Pathologized accumulation: stakeholders and social position in hoarding definition, detection, and “treatment”
Embargo Date
2027-04-04
OA Version
Citation
Abstract
Hoarding, a condition characterized by the acquisition of and inability to discard possessions regardless of their value, resulting in the extensive buildup of clutter in active living spaces, is a complex psychological and social problem. Knowing someone who hoards is not unlikely: Prevalence estimates suggest up to 4% of the U.S. population—that is, roughly 13.4 million people—have a hoarding problem. Hoarding severity increases as people age, and prevalence rates are higher among older adults. As overall populations age and individuals live longer, we can expect to see hoarding occupy more attention and resources. This dissertation examines the medicalization and management of overaccumulation by investigating how object hoarding is defined, detected, and “treated” by municipal stakeholders in Boston. Hoarding was officially medicalized in 2013 with the codification of hoarding disorder in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V). Hoarding is highly stigmatized, contributing to high rates of social isolation. Yet the consequences of this disorder extend beyond the individuals who hoard; extensive clutter poses public health and safety issues, leading to intervention from municipal and community stakeholders. Most of those who encounter hoarding issues in the community are not mental health practitioners but are a heterogeneous group, including landlords; neighbors; and street-level bureaucrats (Lipsky 2010), especially first responders, housing inspectors, and public housing employees. These actors may hold biases about the people they serve, and they are not formally trained to provide therapeutic treatment for mental illness. I find that rather than receiving mental health treatment, those whose hoarding comes to municipal attention instead face dire consequences that further erode their health and quality of life: eviction, forced relocation, removal of dependents, loss of housing vouchers and their homes, and residential condemnation. Hoarding itself is not illegal, but regulators use tools, like the sanitary code, leases, and housing policy, to criminalize clutter, even among homeowners in their own homes. I use mixed methods to examine how hoarding is defined, detected, and “treated” in Boston. Specifically, I (a) conducted 61 semistructured in-depth interviews with stakeholders involved in detecting and managing hoarding and those with personal experience; (b) used the “go-along” method of ethnography to observe over 250 hours of housing inspections, housing court proceedings, internal City meetings, cleanouts, hoarding trainings, and other events; and (c) analyzed administrative data (i.e., 311 reports, code violations, and eviction filings). The qualitative data provide a nuanced portrayal of stakeholders’ experiences with hoarding in the community and demonstrate how they respond to hoarding cases in situ. The administrative data analyses help contextualize the rich qualitative data by documenting the spatial and demographic distribution of 311 reports about potential hoarding, code violations related to hoarding, and evictions related to extensive clutter. In addition to an introduction and conclusion, my dissertation includes four analytic chapters. I examine what is deviant about hoarding and chronicle and contextualize the medicalization of hoarding behaviors into a medical disorder in Chapter 2. In Chapter 3, I describe how hoarding is reported and detected, including how inspectors and landlords make decisions about how many—and what types of—objects are acceptable relative to the space in which they are housed. In addition to heightened surveillance contributing to the detection of low-SES individuals who hoard, inspectors assess the value of the possessions amassed to decide whether what they are seeing is “collecting,” thus normal, or hoarding, which is abnormal. Chapter 4 uses observations of housing court proceedings to show the surprising ways that SES can shape outcomes for those who hoard. Judges and court inspectors employ constructions of deviance (i.e., how deviant hoarding is in a given housing context and neighborhood) and deservingness (i.e., how vulnerable an individual seems and how legible their disability is) to determine how “hard” to pursue cases. Chapter 5 discusses the “final” stage in the process, “cleaning out,” using interview and observational data from professional, and less professional, cleanouts of hoarded dwellings. I also describe the ways that actors attempt to leverage compliance from those who hoard. My conclusion suggests policy recommendations to support those who hoard and considers possible applications of some of my findings.
Description
2024
License
Attribution-NoDerivatives 4.0 International