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，當她還是孩子時，每當聽到門鈴響，她都會感到心悸。通常，她會在外面跟朋友見面，而不讓他們看到新澤西的家中四處都是的報紙、箱子、用過的紙巾和其他垃圾。

    利茲說，媽媽會讓我撒謊。她會說，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，利茲就打工給自己買吃的和穿的了。她說，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，這也算相輔相成了。利茲今年50歲，在新澤西州一所大學做市場營銷工作。

    她的母親如今年已80歲，住在一個退休社區，仍舊喜歡囤東西。利茲說，她永遠也不會變。心理學家說，你應該原諒這些，但這很難做到，尤其是不得不去看她的時候，你仍然會想：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，強迫性囤積癥──積累太多東西以致沒有可用的生活空間──現在也走進了人們的視野。（我在10月20日的專欄中第一次寫到這方面內容。）心理健康專家認為，它是一種形式的強迫癥。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個美國人中可能就有一人符合這個標準。

    但是，許多家庭成員說，囤積給他們造成的痛苦在很大程度上仍未得到承認。一些小時候家庭環境與利茲相似的人認為這是對孩子的一種虐待。除了基本需要被忽略之外，囤積者的孩子在成長過程中往往不注重整潔，要么他們會尋找自己的私人空間以遠離混亂。有些人成年后會變成潔癖，害怕再陷入相同的模式中。利茲說，時至今日，我也不剪優惠券──我母親過去常會為了優惠券而留著整張報紙，如果有什么東西一年左右還沒用壞，我就會扔掉。

    許多家庭仍然苦苦思索如何對付囤積者，他們拒絕改正，甚至不承認自己有這個問題。他們不希望干涉年邁的父母或長大的兄弟姐妹的生活，但他們擔心這樣會導致安全方面的風險惡化。有些人也聽夠了專家要求對囤積者保持耐心和理解的建議。

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

    2005年成立的全國性組織囤積者子女（Children of Hoarders）的發言人納爾遜（Elizabeth Nelson）說，至于指責受害者，我不會為清理我母親那一團亂請求原諒。這個組織主要幫助家庭共享資源和經驗。

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

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

    一個技巧是找到捐贈囤積者關心的物品的辦法，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。

    但這個過程可能需要幾周甚至幾個月時間，職業組織者的收費從每小時45美元到200美元不等。

    心理學家還建議，讓囤積者進行全面的心理健康評估，以幫助了解驅使這種行為的可能原因。有時，抗抑郁藥也會有用，或至少可以減輕與擁有的物品分手帶來的一些痛苦。