This week Aaron Norris is joined by Dr. Robin Zasio. They had originally posted on Facebook to get people’s questions they wanted to ask her. She is a licensed clinical psychologist and licensed clinical social worker who has been specializing in the treatment of OCD and anxiety disorders for over twenty years. You may recognize her from several different shows, but the one that he was introduced to her on was “Hoarders.” He was always so fascinated how calm and collected and patient she was with the people with whom she worked.
It is always such a pleasure for her to be able to go on public venues and really be able to help the community better understand no just hoarding disorders, which she specializes in, but also anxiety disorders. Aaron asked if it is typical to be both a licensed clinical psychologist and social worker. He has never seen this combination and wondered if it was unusual. She said it is not unusual, although sometimes people go in one direction or another, like shooting straight through because they want their doctorate. They could also be wanting to add a license in marriage and family therapy or something else. This was her initial goal since she had not really thought about her doctorate.
What happened was she got her license as a clinical social worker, and she didn’t feel like she had the level of education she really wanted to really be as proficient as she could. She went back to school to get her third degree. Before this she had gotten her Bachelors and her Masters. There was a much more streamlined way to do it since she could have just gone for the doctorate and gotten all three built into one. She was really happy she went back since it has really changed her life and contributed to her abilities as a doctor.
She specializes in something very unusual, and Aaron wondered what attracted her to this line of psychology and social work. She said it started out as somebody who was quite interested in forensic psychology, which really refers to those who connect crimes that are mentally ill. There were lots of people in the media with high profile cases, and she was really fascinated by it. When she got here doctorate and was ready to graduate, she needed to get her post-doctoral hours. She found an organization that was starting an OCD program, and she knew nothing about it at the time. She thought it was interesting, and two weeks in she changed her complete course of direction because the treatment modalities are evidence based. They can prove that through giving people behavioral assignments to make change; it actually changes the brain chemistry, and there is nothing out there like it.
She was really able to produce change very quickly and help restore people’s lives back to them. Aaron said the reason he reached out to her is because we have gone from a market in 2009 where our real estate investor communities were working a lot with banks. It was not very relational-focused, it was more transactional. Now, we are working with people directly and almost exclusively. The shift is extreme, and now it is not unusual at all for the industry to be working with somebody with a hoarder house.
Some of the questions Aaron got online was what the difference is between someone who is just really messy, somebody who has a disorder, and somebody who is in a really dark place and we should recognize the risk. Robin discussed her book The Hoarder and You: How to Live a Happier, Healthier, Uncluttered Life. There is a lot of information in there to really understand the difference between someone who is messy and has difficulty with organization and somebody who has a hoarding disorder. Robin said when talking about a hoarding disorder, they are talking about somebody who has a level of acquisition of things that reaches a point where areas in the house cannot be used for the purpose in which they are intended. It gets to the point where they can no longer prepare meals since there is so much on the countertops that rooms are not accessible because there is so much. There are narrow pathways that could even lead to safety issues.
There are all different degrees, but a hoarding disorder reaches that level where there is that impairment in functioning. Often times, they are also seeing an impairment psychologically as well, meaning there is increased isolation, depression, estrangement from family members because if that person has let a family member in the home they will get a lot of flak. They get to a point where they don’t want to hear people asking them what’s wrong with them and why they won’t clean up their mess. The family members do not understand that hoarding disorder is a form of mental health condition. It is a mental disorder.
If they could just clean up, they would. If they could curb the acquisition of items, they would. It is like going to someone who is depressed and telling them to knock it off. People don’t think about it this way; and one of the reasons why is because depression is so accepted. It has been around for so long. When people look at individuals who are struggling with their things and letting it overtake their home, there is this logical part that does not make any sense. However, if we can all go into this place of understanding that it is not logical and is a mental health condition that causes somebody’s brain to engage in these ways, they can have a little more compassion and understanding and sympathy. This is really the key difference and why she does so much activity across the country trying to promote awareness because people are not going to accept help if they think they are going to be met with judgement rather than understanding.
Aaron asked Robin when people would get to the point where they would call her. It would probably mirror why The Norris Group, as real estate investors, get calls because something is off. Aaron asked what is going on in the background, whether it is family or the health department coming on top. Aaron asked what the trigger point is to where something has to change. Robin said that historically, individuals struggling with hoarding disorders and behaviors do not seek help because of the shame, embarrassment, and fear that enforcement officials and child protective services are going to come down on them.
They don’t really realize that these institutions are not designed to be punitive as they are designed to be helpful. When we are in trouble and feel unsafe, we call the police to come help use and don’t think they will come to hurt us. It has turned around because they are so afraid of what they are going to think about them. They don’t let people in their houses and completely avoid them, so the problem gets worse and worse. Family members do not know what to do. Sometimes what they think is helpful is if their family members are on vacation they will go in and clean up their house not realizing that this is one of the most detrimental things they can do.
Robin used the analogy of if Aaron went on vacation and somebody thought his house needed cleaning. If he comes back home and somebody else had made decisions about what he needed and didn’t need, that would be pretty devastating. Even if it is true that a person struggling with this condition might have things that are broken or unusable and not really usable, it is still their stuff. One interesting thing she said is that there is a cognition that if they ask for help, there could be a risk of their behavior causing health issues. They may be afraid to reach out due to embarrassment, but Aaron wondered if they are thinking in their mind that they are just a collector and everything they have is important to them.
Robin said interestingly enough, one of the cases that has been showcased on tv was a gentleman in California who had over 200,000 beer cans. He had other collectibles as well, but he was adamant that he was a collector. However, if you imaging walking into a space where there are 200,000 beer cans, you would have to be incredibly organized and strategic to be able to take care of them. When walking in, you are stepping on them and destroying them because there is no place else to walk since he ran out of space. They invaded entire floor; and as much as they were trying to be careful and cautious there was no place else to walk. They could not help him if they were not able to get into the house. They were very apologetic, and he insisted he was a collector.
What they have to explain to people is that a collector is very strategic. When they go out, maybe collect Barbie Dolls. They do not collect every single doll they see. If one has a broken arm they might say they cannot really do much with it rather than just buying it simply because it’s a Barbie Doll. A collector would say they already have one and it is not helpful for their collection and would only look for the one or two pieces that would make their collection. A collector can also care for the items, protect them, have them boxed, shelved, or in a nice cabinet where they can display them. When people are more struggling with the excessive acquisition, it doesn’t mean that in their mind as you are asking them that they are not thinking they are a collector. However, when it gets to that place where your space is invaded and you cannot live a life in which you or the community is safe, then it’s a problem.
The hoarder is not thinking about how their place could go up in flames. They are not thinking of the fact they have not fixed their appliances or that there are wires hanging out, and it could produce an electrical problem. This not only puts the person in danger, but also the community around them. They don’t think that far ahead. Part of what Robin tries to explain to them is that their home is their castle. They may say they want and like all their stuff and that may not even be particularly bothered by having to develop a sort of goat skills to climb over mounds of items and narrow pathways called goat paths. If you had a medical problem, you would need to ask yourself if a gurney could get in there to save you. If you could even get to the phone, would you even be able to get out of the house? On top of this, if they are in an apartment or condo it puts their neighbors at risk.
These are all things they really have to take into consideration. It is at these points that Code Enforcement will come in, cite them, and fine them. They will give them an allocated amount of time to get their house in order. This is not the best way to trap them in a corner and tell them if they do not clean it up, they will be locked out of their home. Aaron wondered if this induces change or if it just causes them to fear and comply. Does it really fix what is going on underneath the surface? Robin said that all depends on what happens next. When they go out into the community and need a crew to start helping them get the massive number of things out, you want to have a mental health professional there. If they could get rid of their stuff, they would. Just sending the crew in to bring everything out is not going to work.
Typically the best thing to do in the ideal world that does not always work out but is the best thing to do is to get them into therapy first and understand what is leading them to all the acquisition of items and how they can start to make good decisions about what they can let go. Like anything, when you can feel empowered to make those decisions yourself, then you feel good about yourself. You don’t want them to feel like a terrified caged lion since they might get rid of things out of force, and there is a higher risk they will bring the item back again because they have not really learned anything.
Aaron asked about when Robin does her show and if it is because the family members are reaching out since they need help or the city law enforcement tells her. She said it can be a combination of things. Recently they went out to an extremely dangerous situation because of the level of fecal matter in the home. It was not under the radar of code enforcement or any other enforcement agencies. It was at the request of the family because the loved one ended up in the hospital. It was not until then they realized how dangerous it was. When they are called out, it is always in some way a pretty extreme and emergency type situation.
It is never easy; and what you see when you watch the show is incredibly extreme and dramatic. People watching the show will sometimes think they staged everything. However, when she walks in the house, what you see and what she sees is first eyes on. She has a sense of what she is headed for and that when she walks in, their eyes are all seeing the same thing. It is what she does. When asked how she remains so calm, she says first she is the doctor, not the family member. None of them can really imagine what it is like to have or live with a family member who is going through this. It is so incredibly painful.
However, she knows she will get a lot farther with that person if she can meet them at their level, at their anxiety, at their fear, and their desire to get their home cleaned. If they are feeling forced into it, she wants to help them get to a place where they can understand why it has gotten so overwhelming and what they can do to help them
Aaron asked if they are born with this disorder or if it is learned. He wondered what the trigger point is and how it starts. She said she covers a lot of this in her book. She talks about how when a teacher asks you in school what you want to be when you grow up, no one is going to say they want to be a hoarder. You are now going back to the question of whether it is nature versus nurture. Nature is the chemicals in your body and genetics. Nurture is the environment in which you are raised. You cannot always tease it out because if you have the nurture part, then that really suggests there is a genetic pre-disposition.
There are lots of people who grow up in families who say that they grew up in a clean home or their mother was organized, and you do not see this lineage. However, you can also see other triggers like trauma, abuse, or loss. Many times this happens when a family member passes away and they cannot make decisions about what to get rid of and what to keep. They bring everything into their house with a plan to sort through it. However, when they start to touch it and look at it and the memories come up, it is so painful for them. They almost want to go to this place of what they think their relative would want them to keep. They cannot answer this question, and if they cannot talk or communicate then they get very paralyzed and put it aside. Procrastination is one of the biggest offenders to this process because they put it off thinking they will get to it later. However, later never comes because they have anticipatory disorder. When they think about having to do this, it becomes so overwhelming that they put it off. With all the other items they have in their house and demand between family and work and commitments, it is easy to put off the things that are more difficult.
Robin always tells people when they wake up in the morning, they don’t say they cannot wait to go clean out the cat box. This is the very last thing you want to do because it is uncomfortable. This illustrates the human behavior to put off the things that are uncomfortable for you.
Aaron asked about her experience working with people and what percentage can go on and lead a normal life when going through the appropriate process. Robin said unfortunately, the research right now is still in process. Historically, they did not have a lot of information before; but now since the media showcases this condition, more people are seeking help. They are now getting a better sense of the condition. Unfortunately, statistics say 90% of individuals who do get their house in order go back to their prior behaviors. These are really similar to the statistics of things like alcoholism. Of the people who go through treatment, the percentages of those who stay sober is not real high.
With any condition, there are some things they would look at in terms of one’s prognosis. One is their motivation to change. Is there an internal desire to change versus being forced. There may be someone with a substance abuse problem whose significant other tells them they will leave them if they do not get help. If they get help this way, they are not really thinking about their behavior and how it has affected their relationship. You have to look at motivation to change and being able to openly work with somebody and apply the things you are teaching them.
The critical part is that after they get their homes cleaned up, they should have a plan. If they are in a grocery store, they should have a list and not just buy things because it sounds good. They check the refrigerator before they go out and realize what they already have. Robin had just talked to somebody who said they discovered year-old cookies in their pantry. There are so many things they could do. They could not stop in stores they know will trigger them, such as the dollar store or clearance stores. They should also get follow-up care to see that it is not just about a cleaning-up process. It is not about cleaning up your home, but rather why you struggle to say no to the temptation of items and ensure you only bring something into your house if it has a home in your house.
You may have a large floor space, but just because you see a couch that is 75% off, you do not have to get it just because you can. It needs to have an actual home that is for its purpose and usable. You would need to follow up with them and make sure they stay on top of things and have that accountability. You would need to make sure someone comes into their house every single week for a period of time and make sure they are staying on top of things. It is easy to get comfortable again in the dysfunctional ways that were what they know. For example, couples can argue about every little thing. Instead, they have to work really hard to not argue, listen, and not be defensive. It seems like this would be the easy thing to do. But when you have been living in dysfunction for so long, that is what you know and it becomes easier.
Tune in next week as Aaron continues his discussion with Dr. Robin Zasio. For more information, you can visit her Anxiety Treatment Center office in either Sacramento, Roseville, or El Dorado Hills. You can always email her at firstname.lastname@example.org or email@example.com. You can also give them a call at (916) 366-0647. Their website is also www.anxietytreatmentexperts.com. Finally, her title of her book again is The Hoarder and You: How to Live a Happier, Healthier, Uncluttered Life. You can find it on Amazon or at Barnes and Noble.