How do you do an intervention for depression and/or hoarding?

May 11, 2014 12:05 PM

My sister recently did something completely out of character - she failed to pay taxes on a family property which led to it being sold at auction. She never told anyone about this, she lied for at least two years, and it affected everyone in the family. I think this is a cry for help. I know I could reach out to her and ask but I think she needs something more dramatic to make her realize that she has hurt a lot of people (including herself) with her behavior and actions. I think an intervention is appropriate but I don't know the best way to do it.

I think she is depressed. She is morbidly obese and her house is out of control. I don't know if she would truly be called a "hoarder" in that she does not go and try to find things to add to her collection. She just never cleans and her house is full of crap.

As far as I know, she doesn't have many close friends so I feel like I need to step in and show her that she hurt her family. I have pollyanna view that if she actually sees how she is living, she might want to change but I also think she needs support and resources to do this. I am just unsure what these might be.

I realize I can't "change" her but I figure the worst thing that can happen is she knows that people care about her and she goes on with her life.

If you had experience with this, what was it like? What else should I be considering? Where do I even start. Throwaway email: [e-mail]

posted by anonymous to Human Relations (16 answers total)

"[T]he worst thing that can happen is she knows that people care about her and she goes on with her life." Well, no. The worst thing that can happen is that you can leave her thinking that her body shape, her housekeeping, and other people's emotional attachment to real estate are all more important factors in this than whether or not she is actually happy and what might be necessary in her life for her to be actually happy, which appears nowhere in this question.

It is not impossible, but it is extremely unlikely that it has actually escaped her notice that her life is pretty cruddy and her house is a mess and people are judging her for this. Communicate. Ask how she's doing. Ask if there's anything small you can help with, even if it's just talking awhile or going to lunch. You could do that. But it sounds a lot more like you're upset with her for doing this and you want a way to justify communicating that to her like it's for her own good, and not out of your own feelings about what happened.

People > Stuff. Always. Even real estate.
posted by Sequence at 12:15 PM on May 11, 2014 [54 favorites]

I would not recommend an "intervention". Especially if she is depressed- it may be much, much too overwhelming, and especially if the intervention is to show her the misery she has caused others. If you want to help her do it gently and make it all about her life, not how she is screwing up others' lives. I'm sure she is on some level aware of that and she can't handle doing otherwise right now, otherwise she would.
posted by Blitz at 12:22 PM on May 11, 2014 [8 favorites]

Yeah, an intervention would be more about you and your feelings than actually changing anything. If you actually want to support her, this might help.
posted by cotton dress sock at 12:25 PM on May 11, 2014 [3 favorites]

The wording of you question sounds to me like you're angry with your sister and your goal is to make her feel worse about what she's done to your family rather than to help her.

If I am misreading this and helping her is what you really want to do, then spend a lot of time with her to get to know her better and to show her someone cares, use that information to figure out where her problems are coming from, and after you have shown her she can trust you, talk to her about things SHE might like to change and discuss possible ways to do it.
posted by metasarah at 12:38 PM on May 11, 2014 [14 favorites]

if she actually sees how she is living, she might want to change

Most people with problems know that they have problems. She needs support, but she does not need an "intervention" in the reality TV sense, and the last thing she needs is shaming.

Your message and your intent should be "I'm concerned about you and I want you to feel better," and absolutely not "look how you've hurt everyone else." If you can't help her out of kindness with no trace of spite, you can't help her.
posted by Metroid Baby at 12:48 PM on May 11, 2014 [4 favorites]

I feel like I need to step in and show her that she hurt her family.

Why do you think that she doesn't know that she hurt her family?
posted by Flunkie at 12:50 PM on May 11, 2014 [7 favorites]

She was likely so depressed that she couldn't take care of business and so ashamed that she hid it for two years. She knows already.
Think of some other way to help besides pointing out her failures to her.
posted by SLC Mom at 1:08 PM on May 11, 2014 [19 favorites]

You sound like you don't know much about how depression or hoarding work. Otherwise you'd for example be aware that your "pollyanna" idea would be counterproductive: if *flaw* gets pointed out to depressed person it won't lead the person to a sudden epiphany and cause her to change her ways. It just makes her more depressed and less likely to be able to function.
Therefore I would start by reading up on both subjects. Perhaps other mefites have links or recommendations for you, or you'll find some by searching the archive.

I know the news is new and shocking to you, but you don't have to do something right now. Reach out to your sister. Show her you love her even now. Read up on the topic and then form a plan (or better questions to ask).
posted by Omnomnom at 1:40 PM on May 11, 2014 [6 favorites]

If you believe that your sister is depressed, I would suggest that you gently and lovingly tell her that you are concerned and would like to take her to the doctor. Don't worry about her weight.

If she doesn't agree, and you believe she's a danger to herself, contact her local adult protective services and ask them to perform a home check.

This is difficult and scary, and I understand that you are angry and frustrated, but please remember that all these things are symptoms of an illness; your sister didn't choose to be this way. For both your sakes, try to approach her with love and compassion.

Also, your description of your sister sounds exactly like a friend that I am very concerned about. I deal with our state mental health services at work. If she lives in Texas, and if you are willing, you are welcome to PM me.
posted by 1066 at 1:49 PM on May 11, 2014

Maybe I am reading it wrong, but I read "how can I help my sister" more than "how can I hurt and shame my sister" in this question. I think the OP realizes that her sister is more important than stuff - the OP said she thinks this behavior is out of character for her sister, thinks it is a cry for help from the sister and that the OP wants to help since the sister doesn't have friends. The OP's care and concern for her sister does not mean that the OP can't be angry at her sister's actions too-- they are not mutually exclusive emotions.

The sister did something to hurt the OP. The sister lost something of value to the OP and the OP's family. The sister lied about it for 2 years. I'd be pretty angry too. And I would also be concerned. I think it is fair to address the sister with concern without whitewashing what the sister did wrong.

Perhaps " hey sister, I am very concerned about you and love you enough to ask what is going on. I feel angry/sad/etc. that you lost the family real estate and lied to us for years. I dont understand why you did that, but I do believe that it was completely out of your character and I am concerned for you. Can I do anything to help you/what do you need/do you need to talk about anything?"
posted by murrey at 1:54 PM on May 11, 2014 [26 favorites]

If you express your need to punish her, it may very well push her to the very edge. What is wrong in your life that you would drive your own sister to this brink, just over (presumably) not paying a tax and being obese?
posted by Houstonian at 3:19 PM on May 11, 2014

After reading the responses I must say that I completely agree with murrey. Perhaps the question and issue was not perfectly asked by the poster but I certainly saw no malicious intent. There is nothing wrong with directly and matter-of-factly stating the objective facts whether the person has a mentally illness or not. Candid and forth right concern is a reasonable approach. As posters have said--the sister most likely knows the truth--pussy footing around it is a disservice to her and the rest of the family--and possibly just a bit patronizing. I particularly appreciated murrey's suggestion about stating it was out of character for the sister. There is a significant difference between approaching persons with an objective statement of facts and concerns versus angily denouncing and belittling the person.
And I will add with considerable certainty--if the sister is confronted with concern, reasonableness and not combatively and this pushed her over the edge the edge is very close anyway
posted by rmhsinc at 3:52 PM on May 11, 2014 [3 favorites]

The OP framed the question as "how can I intervene in my sister's depression?" not "how can I express my anger at the loss of our family property?". If the former is the priority then it is not helpful to approach the sister with an over(any?)-emphasis on the loss of the family property and the anger they feel about that. Of course if you feel anger it's okay to express that if you must, but using that as a way to "show" her how much she screwed up, how depressed she is, and how much she needs to get her act together is not going to help. In fact it would be at cross purposes and she will notice how her sadness only got attention when it resulted in a negative consequence for other people's lives, which will not make her feel understood, while her life was just as horrible as it was before the loss of the property and the "out of character" action. Was it okay that she seemed miserable all this time since it was only in ways that were "in character"? If you express anger at the loss of the property then that has to be kept completely separate from any trying to help her situation, as a separate issue. I think metasarahs's advice is best. If you want to help just spend time being in her life and getting to understand her.
posted by Blitz at 10:21 PM on May 11, 2014

So as a gentle, maybe not "intervention", but a wakeup call, how about you invite her to live in your house for a few weeks? Maybe frame it as a vacation, even if she lives in the same town as you. It'll get her out of the very literal comfort zone she's built. You'll have plenty of time to talk and connect.

Maybe while she's there she can see there are ways to making yourself feel happy than overeating and hoarding. Have her involved in family meals, outings with friends, etc. Let her know that you support her and love her despite letting you down.

Maybe she'll get to the point where she doesn't want to go back to her old life in the imposing fortress of crap and she's more receptive to connecting with a therapist or OA group.
posted by fontophilic at 6:39 AM on May 12, 2014

I think starting from a message of love and acceptance will be more helpful than an angry judgey command for her to get her act together. She likely already knows she should "get her act together" but she hasn't been able to, and a lot of times when people stage interventions they aren't actually saying "We love you and want to bring support to you" they are actually saying "You're behavior is unacceptable and we are going to try to force you to change by shaming and guilting you into seeing how harmful you are."

While that type of intervention is popular on dieting shows and sensationalistic hoarding/addiction intervention shows, and unfortunately even makes it's way into the mindsets of some therapists- the majority of therapists and professionals who are well trained to work with stuff like this have found that evidence based research does not support the latter type of intervention. Often shame IS driving a lot of the retreat from support services, it's not helping. Shame might not have caused the problem itself, that could be a biological or health problem, or it could be an emotional issue the person is struggling with, but shame drives people into addictive and harmful coping mechanisms and away from support.

The whole point is that the person has likely tried to change their behavior and isn't able to. They have often already gone through a process of feeling guilt and shame, wishing they had more energy to clean or work out, and it's just not there. They think badly of themselves and fear others judgements and retreat even more. They need help finding out what was going wrong (is going wrong) and support services both in terms of helping them manage their house without the assumption they WANT their house to be messy (many people with physical health problems are just TIRED.) They don't necessarily want a house full of stuff they just don't have the energy to store things in a reasonable way or to get to the projects they wish they could do so things pile up and sometimes they start living out the things they wish they could do through just having the stuff associated with those things around. Hoarding/chronic messiness/fatigue induced messiness can come from lot's of different types of problems and do not have one size fits all origins or solutions. Chronic disorganization is considered a very different condition than hoarding and should be treated as such "While chronic disorganization may result in clutter and loss of living space, it is not the same as hoarding. Chronic disorganization may lead to clutter in the home or office, time management issues and a reactionary response rather than long-term planning. Chronic disorganization may be a result of ADD/ADHD, a chronic pain condition, dementia, or other health condition."

So on your end, offering her support and understanding would be the best place to start, it's ok to be angry, but try to let her know that while you were upset you really love her and it seems like she's having a hard time managing things in her life from what you can tell. Let her know that you've heard there are some neat support services that will help her with organizing her home (don't frame her difficulty as a pathology, just let her know there are services that can help). It will help if you look at this as a situation of your sister needing help and not knowing there are resources who really understand her limitations and won't expect too much of her, rather than a situation of your sisters bad choices to choose bad behavior and need of intervention to set her straight and make her behave better. She will likely not be changing her behavior very much as part of beginning access to resources and often resources for chronic disorganization are geared toward helping a person develop the skills they are able without the expectation they will be become normal or that they can do the same amount of tasks as others. Some people will just need ongoing help managing their homes. Some others will become able to manage their life completely on their own after services and some will develop some skills but still occasionally need help when things build up.

The best thing you can do is check your city for resources that are kind and understanding about these sorts of conditions-- know what they are and as you open the door to talking to and supporting your sister be ready to drop the referrals to your sister here or there without an expectation she will use them. Don't offer referrals with the expectation she has to use them or she doesn't care about herself. Show her you just genuinely care if that's the case.

A few fact sheets from the Institute for Challenging disorganization
Tips for communicating with someone who has chronic disorganization

An example of the kind of services your sister might benefit from is something like A Helping Hand which has a lot of information that might help you find resources in your city. She might need help with cooking and household chores and considering recommending she hire both professionals to help with the initial decluttering and ongoing cleaning and chore help would be worth recommending. If she has financial limitations to paying for that you might consider if you and/or other family might could help pitch in. Let her know she doesn't have to feel stigma or shame from you for needing help (for lying and losing the family property may be another matter, but I would recommend leaving that aside for now if your goal is really to get her help).

Remember it is likely shame and the fear that these professionals are going to judge and shame her for not being able to do this herself that makes her shut down from these kinds of services, and remember not to judge her for being afraid or resisting things you recommend or offer as help- she might not believe you that these people really will just want to help without the judging and shaming or expectation she fix all of her limitations that happens in the sensational shows. If YOU can get to know the resources in your area yourself, make a phone call to them, ask them about how to talk to your sister about the help available, you can try to really help her feel safe getting help.

You don't have to do this for your sister of course, it's your choice if you want to help her, but those are some options you can look at if you want to make the door to help more accessible to her. A way to reframe your thinking about this is instead of seeing these behaviors as choices, see them as limitations. If you're telling a person whose legs are too weak to walk they need to hop out of bed or get into physical therapy to start intensive walking therapy, they will resist because they know they just don't have the energy. If you approach them with the understanding it's ok they are having a hard time walking, and you want to help them get wheelchair and other services or household help and assistance managing their difficulty, the shift may help a lot in your chance of them feeling like you really want to support them rather than change them. But often people are ashamed of their limitations no matter how nice you are about it, most people want to be self sufficient and know that culturally that is the ideal and people DO judge you for having limitations. They see you as a less ideal romantic partner, less worthy of being a parent or having your children, and many other things that are still considered acceptable ways to judge those with limitations. An aversion to that kind of labeling really is self protective and not a sign a person doesn't care about themselves. But helping your sister see that not everyone will judge her for that (like you and her family!), and her life might be so much better with help could make it easier for her. And yeah don't worry about the weight, focus on ensuring she has help cooking healthy meals because you have noticed it seems harder for her to manage the house and you just want her to know you're there to help her get resources with that if she needs it.

I know I wrote a lot here, but really, shifting your attitude, knowing the resources, and keeping the door open to her that you will help her with the understandably scary process of accessing help are the major points I have to offer. And ultimately be prepared for her to not want help with this and to just love her as a sister and also plan accordingly to not trust her to manage affairs in the family.
posted by xarnop at 8:34 AM on May 12, 2014 [2 favorites]

I think you'd get a lot out of reading _Stuff: Compulsive Hoarding and the Meaning of Things_, by Gail Steketee and Randy Frost. One of the key points that they make clear with many, many examples, is that hoarding is a disease which is typically accompanied by _lack of insight_. Many hoarders, in fact, do *not* "see" their living situations the way that outsiders do; many only "see" the situation when an outsider comes into the home (and so they avoid having company), and some, when confronted with *pictures* of their home, will have to be painstakingly convinced that that place in the pictures is, in fact, their home.

I think it would help you get some perspective on the scope of mental illness and how it's not just a matter of "will" or "no one's pointed it out to her before", but a more complex and entrenched pattern. And while it sounds like hoarding isn't your sister's only problem (compulsive acquisition isn't necessary for hoarding), a lot of those insights will carry over to other aspects of severe depression.
posted by endless_forms at 8:11 AM on May 14, 2014