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The impulse is to get a dump truck in the house and toss everything.真有股沖动把垃圾车开进家里，将囤积的东西全扔出去。
I watched the “hoarding show” when it was still on Discovery Health （when Discovery Health still existed！）， but in visiting the homes of patients as an LCSW1 I have seen the effects of real-life hoarding. Hoarding is a disease that acts， in many ways， like an addiction. As such， it affects the family much like addiction affects the family. Everyone needs help but， most often， the patient—the hoarder—is identified as the sick one， the “identified patient2.” Once that happens， it seems， the “judging” begins.
The show， with its cameras and varying views of the accumulation， can lead you to believe that hoarding is always messy， dirty， disgusting. That if a person is a hoarder they are completely disorganized. I learned over the years that， while those things are true， that some who hoard are in fact quite anal3 about it. And proud. And maybe a little arrogant. For example， I once visited a patient who saved decades worth of daily newspapers. Like， five decades worth. He kept them stacked in meticulous4， edge-to-edge order against the walls， and when he was out of wall space （which appeared to have happened a good decade or so before I met him） he constructed little pathways that traversed the living room and dining room. Each winding path was bordered by newspapers that stood waist or shoulder high， but every single one was very neat and tidy and a fire hazard5. The house smelled musty and stale. But the patient liked it and had no intention of changing a thing， which is why the fire department had been called in.
In the current issue of the Diagnostic and Statistical Manual of Mental Disorders6 （DSM-IV）， hoarding is listed under Obsessive-Compulsive Personality Disorder， as one of 8 criteria for diagnosis. It’s described as： “The inability to discard worn-out or worthless objects even when they have no sentimental value.”
It seems as though it deserves its own category.7
In 2018 National Public Radio aired a story about how researchers are realizing that hoarding behaviors begin in the mind. At the University of California， San Diego Department of Psychiatry， psychologist Catherine Ayers， a specialist in anxiety disorders and late-life hoarding， is researching treatment for older adults who hoard. Currently， she’s using a form of behavior therapy and cognitive remediation8 that focuses on building concrete skills.
That’s a good thing. As I mention above， hoarding resembles an addiction， progressing in severity over time. If a parent is hoarding in older age， he or she may have always been a hoarder or， perhaps， that behavior has taken the place of another compulsive behavior that， for whatever reason， has been abandoned. A loved one’s hoarding can make their caregiver—son， daughter， spouse， lover， caregiver—feel as out of control as the person who hoards feels deep down. For some people the worsening of symptoms is slow and steady， for others it’s rapid and frantic9.
For family members who are ashamed or saddened or overwhelmed or disgusted， the impulse is to get a dump truck in the house and toss everything. Of course， this would never work in the long run. If a big clean-up is imposed to rid the house of clutter but no follow-up treatment is offered to treat the underlying disease process， the person will typically replenish the clutter and then some10， much to the dismay11 of the interveners. That’s the pathological part. Remember that if you care about someone who hoards， so you don’t find yourself too angry that your efforts to clean up once and for all failed， over and over again. Be gentle with them—and yourself. In fact， seek help for yourself. Admit， to yourself， that you need it and that you cannot control the hoarder in your life.
当“囤积秀”还在《探索健康》栏目中播出的时候（当时《探索健康》还没停播呢），我曾经看过这个节目，但是当我以临床社工的身份亲身拜访这些病人的家时，才感受到现实生活中囤积行为的影响。囤积行为是一种疾病，它在许多方面都和成癮行为相似。正因如此，它对于家庭的影响也跟成瘾的影响多有类似。所有人都需要帮助，但最常见的是这些病人——也就是囤积者——被认定为病态个体，也即“被认定患者”。这一旦发生，就意味着一场“批判”开始了。
靠着它的摄像机和各种堆积物的镜头，这个节目能让你相信囤积行为总是凌乱、肮脏和恶心的，如果一个人有囤积习惯，那他/她为人处事肯定是毫无章法的。这些看法确实没错，但我这些年来也认识到，有些囤积者对于囤积这件事实际上是极为挑剔细节的，同时他们还为之自豪，甚至有些许傲慢。举例来说，我曾经拜访一位病人的家，他囤积了几十年的日刊报纸，估计能有五十年的量吧。他把报纸一丝不苟、整整齐齐地码在墙边，当墙边空间用完之后（早在我遇见他的大约十年前就用完了），他堆砌出横贯整个起居室和饭厅的小小过道。每条曲折过道的两边都堆着齐腰高甚至齐肩高的报纸，每条道都干净整洁，每条道也都是火灾隐患。那间屋子充斥着一股霉腐味，但是病人喜欢这样而且不愿做出任何改变，所以消防队被召来处理这种情况。
在《精神障碍诊断与统计手册》的现行版本（第四版）中，囤积行为被列在“强迫型人格障碍”这一条目下，作为后者的八项诊断标准之一。它被描述为：“对于破旧或无价值的物件，即使它们已经没有情感价值，仍然无法将其丢弃的行为”。
但是看起来它值得有自己的单独分类。
2018年，国家公共广播电台报道了研究人员如何认识到囤积行为源自心理问题的故事。在加州大学圣地亚哥分校的精神病学系里，心理学家凯瑟琳·艾尔斯——一位在焦虑症和晚年囤积行为领域的专家，正在为年长的囤积者寻找治疗方法。目前，她在使用一种行为疗法和认知矫正，着重培养具体技能。
这是一件好事。
正如我上文所述，囤积症好比成瘾，随着时间推移它会愈加严重。假如年迈的父/母亲出现囤积行为，那他/她或许一直以来都是一位囤积者，又或者，囤积行为只是取代了另一种出于某些原因而被摒弃的强迫行为。亲人的囤积行为会使得照顾他们的人——儿子、女儿、配偶、爱人、看护——感到与囤积者内心深处一样的失控。对某些人来说，症状恶化来得既慢又平稳，对其他人来说，则既快又疯狂。
那些感到或羞愧、或悲伤、或震惊、或恶心的家属，心里都有股冲动把垃圾车开进家里，将囤积的东西全扔出去。当然，这在长远来看是绝对行不通的。假如硬要给房子来一个大扫除，把所有杂物统统清走，但事后却不对潜在的疾病跟进治疗，那么这些干预者会失望地发现，当事人只会照例把杂物再次塞满房子且更甚，这就是病态所在了。记住，如果你关心某位囤积者，那么当你发现自己试图一劳永逸地清除所有冗杂的努力全然白费，再三尝试依然无果，请不要太过愤怒。对他们——还有你自己温柔一点。实际上，为你自己寻求帮助吧。向自己承认：你需要帮助，而且你永远无法控制你生活中的囤积者。 □
（译者为“《英语世界》杯”翻译大赛获奖者）
I watched the “hoarding show” when it was still on Discovery Health （when Discovery Health still existed！）， but in visiting the homes of patients as an LCSW1 I have seen the effects of real-life hoarding. Hoarding is a disease that acts， in many ways， like an addiction. As such， it affects the family much like addiction affects the family. Everyone needs help but， most often， the patient—the hoarder—is identified as the sick one， the “identified patient2.” Once that happens， it seems， the “judging” begins.
The show， with its cameras and varying views of the accumulation， can lead you to believe that hoarding is always messy， dirty， disgusting. That if a person is a hoarder they are completely disorganized. I learned over the years that， while those things are true， that some who hoard are in fact quite anal3 about it. And proud. And maybe a little arrogant. For example， I once visited a patient who saved decades worth of daily newspapers. Like， five decades worth. He kept them stacked in meticulous4， edge-to-edge order against the walls， and when he was out of wall space （which appeared to have happened a good decade or so before I met him） he constructed little pathways that traversed the living room and dining room. Each winding path was bordered by newspapers that stood waist or shoulder high， but every single one was very neat and tidy and a fire hazard5. The house smelled musty and stale. But the patient liked it and had no intention of changing a thing， which is why the fire department had been called in.
In the current issue of the Diagnostic and Statistical Manual of Mental Disorders6 （DSM-IV）， hoarding is listed under Obsessive-Compulsive Personality Disorder， as one of 8 criteria for diagnosis. It’s described as： “The inability to discard worn-out or worthless objects even when they have no sentimental value.”
It seems as though it deserves its own category.7
In 2018 National Public Radio aired a story about how researchers are realizing that hoarding behaviors begin in the mind. At the University of California， San Diego Department of Psychiatry， psychologist Catherine Ayers， a specialist in anxiety disorders and late-life hoarding， is researching treatment for older adults who hoard. Currently， she’s using a form of behavior therapy and cognitive remediation8 that focuses on building concrete skills.
That’s a good thing. As I mention above， hoarding resembles an addiction， progressing in severity over time. If a parent is hoarding in older age， he or she may have always been a hoarder or， perhaps， that behavior has taken the place of another compulsive behavior that， for whatever reason， has been abandoned. A loved one’s hoarding can make their caregiver—son， daughter， spouse， lover， caregiver—feel as out of control as the person who hoards feels deep down. For some people the worsening of symptoms is slow and steady， for others it’s rapid and frantic9.
For family members who are ashamed or saddened or overwhelmed or disgusted， the impulse is to get a dump truck in the house and toss everything. Of course， this would never work in the long run. If a big clean-up is imposed to rid the house of clutter but no follow-up treatment is offered to treat the underlying disease process， the person will typically replenish the clutter and then some10， much to the dismay11 of the interveners. That’s the pathological part. Remember that if you care about someone who hoards， so you don’t find yourself too angry that your efforts to clean up once and for all failed， over and over again. Be gentle with them—and yourself. In fact， seek help for yourself. Admit， to yourself， that you need it and that you cannot control the hoarder in your life.
当“囤积秀”还在《探索健康》栏目中播出的时候（当时《探索健康》还没停播呢），我曾经看过这个节目，但是当我以临床社工的身份亲身拜访这些病人的家时，才感受到现实生活中囤积行为的影响。囤积行为是一种疾病，它在许多方面都和成癮行为相似。正因如此，它对于家庭的影响也跟成瘾的影响多有类似。所有人都需要帮助，但最常见的是这些病人——也就是囤积者——被认定为病态个体，也即“被认定患者”。这一旦发生，就意味着一场“批判”开始了。
靠着它的摄像机和各种堆积物的镜头，这个节目能让你相信囤积行为总是凌乱、肮脏和恶心的，如果一个人有囤积习惯，那他/她为人处事肯定是毫无章法的。这些看法确实没错，但我这些年来也认识到，有些囤积者对于囤积这件事实际上是极为挑剔细节的，同时他们还为之自豪，甚至有些许傲慢。举例来说，我曾经拜访一位病人的家，他囤积了几十年的日刊报纸，估计能有五十年的量吧。他把报纸一丝不苟、整整齐齐地码在墙边，当墙边空间用完之后（早在我遇见他的大约十年前就用完了），他堆砌出横贯整个起居室和饭厅的小小过道。每条曲折过道的两边都堆着齐腰高甚至齐肩高的报纸，每条道都干净整洁，每条道也都是火灾隐患。那间屋子充斥着一股霉腐味，但是病人喜欢这样而且不愿做出任何改变，所以消防队被召来处理这种情况。
在《精神障碍诊断与统计手册》的现行版本（第四版）中，囤积行为被列在“强迫型人格障碍”这一条目下，作为后者的八项诊断标准之一。它被描述为：“对于破旧或无价值的物件，即使它们已经没有情感价值，仍然无法将其丢弃的行为”。
但是看起来它值得有自己的单独分类。
2018年，国家公共广播电台报道了研究人员如何认识到囤积行为源自心理问题的故事。在加州大学圣地亚哥分校的精神病学系里，心理学家凯瑟琳·艾尔斯——一位在焦虑症和晚年囤积行为领域的专家，正在为年长的囤积者寻找治疗方法。目前，她在使用一种行为疗法和认知矫正，着重培养具体技能。
这是一件好事。
正如我上文所述，囤积症好比成瘾，随着时间推移它会愈加严重。假如年迈的父/母亲出现囤积行为，那他/她或许一直以来都是一位囤积者，又或者，囤积行为只是取代了另一种出于某些原因而被摒弃的强迫行为。亲人的囤积行为会使得照顾他们的人——儿子、女儿、配偶、爱人、看护——感到与囤积者内心深处一样的失控。对某些人来说，症状恶化来得既慢又平稳，对其他人来说，则既快又疯狂。
那些感到或羞愧、或悲伤、或震惊、或恶心的家属，心里都有股冲动把垃圾车开进家里，将囤积的东西全扔出去。当然，这在长远来看是绝对行不通的。假如硬要给房子来一个大扫除，把所有杂物统统清走，但事后却不对潜在的疾病跟进治疗，那么这些干预者会失望地发现，当事人只会照例把杂物再次塞满房子且更甚，这就是病态所在了。记住，如果你关心某位囤积者，那么当你发现自己试图一劳永逸地清除所有冗杂的努力全然白费，再三尝试依然无果，请不要太过愤怒。对他们——还有你自己温柔一点。实际上，为你自己寻求帮助吧。向自己承认：你需要帮助，而且你永远无法控制你生活中的囤积者。 □
（译者为“《英语世界》杯”翻译大赛获奖者）