A woman entered her parents' home office, quickly scanned the room and noted the mounds of unfiled bills, stock transactions and tax papers.
"Don't die," she said tersely.
Cleaning out the detritus of others' lives can be a challenge. It's daunting to try to cull the wheat from the chaff, the treasure from the trash, when the owners themselves couldn't figure it out.
"Everybody knows somebody who hoards. We just don't talk about it," said Emily Farber, a social worker case manager with the Palo Alto nonprofit Avenidas. As part of her job, Farber teaches a program called "Everything You Want to Know About Hoarding ... But Are Afraid to Ask!"
Although the extreme cases portrayed on reality TV shows do get people talking, "It's put a really tainted image on the word: It's disgusting, lazy, dirty people. It hasn't trickled down to reasons why people do this (and) how to work with people," she said.
Hoarding affects men and women across all socio-economic groups, Farber said.
It may look different in a subsidized studio apartment than in a four-bedroom Colonial, but "the problem is the same. It's just going to present and play out differently," she said.
Hoarding was recently added to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), with nearly 6 percent of the general population affected, noted Dana Girard, a psychologist with a private practice in Redwood City and Los Gatos specializing in hoarding disorders.
"In San Mateo County alone, that's estimated at about 36,000 people," she said.
In Santa Clara County the total is closer to 90,000.
Palo Alto is not immune to the problem: In January, firefighters were stymied fighting a fire on Embarcadero Road because of the large amount of papers and books scattered throughout the house.
Brian Reynolds, one of the city's two code-enforcement officers, has encountered hoarders through his job, although extreme cases are rarely reported in Palo Alto, he said. Most of the 500 or so complaints he deals with each year relate more to encroachment (tree branches hanging over a property line, for example) or property-maintenance issues, he said.
"In the past 11 years, I've had less than a handful of complaints on interiors," he said. "We're limited on what we can do. ... We don't want to be in the business of telling them how to live inside, unless there's a hazard to themselves or neighbors."
When neighbors do call with concerns, he added, they can be referred to the county health department or even the Palo Alto Mediation Program.
Technically, hoarders are different from garden-variety clutterers. Compulsive hoarders tend to acquire (and fail to discard) a large number of useless items, to live in spaces so cluttered as to preclude activities for which those spaces were designed (like so much stuff on the bed one can't actually sleep in it), and to suffer significant stress or impaired functioning caused by the hoarding, according to early researchers R.O. Frost and T.L. Hartl.
Clutterers, on the other hand, can clear spaces pretty quickly, make things neat and have people over.
"We all have some amount of clutter," Girard said. "For people struggling with hoarding, it's much more difficult.
"They tend to have more clutter than the average person. Thanksgiving dinner is unlikely to happen because they cannot put things away," she said.
"They get easily distracted; they doubt their memory; they have information-processing deficits. They'll find a cushion in the stove" that doesn't even belong with a sofa in the house, she said. "They'll have unhealthful beliefs, emotional attachments (or underlying) genetic vulnerabilities."
People rarely self-identify as hoarders, Farber said. They're often referred for counseling by landlords, family members, neighbors, a dialysis nurse, a condominium association or paramedics who can't easily gain access during an emergency.
"It's much less common for someone to say, 'I'm feeling overwhelmed,'" she added.
But some do. After moving in 2012 from Detroit, where she helped create a hoarding task force, Farber decided to share her experiences in Palo Alto, with no idea how many people would show up to an introductory talk.
Her first program drew 50 attendees. Many opted to sign up for her four-session workshop, "Hoarding & Cluttering 101." And some continue to meet monthly for a support group she leads.
Like many who are afflicted with hoarding or cluttering disorders, Perry Bautista of South San Francisco was in denial.
But when he could no longer park a car in his large garage because it was filled to the rafters with old newspapers, he knew he had a problem.
Once that light bulb went on, he started looking for help by attending hoarding and cluttering conferences in the City sponsored by the Mental Health Association of San Francisco.
His wife came upon Farber's Avenidas class on hoarding. Bautista attended in January, then signed on for the workshop.
Bautista encountered a variety of declutterers in the workshop, from the children who have to get rid of their parents' belongings to people downsizing and trying to make more space.
"That's when all the emotions and feelings and attachments come into play," he said.
"I fit in with the 'practicality' type of attachment. My father was a survivor of the Great Depression; my father-in-law was the same way. ... Back in those days it was a 'survivor' type of living: You don't throw things away because you might be able to use it."
Bautista started saving newspapers because "I figured there were a lot of articles I never read, and so I figured some day, some time I would be reading them. But that day never came, and the newspapers kept collecting.
"Eventually I realized I wouldn't be losing the information because they'd be on the Internet or some other source," he said. "Once I made that decision, I started recycling newspapers."
But that realization didn't come until his garage was crammed full, and one of the house's three bedrooms was useless.
At first it was difficult to get rid of things.
"It felt like I was in quicksand," he said. "The harder I tried, the harder it got."
But since attending the workshop it's gotten easier and easier.
He acknowledged that he's not quite finished paring down and hasn't reached "maintenance."
"The biggest problem for me is managing my schedule," he said. "My wife wants me to resurface our patio deck before the end of summer. I've made that my No. 1 priority.
"After the deck is done, I'm going back to downsizing. Throughout my life, it'll be a balancing act, just like Weight Watchers," he said.
"I feel like I am making progress. It's one step at a time," he said. "I'm lucky my wife is very supportive, but as Emily always says, 'This is a marathon and not a sprint.'"
Pamela Hardy was working full-time in a corporate job three years ago when she moved into a roomy but smaller home in Mountain View.
"I kind of moved in and put stuff in boxes and said I'd deal with it some day. Well, some day finally got here," she said.
When she couldn't find beloved objects in a display case in her living room because it was just too crammed full -- or couldn't open a cabinet in her dining room -- she knew she had to act.
She saw the notice for Farber's talk in the Avenidas newsletter and signed up. Then she followed up with the four-session workshop and began attending the monthly support group.
"Emily gave out a lot of tips on how to handle your own space," she said, describing a homework project that involved taking before-and-after pictures.
"I take one room, one area, one station and concentrate on that and not get distracted. Distraction is a big thing," Hardy said. "I'd pick up an object and think, 'This belongs in another room.'"
But, instead of taking it into another room, Hardy has learned to "stage" the item somewhere and take all those things out later.
Farber also taught her students to ask questions about each item, Hardy said: "Why are we holding onto this? Is it sentimental, an heirloom? Is it worth anything?
"I ... went room to room and took things away that I no longer want," Hardy said. "Actually, I sat down and felt freer. I could breathe -- (there was) not so much stuff."
Since retiring a year ago, Hardy isn't traveling on business anymore, and she's no longer acquiring trip mementos. But having the monthly support group helps her to stay on top of the temptation to accumulate more stuff, period.
Hardy is taking her downsizing one step at a time, allocating specific time for it and pacing herself.
"I tackle the job around 10 o'clock, then I'll break for lunch, then depending on what I've done or not done, I might work for another hour or sit back and think about where I am, what I'm doing," she explained.
She keeps in mind her goal for her home: "I need to keep it open and comfortable and allow people to enjoy what I have here."
In her living room, she tackled one over-stuffed bookcase full of items from various people.
After decluttering, she said, "Now I can look at the thing and know where it came from."
She's made an effort to be more efficient when new things enter her home.
"I moved bags into the laundry room. Now when I bring the mail in, I sort it in the laundry room," next to the recycling area, she said.
But she has hit stumbling blocks, like not knowing what to do with pieces of carpet.
"They're going to have to sit there until I know what to do with them."
She also doesn't know what to do with her late father's box of Rotary pins and caps.
"It's hard for me because Rotary was a very important part of his life, but it's not part of my life," she said.
Hardy sympathizes with people who feel paralyzed by their belongings.
Three years ago, Hardy had 30 days to pack up and move from the home where she had been for 10 years.
"I had a sun porch -- it was huge. I had boxes and boxes and boxes of stuff," she said.
"I was by myself, at the holidays, tears running down my eyes. ... I can understand people who have this overwhelming 'Where do I start?' It can stop you. The first step with any issue in your life is admitting it and getting help," she said.
Hardy's home is still a work in progress. She's managed to sort through clothing so she can now keep her sweaters in a drawer, rather than on top of the dresser. And as for her office, "The books still need to be worked on, but I have a surface here. I can now work in here," she said.
She's set aside her proprietary shredding in boxes and is thinking of taking them to Sunnyvale's SMaRT Station (see Where to learn more about hoarding). Some items are set aside for a flea market coming up in November.
Hardy has done most of her sorting and downsizing alone, but both Farber and Girard say that working with the right person -- or persons -- can be helpful. The key is identifying a nonjudgmental person who can make the process fun, Farber said.
Girard describes the dream team for a hoarder: a therapist to work on internal clutter, a professional organizer or clutter coach to work with what's at home, family members, a psychiatrist to prescribe medication for co-disorders and a medical doctor for any existing conditions.
"Three-quarters (of true hoarders) have no insight at all," Girard explained. They believe that "the city, family or landlord are oppressing them and making it difficult for them to live."
Another 12 percent have what Girard calls "partial insight. ... They'll call, but when it comes to making decisions, anxiety comes up. It tends to block them from moving forward."
Girard mostly deals with that final 15 percent, who "struggle with the disorder and tend to have adequate insight and motivation. They're ready to go."
"My colleagues say they've rarely seen hoarding exist on its own. There's always some underlying component -- it could be trauma-based (with trauma as a trigger). The clutter is just an externalization of the trauma. Some look at it as another form of addiction, like sex or food.
"I don't know who I have in the moment until they show up," she said.
One common treatment is Cognitive Behavioral Therapy (CBT), a form of psychotherapy. But "what I'm finding is CBT doesn't seem to be enough," she said. "Showing someone how to be in a store without making purchases, or practicing letting go of an item, or showing them organizing items in the home seems not enough -- (it) just scratches the surface. You need to look closer at the relationship with the objects, where healing has to begin."
Girard sees patients both individually and in groups.
"They are both needed, in terms of treatment," she said. "In groups you hear your own story coming back at you. What others are struggling with resonates with you. You start to have more self-compassion, more motivation to do work you need to do.
"But in group, you can't go deeper into your own stuff. Everybody has a story," she said.
In Bautista's opinion, the problem of collecting stuff is more common than people think.
"It can sneak up on you before you know it. You don't have to be a hoarder or clutterer to fall into that trap," he said.
"I hear a lot of people say, 'I have to clean up my garage.' They let it go for a few months or a year, but then they do a purge.
"For the rest of us, we have to go through a process where you have to make a decision. ... Sometimes, you think it's like saying 'goodbye,' and you'll never see this particular item again. You have to ask yourself, 'Am I going to miss it? Do I need it?' Once you're satisfied you can let it go, you let it go," he said.
"It's still hard, but each time gets easier."
Take the quiz: Are you a hoarder or clutterer?