As a child, Liz C. remembers having 'heart palpitations' whenever the doorbell rang. Usually, she'd meet friends outside rather than let them see the stacks of newspapers, boxes, used paper towels and other trash cluttering her family's home in Short Hills, N.J.

    'My mother would tell me to lie. She'd say, 'Tell your friends we're painting -- that's why all these boxes are here.' How sick was that?' says Liz, who asked that her full name not be used. By age 11, Liz was working to buy her own food and clothing. 'You expect your parents to have food for you, but the kitchen table and counters were just cluttered with garbage,' she says. Yet her mother rebuffed any offers of help, and her father, an alcoholic, didn't want to upset her. 'It was a mutual enabling situation,' says Liz, who is 50 years old and works in marketing at a New Jersey university.

    Her mother now lives in a retirement community and, at 80, is still hoarding. 'She'll never change,' Liz says. 'The psychologists say you have to forgive to move on, but it's hard, especially when you have to visit and you still think, 'Jeez -- look at this mess!' '

    ****

    Compulsive hoarding -- accumulating so much stuff that one's living space is rendered unusable -- is coming out of the closet these days, thanks to books, movies and TV shows like A&E's 'Hoarders.' （I first wrote about it in my Oct. 20 column.） Mental-health experts view it as a form of obsessive-compulsive disorder. It's also seen in people with dementia, depression, attention-deficit disorder and brain injury, and after major life losses. As many as one in 50 Americans may fit the criteria.

    But many family members say the pain that hoarding inflicts on them is still largely unacknowledged. Some who grew up in homes like Liz's see it as a form of child abuse. Besides having their basic needs neglected, children of hoarders often grow up with little appreciation for cleanliness, or they seek out their own private space to keep clear of the clutter. Some become hyperneat adults, fearful of falling into the same pattern. 'To this day, I will not clip coupons -- my mother used to save entire newspapers for them -- and if I haven't worn something in a year or so, I throw it out,' says Liz.

    Many families are still agonizing over what to do with hoarders who refuse to change or even acknowledge the problem. They don't want to run their elderly parents' or grown siblings' lives, but they're fearful of letting safety hazards fester. Some are also fed up with experts who counsel patience and understanding with hoarders.

    Psychologists who specialize in treating hoarders generally advise families not to impose their standards of organization on a loved one or make decisions for him or her. Such experts also advise against forced cleanups, on the grounds the hoarder is likely to simply acquire even more as soon as possible. In his new book, 'Digging Out,' San Francisco psychologist Michael A. Tompkins tells families to accept that they can probably never stop the hoarding behavior and focus instead on 'harm reduction' -- such as eliminating immediate safety threats. He also tells family members to ask forgiveness from their hoarding loved ones for past efforts to clean against their will. 'Tell your loved one it won't happen this way again,' he counsels.

    'Talk about blaming the victim,' says Elizabeth Nelson, a spokeswoman for Children of Hoarders, a national group founded in 2005 to help families share resources and experiences. 'I'm not going to ask forgiveness for cleaning up my mom's mess.'

    Some professional organizers are trained in dealing with hoarders -- but like psychologists, they often espouse a slow and patient approach that some families find frustrating.

    Kit Anderson, who owns Anderson Organizing Systems in Albuquerque, N.M., tries to win hoarders' trust by promising not to throw out or even touch any of their belongings without their permission. Though it starts slowly, she says, the process eventually moves faster. 'We have some tricks up our sleeves,' says Ms. Anderson, who is president of the National Study Group on Chronic Disorganization.

    One trick is to find ways to donate items the hoarder cares about -- particularly if he is grieving for a lost loved one. Another approach is to have the hoarder collect every item in the same category, and then decide how many he really needs.

    But such a process can take weeks or months, and professional organizers charge from $45 to $200 an hour.

    Psychologists also suggest having the hoarder undergo a thorough mental-health evaluation to help understand what may be driving the behavior. In some cases, antidepressants help, or at least can alleviate some of the anguish involved in parting with possessions.

    利茲（Liz C.）記得，當(dāng)她還是孩子時(shí)，每當(dāng)聽到門鈴響，她都會(huì)感到心悸。通常，她會(huì)在外面跟朋友見(jiàn)面，而不讓他們看到新澤西的家中四處都是的報(bào)紙、箱子、用過(guò)的紙巾和其他垃圾。

    利茲說(shuō)，媽媽會(huì)讓我撒謊。她會(huì)說(shuō)，告訴你的朋友我們正在刷漆──這就是有這么多箱子的原因。這樣做多難受啊？利茲要求文中不要用她的全名。到11歲時(shí)，利茲就打工給自己買吃的和穿的了。她說(shuō)，你希望父母給你做吃的，但餐桌和櫥柜上全都是垃圾。然而，她的母親拒絕任何人幫忙收拾，而酗酒的父親不想惹惱母親。利茲說(shuō)，這也算相輔相成了。利茲今年50歲，在新澤西州一所大學(xué)做市場(chǎng)營(yíng)銷工作。

    她的母親如今年已80歲，住在一個(gè)退休社區(qū)，仍舊喜歡囤東西。利茲說(shuō)，她永遠(yuǎn)也不會(huì)變。心理學(xué)家說(shuō)，你應(yīng)該原諒這些，但這很難做到，尤其是不得不去看她的時(shí)候，你仍然會(huì)想：天哪，可真夠亂的！

    由于A&E的《囤積者》（Hoarders）這類圖書、電影和電視劇，強(qiáng)迫性囤積癥──積累太多東西以致沒(méi)有可用的生活空間──現(xiàn)在也走進(jìn)了人們的視野。（我在10月20日的專欄中第一次寫到這方面內(nèi)容。）心理健康專家認(rèn)為，它是一種形式的強(qiáng)迫癥。老年癡呆癥、抑郁癥、注意力缺失癥和腦損傷，以及遭受重大生活挫折的人群可能也有這種情況。每50個(gè)美國(guó)人中可能就有一人符合這個(gè)標(biāo)準(zhǔn)。

    但是，許多家庭成員說(shuō)，囤積給他們?cè)斐傻耐纯嘣诤艽蟪潭壬先晕吹玫匠姓J(rèn)。一些小時(shí)候家庭環(huán)境與利茲相似的人認(rèn)為這是對(duì)孩子的一種虐待。除了基本需要被忽略之外，囤積者的孩子在成長(zhǎng)過(guò)程中往往不注重整潔，要么他們會(huì)尋找自己的私人空間以遠(yuǎn)離混亂。有些人成年后會(huì)變成潔癖，害怕再陷入相同的模式中。利茲說(shuō)，時(shí)至今日，我也不剪優(yōu)惠券──我母親過(guò)去常會(huì)為了優(yōu)惠券而留著整張報(bào)紙，如果有什么東西一年左右還沒(méi)用壞，我就會(huì)扔掉。

    許多家庭仍然苦苦思索如何對(duì)付囤積者，他們拒絕改正，甚至不承認(rèn)自己有這個(gè)問(wèn)題。他們不希望干涉年邁的父母或長(zhǎng)大的兄弟姐妹的生活，但他們擔(dān)心這樣會(huì)導(dǎo)致安全方面的風(fēng)險(xiǎn)惡化。有些人也聽夠了專家要求對(duì)囤積者保持耐心和理解的建議。

    專門治療囤積癥的心理學(xué)家通常建議患者家人不要自己收拾東西的標(biāo)準(zhǔn)強(qiáng)加到所愛(ài)的人身上，或是替他作出決定。這些專家還建議不要強(qiáng)行清理，理由是囤積者可能馬上會(huì)去囤更多東西。舊金山心理學(xué)家湯普金斯（Michael A. Tompkins）在他的新書《挖掘》（Digging Out）中告誡患者的家庭成員，應(yīng)當(dāng)接受他們可能永遠(yuǎn)無(wú)法阻止囤積行為的事實(shí)，而將重點(diǎn)放在"減輕危害"上，如消除迫在眉睫的隱患。他還讓家庭成員就過(guò)去違背囤積者意愿進(jìn)行清理的行為向所愛(ài)的人請(qǐng)求原諒。他建議，告訴親愛(ài)的家人，不會(huì)再出現(xiàn)這種情況了。

    2005年成立的全國(guó)性組織囤積者子女（Children of Hoarders）的發(fā)言人納爾遜（Elizabeth Nelson）說(shuō)，至于指責(zé)受害者，我不會(huì)為清理我母親那一團(tuán)亂請(qǐng)求原諒。這個(gè)組織主要幫助家庭共享資源和經(jīng)驗(yàn)。

    有些職業(yè)組織者受過(guò)與囤積者打交道的培訓(xùn)，但同心理學(xué)家一樣，他們往往也贊成緩慢而耐心的辦法，而有些家庭對(duì)此感到灰心。

    新墨西哥州Anderson Organizing Systems的老板安德森（Kit Anderson）試圖通過(guò)承諾不拋棄，甚至在未經(jīng)允許的情況下不碰囤積者的任何物品來(lái)取得他們的信任。她說(shuō)，雖然開始進(jìn)展緩慢，但這個(gè)過(guò)程最終會(huì)加快。安德森說(shuō)，我們有一些獨(dú)到之處。安德森是全國(guó)慢性失范研究組織（National Study Group on Chronic Disorganization）的主席。

    一個(gè)技巧是找到捐贈(zèng)囤積者關(guān)心的物品的辦法，尤其是如果他是因失去親人感到悲痛而囤東西的話。另一種方法是讓囤積者收集同一類別的所有物品，然后決定他到底需要多少。

    但這個(gè)過(guò)程可能需要幾周甚至幾個(gè)月時(shí)間，職業(yè)組織者的收費(fèi)從每小時(shí)45美元到200美元不等。

    心理學(xué)家還建議，讓囤積者進(jìn)行全面的心理健康評(píng)估，以幫助了解驅(qū)使這種行為的可能原因。有時(shí)，抗抑郁藥也會(huì)有用，或至少可以減輕與擁有的物品分手帶來(lái)的一些痛苦。