梅雷迪思·雷斯尼克

The impulse is to get a dump truck in the house and toss everything.真有股沖動把垃圾車開進家里，將囤積的東西全扔出去。

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. Its 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， shes using a form of behavior therapy and cognitive remediation8 that focuses on building concrete skills.

Thats 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 ones 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 its 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. Thats the pathological part. Remember that if you care about someone who hoards， so you dont 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.

當“囤積秀”還在《探索健康》欄目中播出的時候（當時《探索健康》還沒停播呢），我曾經(jīng)看過這個節(jié)目，但是當我以臨床社工的身份親身拜訪這些病人的家時，才感受到現(xiàn)實生活中囤積行為的影響。囤積行為是一種疾病，它在許多方面都和成癮行為相似。正因如此，它對于家庭的影響也跟成癮的影響多有類似。所有人都需要幫助，但最常見的是這些病人——也就是囤積者——被認定為病態(tài)個體，也即“被認定患者”。這一旦發(fā)生，就意味著一場“批判”開始了。

靠著它的攝像機和各種堆積物的鏡頭，這個節(jié)目能讓你相信囤積行為總是凌亂、骯臟和惡心的，如果一個人有囤積習慣，那他/她為人處事肯定是毫無章法的。這些看法確實沒錯，但我這些年來也認識到，有些囤積者對于囤積這件事實際上是極為挑剔細節(jié)的，同時他們還為之自豪，甚至有些許傲慢。舉例來說，我曾經(jīng)拜訪一位病人的家，他囤積了幾十年的日刊報紙，估計能有五十年的量吧。他把報紙一絲不茍、整整齊齊地碼在墻邊，當墻邊空間用完之后（早在我遇見他的大約十年前就用完了），他堆砌出橫貫整個起居室和飯廳的小小過道。每條曲折過道的兩邊都堆著齊腰高甚至齊肩高的報紙，每條道都干凈整潔，每條道也都是火災隱患。那間屋子充斥著一股霉腐味，但是病人喜歡這樣而且不愿做出任何改變，所以消防隊被召來處理這種情況。

在《精神障礙診斷與統(tǒng)計手冊》的現(xiàn)行版本（第四版）中，囤積行為被列在“強迫型人格障礙”這一條目下，作為后者的八項診斷標準之一。它被描述為：“對于破舊或無價值的物件，即使它們已經(jīng)沒有情感價值，仍然無法將其丟棄的行為”。

但是看起來它值得有自己的單獨分類。

2018年，國家公共廣播電臺報道了研究人員如何認識到囤積行為源自心理問題的故事。在加州大學圣地亞哥分校的精神病學系里，心理學家凱瑟琳·艾爾斯——一位在焦慮癥和晚年囤積行為領(lǐng)域的專家，正在為年長的囤積者尋找治療方法。目前，她在使用一種行為療法和認知矯正，著重培養(yǎng)具體技能。

這是一件好事。

正如我上文所述，囤積癥好比成癮，隨著時間推移它會愈加嚴重。假如年邁的父/母親出現(xiàn)囤積行為，那他/她或許一直以來都是一位囤積者，又或者，囤積行為只是取代了另一種出于某些原因而被摒棄的強迫行為。親人的囤積行為會使得照顧他們的人——兒子、女兒、配偶、愛人、看護——感到與囤積者內(nèi)心深處一樣的失控。對某些人來說，癥狀惡化來得既慢又平穩(wěn)，對其他人來說，則既快又瘋狂。

那些感到或羞愧、或悲傷、或震驚、或惡心的家屬，心里都有股沖動把垃圾車開進家里，將囤積的東西全扔出去。當然，這在長遠來看是絕對行不通的。假如硬要給房子來一個大掃除，把所有雜物統(tǒng)統(tǒng)清走，但事后卻不對潛在的疾病跟進治療，那么這些干預者會失望地發(fā)現(xiàn)，當事人只會照例把雜物再次塞滿房子且更甚，這就是病態(tài)所在了。記住，如果你關(guān)心某位囤積者，那么當你發(fā)現(xiàn)自己試圖一勞永逸地清除所有冗雜的努力全然白費，再三嘗試依然無果，請不要太過憤怒。對他們——還有你自己溫柔一點。實際上，為你自己尋求幫助吧。向自己承認：你需要幫助，而且你永遠無法控制你生活中的囤積者。? ? ? □

（譯者為“《英語世界》杯”翻譯大賽獲獎?wù)撸?/p>