Hoarders Shows How Reality TV Can Get Mental Illness Right
“Let’s just go right out and say it,” Matt Paxton says. “We put a mental disorder on television for entertainment.”
Paxton is one of the regular “extreme cleaning specialists” on A&E’s Hoarders, which returned for its 11th season in July. The show documents people suffering from hoarding disorder and the process of cleaning up their home. Hardly an episode passes without some sort of family conflict, the subject refusing to give up a feces-laden bed sheet, the discovery of dead animals (be they pet or pest), or a home on the verge of ruin. Often, episodes will have all of these elements, and more. It’d be easy to dismiss the show as yet another in the long line of trashy reality shows, an easy hit of schadenfreude with little other value.
Yet just below the surface is a show grounded in empathy and education, with professionals trying their very best to help those in dire need. It hides in plain sight as one of the most important shows of the last decade.
When Hoarders debuted in 2009, hoarding disorder was not its own distinct disease, but rather a subset of obsessive-compulsive disorder, as classified by the APA. Mental health experts and cleaning specialists such as Paxton and Cory Chalmers (another of the show’s regular cleaners), knew this classification was incorrect, and had been for years.
“We worked with people that clearly didn’t have OCD, and we worked with people that had OCD and hoarding but they were completely different,” Chalmers said. “There’s about 15 reasons that we see that make up 99% of the Hoarders out there, and OCD is definitely one of them, but so is ADHD, so is PTSD. There’s a ton of them.”
A landmark 2012 study conducted by Dr. David Tolin, an expert on hoarding and one of the show’s recurring mental health experts, catalyzed the changing perception of hoarding disorder within the medical community. Tolin and his team brought in three separate groups of people: those with hoarding disorder, those with OCD, and a control group. They asked each of those groups to bring in junk mail from their homes. They then had subjects from each sample group lay in an MRI machine while they showed the subjects pictures of their mail, along with mail from the lab. The subjects were asked whether each piece of mail should be kept or shredded.
The brains of the subjects with hoarding disorder acted drastically different from those of the control group and the OCD group. Tolin and his colleagues published their findings in the October 2012 edition of the Archives of General Psychiatry:
“Compared with participants with OCD and HC, participants with HD exhibited abnormal activity in the anterior cingulate cortex and insula that was stimulus dependent. Specifically, when deciding about items that did not belong to them, patients with HD showed relatively lower activity in these brain regions. However, when deciding about items that belonged to them, these regions showed excessive functional magnetic resonance imaging signals compared with the other 2 groups. These differences in neural function correlated significantly with hoarding severity and self-ratings of indecisiveness and “not just right” feelings among patients with HD and were unattributable to OCD or depressive symptoms.”
In 2013, the APA released the DSM-V, which finally categorized Hoarding disorder as its own separate disease. By that time, Hoarders was in its fourth season. Dr. Michael Thompkins, one of the show’s regular mental health professionals, said the show had no impact on the reclassification of the disease, which the APA confirmed.
While the research changed the minds of the APA, the show, just as importantly, changed the minds of the public and those affected by the disorder.
As the research and understanding of the disease evolved, so too did the show. In the first season, each hoarder was paired with either a mental health professional, a professional organizer, or a cleaning specialist. It was a show very much focused on the spectacle of stuff, and the seemingly impossible clean-up that accompanied it.
By the second season, the focus shifted, and the show paired each Hoarder with both a mental health professional and a cleaning specialist, because while the cleanup may have drawn ratings, it wasn’t actually helping people. Zasio says that, at the beginning, there wasn’t the awareness that hoarding was about so much more than the cleanup. By pairing a Hoarder with both a psychologist and cleaning professional, the show could address both the symptom and the issues feeding it.
There are 157 disorders in the DSM-V. Some are well known to the general public, such as ADHD, Anxiety, and Depression. The gulf between knowing and understanding — though ever so slightly narrowing every year — remains a vast chasm. That lack of understanding leads to a lack of empathy. Outsiders ask why those with depression can’t just be happy, why those with ADHD can’t just pay attention, why those with anxiety can’t just relax.
That gulf exists for Hoarding disorder, too, and made even wider by the physical element of the hoard. A common refrain in the series is that of a hoarder’s family member or loved one asking repeatedly, in confusion and anger, why they can’t just get rid of the stuff. To them, that’s all it is: stuff. To those suffering from hoarding, every ounce of stuff has meaning, or value, whether sentimental, monetary, or both.
“By educating the family and really helping them to understand that this is a mental health condition, Zasio says. “That they’re not lazy people, they’re not people that don’t care about you. it’s not that they like their stuff more than you, it’s that they have mental health problems that are driving the success of acquisition and difficulty letting go.”
As Zasio and the other psychologists educate both the family and the hoarder on the disease, they’re also educating the audience at large. And it’s not just non-hoarders or family members of hoarders watching. Paxton says that, after ten years of the show, he’s seen a marked shift in the mindset and awareness of those afflicted by the disease. He’d walk into a hoarders house and see fifty pictures of the same person lining the wall. The subject of the pictures was the hoarder’s deceased husband, and the trauma of that loss was clearly what led to the hoarding behavior. The hoarder, however, wouldn’t make that connection.
Now, when Paxton goes to a cleanup, the hoarder more often than not has watched every episode of the show, knows Paxton by name, and can make the connection between their specific trauma and their hoarding behavior.
This is what makes Hoarders revolutionary and separates it from so much of reality television.
It’s easy to script situations that would cause someone’s anxiety to turn from a simmer to a boil, or send someone into a depressive episode. Those moments can be sung about, as in Crazy Ex-Girlfriend; animated, such as in Bojack Horseman; or even fought, like in Doom Patrol.
Far harder is following a subject around in reality waiting for those moments to happen authentically. Hoarders does not have to wait, nor does it have to manufacture the drama. The hoard, everything that splinters from it, is the drama and the physical manifestation of the disease. And, yes, while A&E certainly benefits from that drama, the relationship is more symbiotic than exploitative.
One of the criteria for being on the show is that the person suffering from hoarding disorder must be in some sort of crisis — facing eviction, intervention from child and/or adult protective services, massive fines from the city, to name a few. Obviously, this gives the network ample drama to document, but it also gives the mental health and cleaning experts the opportunity to make an outsized impact.
The clean up, plus the funds for after care therapy — provided to every participant on the show — costs well over $10,000, according to Dr. Thompkins. The individuals and families in crisis don’t have that type of money just laying around. The exchange is simple: the hoarder and their loved ones let the show into their lives, and in return, they’re pulled back from the brink of disaster, and sometimes even set on a course to manage their disease, provided they actually take advantage of the therapy. If the show exploited their side of the deal — artificially escalating the drama, encouraging feuding among participants or purposefully placing them in explosive scenarios — then it wouldn’t be a fair bargain in the least bit. It still might not totally fair as is, with the network potentially making millions, but given the empathy, caution and care with which the show treats its subjects, it’s at least a bargain in which both sides truly benefit.
“The thing that has made it tolerable for me is that, at the end of the day, not always, but most times we’re able to avert a crisis,” Dr. Thompkins says. “I got into this job to help people. And if that show helps people and helps them help people who aren’t even on that show who’s stuck with (hoarding) by creating more understanding within the world and destigmatizing this mental health problem, I’m OK with that.”
