"When you go to the bathroom and use some toilet paper, do you dispose of it?"
The patient hesitated. "That's a good question," she said. More seconds ticked by, still with no answer to my query.
The patient was a compulsive hoarder. By her admission, her house had become virtually unlivable. She couldn't even find her medications or her telephone, because they were completely buried in an ever-accumulating pile of junk. She came to our clinic desperate for help. She couldn't bring herself to throw anything away. She had spent what little money she had on hiring a professional crew, but when they arrived she refused to let them throw away any of her belongings. She was stuck. Repeated fines from the city for keeping her yard in disarray were adding up.
We did what we could: we gave her encouragement, we crafted strategies of how she could begin to tackle the problem, and we referred her to a psychiatrist (she had already been referred multiple times in the past). We even talked about different TV shows about hoarding and tried motivating her to watch an episode. We probably accomplished nothing. She might not even schedule her appointment with the psychiatrist, because she can't locate her telephone.
Some patients' problems are way beyond our powers. Practicing medicine is sometimes an exercise in helplessness.
