there something in the brain that
causes compulsive hoarders to behave as they do? Scientists
such as Sanjaya Saxena, head of the UCLA Neuropsychiatric
Institute are looking into this question.

Saxena and his colleagues study obsessive-compulsive disorder
(OCD) and use positron emission tomography (PET) to look at
the brain functioning in OCD patients. In PET imaging, a
radioactive substance is injected into the subject and the brain
“lights up” in regions of high glucose metabolism. They are
finding that OCD is not a single disorder. For example, one type
of OCD that has received a lot of press involves neatness and/or
hand washing carried to extremes. Saxena’s group is finding that
their PET images show different regions of the brain are
involved in different forms of OCD.

Compulsive hoarding correlates with decreased activity in a
region of the brain known as the anterior cingulate gyrus when
compared with the activity in that region in other OCD patients.
This anterior cingulated gyrus is involved in decision-making,
focusing, motivation and problem solving. These are the areas
where compulsive hoarders have trouble, deciding what to throw
out, focusing on the problem, getting up the energy to throw
things out, etc.

Saxena’s group also found that in compulsive hoarders there is
low activity in another region of the brain, the posterior cingulate
gyrus, compared to that in normal subjects. This area of the
brain deals with spatial orientation and memory. Speculation is
that deficits in these areas may help explain the compulsive
hoarder’s difficulty with clutter and a fear of losing belongings.
The involvement of different regions of the brain for different
forms of OCD has important implications in drug treatment of
these disorders. Drugs that help some OCD patients have been
found ineffective for compulsive hoarders. Studies are in
progress to find alternative treatments.

Incidentally, we did make the Philharmonic concert on time and
Lang Lang gave a fine performance, closing out the first half of
the concert. We should have left at that point! The featured
work of the second half was a premier of a work commissioned
by the Philharmonic. In my experience, “commissioned” works
are compositions of a “contemporary” nature, dissonant, devoid
of melody and coherence and, in my humble opinion, are works
best left undone. Augusta Read Thomas’s “Gathering Paradise:
Emily Dickinson Settings” (for Soprano and Orchestra) proved
no exception. Apparently, I was not alone in my evaluation of
the piece. I have never seen so many members of an audience
leave either before (warned in advance?) or during the
performance of a work.

Allen F. Bortrum



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Dr. Bortrum

10/06/2004

Super Savers

Last week, we attended a Friday afternoon concert of the New
York Philharmonic Orchestra featuring Lang Lang, the
acclaimed 20-year old Chinese pianist. Our concert group
typically spends the morning at the Metropolitan Museum of Art,
located on 5th Avenue at about 81st Street, on the east side of
Central Park. Normally, our bus driver crosses through the park
on a street that takes us to 5th Avenue just a few blocks north of
the museum. This time we had a new driver who didn’t take that
road because he saw a sign indicating low clearance and he
didn’t trust the height measurement he was given for our vehicle.
Every road through the park north of that one was blocked off
and we ended up in Harlem.

We finally crossed over to 5th Avenue at about 110th Street and
arrived at the museum a half hour later than usual. At the time, I
didn’t realize that we had been close to 5th Avenue and 128th
Street, site of the infamous Collyer mansion. Which brings us to
our topic for this week – compulsive hoarding. The October
issue of Discover magazine has a short, 2-page article by Mary
Duenwald titled “The Psychology of Hoarding”. The article had
pictures showing rooms and closets cluttered with clothing,
boxes, papers, etc. in total disarray. The clutter belonged to an
older New York City woman, who found it difficult to move
around the apartment due to the mess. A poll of community
service agencies that deal with older clients in Manhattan
indicates that about 10 percent of them hoard things to such an
extent that it becomes a problem.

Could I be a compulsive hoarder? We’re vacating our premises
at UMDNJ Robert Wood Johnson Medical School and I’ve spent
many hours throwing out books, papers, journals, etc. that I
haven’t touched in years. It’s the same thing at home. We’re
considering downsizing and the most daunting challenge is to
decide what treasures to throw out. I’ve spent days shredding
papers that should have been retired years ago.

However, after reading the Discover article, I decided that my
hoarding problem pales when compared with those of cases cited
in the article. Take a recluse named Moore, who lived in a 10-
foot by 10-foot Manhattan apartment. For years, he just kept
piling up papers, catalogs, magazines and other reading material
he got in the mail. When I say “piling up”, I mean it was from
floor to ceiling! Finally, late last year, the hoard overwhelmed
him and he was actually buried standing up! It was two days
before his landlord heard his moaning and pried the door open
with a crowbar. It took firefighters and neighbors half an hour
just to dig the fellow out of the debris and get him to a hospital
for medical treatment. I checked the story and found a news
release dated December 30, 2003 on sfgate.com stating that
Moore was on public assistance and was selling magazines and
books on the street for money.

But let’s return to that once luxurious 3-story Collyer mansion at
5th Avenue and 128th Street. Langley Collyer was an admiralty
lawyer and brother Homer had a degree in engineering. Born in
the 1880s, they lived in the mansion with their mother. After her
death, they found themselves in a decaying neighborhood filled
with poverty and crime. They secluded themselves, boarded up
the windows and turned off the gas, water and electricity! They
got water from a park and heated the place with a little kerosene
stove, on which they cooked their meals. They began hoarding
things, partly to use in booby traps and to block up the entrances
to their home. Homer went blind in 1933.

On March 21, 1947, police were told there was a dead man in the
house. I found a detailed account of what followed on the Web
site tripod.com. The police couldn’t get in the doors or windows
on the ground floor and finally gained entrance through a
window on the second floor. There they found Homer’s body. It
took 18 days before, after removing tons of junk, they found
Langley’s body less than ten feet from his brother. The body
was covered under bundles of newspapers, a suitcase, and three
metal breadboxes. Police theorized that one of the booby traps
had collapsed on him as he was crawling through the maze to
feed his blind and paralyzed brother. Langley suffocated and
Homer, without food, died of starvation.

Workers took out well over a hundred tons of junk, including
such items as a horse’s jawbone, pianos, lots of outdated phone
books, a dismantled car, to name just a few oddities. These guys
were not only compulsive hoarders, they were really weird! The
mansion was condemned and turned into a parking lot.

Compulsive hoarding isn’t a rarity in the animal world. Today, I
see the squirrels in our neighborhood digging holes in our lawn,
storing acorns, nuts, etc. in them and covering them up for future
retrieval. Some birds hoard bits of food in thousands of places
over a wide area. Other birds hoard stones, piling them up to
impress potential mates, who apparently consider the number of
stones a sign of the ability of the male to provide and store
sustenance. Obviously, these examples of hoarding serve useful
and even life sustaining purposes. Could human compulsive
hoarding be an example of an inbred instinct gone amok?

Typically, the compulsive hoarder likes and enjoys what he or
she is hoarding and may also envision different uses for the item
in the future. A key factor in compulsive hoarding is indecision.
The hoarder can’t decide whether to throw the item out or keep it
and opts to do the latter. However, as a hoard builds, the normal
person makes a decision to throw out some things before a hoard
becomes life threatening. Is there something in the brain that
causes compulsive hoarders to behave as they do? Scientists
such as Sanjaya Saxena, head of the UCLA Neuropsychiatric
Institute are looking into this question.

Saxena and his colleagues study obsessive-compulsive disorder
(OCD) and use positron emission tomography (PET) to look at
the brain functioning in OCD patients. In PET imaging, a
radioactive substance is injected into the subject and the brain
“lights up” in regions of high glucose metabolism. They are
finding that OCD is not a single disorder. For example, one type
of OCD that has received a lot of press involves neatness and/or
hand washing carried to extremes. Saxena’s group is finding that
their PET images show different regions of the brain are
involved in different forms of OCD.

Compulsive hoarding correlates with decreased activity in a
region of the brain known as the anterior cingulate gyrus when
compared with the activity in that region in other OCD patients.
This anterior cingulated gyrus is involved in decision-making,
focusing, motivation and problem solving. These are the areas
where compulsive hoarders have trouble, deciding what to throw
out, focusing on the problem, getting up the energy to throw
things out, etc.

Saxena’s group also found that in compulsive hoarders there is
low activity in another region of the brain, the posterior cingulate
gyrus, compared to that in normal subjects. This area of the
brain deals with spatial orientation and memory. Speculation is
that deficits in these areas may help explain the compulsive
hoarder’s difficulty with clutter and a fear of losing belongings.
The involvement of different regions of the brain for different
forms of OCD has important implications in drug treatment of
these disorders. Drugs that help some OCD patients have been
found ineffective for compulsive hoarders. Studies are in
progress to find alternative treatments.

Incidentally, we did make the Philharmonic concert on time and
Lang Lang gave a fine performance, closing out the first half of
the concert. We should have left at that point! The featured
work of the second half was a premier of a work commissioned
by the Philharmonic. In my experience, “commissioned” works
are compositions of a “contemporary” nature, dissonant, devoid
of melody and coherence and, in my humble opinion, are works
best left undone. Augusta Read Thomas’s “Gathering Paradise:
Emily Dickinson Settings” (for Soprano and Orchestra) proved
no exception. Apparently, I was not alone in my evaluation of
the piece. I have never seen so many members of an audience
leave either before (warned in advance?) or during the
performance of a work.

Allen F. Bortrum