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.

    利兹（Liz C.）记得，当她还是孩子时，每当听到门铃响，她都会感到心悸。通常，她会在外面跟朋友见面，而不让他们看到新泽西的家中四处都是的报纸、箱子、用过的纸巾和其他垃圾。

    利兹说，妈妈会让我撒谎。她会说，告诉你的朋友我们正在刷漆──这就是有这么多箱子的原因。这样做多难受啊？利兹要求文中不要用她的全名。到11岁时，利兹就打工给自己买吃的和穿的了。她说，你希望父母给你做吃的，但餐桌和橱柜上全都是垃圾。然而，她的母亲拒绝任何人帮忙收拾，而酗酒的父亲不想惹恼母亲。利兹说，这也算相辅相成了。利兹今年50岁，在新泽西州一所大学做市场营销工作。

    她的母亲如今年已80岁，住在一个退休社区，仍旧喜欢囤东西。利兹说，她永远也不会变。心理学家说，你应该原谅这些，但这很难做到，尤其是不得不去看她的时候，你仍然会想：天哪，可真够乱的！

    由于A&E的《囤积者》（Hoarders）这类图书、电影和电视剧，强迫性囤积症──积累太多东西以致没有可用的生活空间──现在也走进了人们的视野。（我在10月20日的专栏中第一次写到这方面内容。）心理健康专家认为，它是一种形式的强迫症。老年痴呆症、抑郁症、注意力缺失症和脑损伤，以及遭受重大生活挫折的人群可能也有这种情况。每50个美国人中可能就有一人符合这个标准。

    但是，许多家庭成员说，囤积给他们造成的痛苦在很大程度上仍未得到承认。一些小时候家庭环境与利兹相似的人认为这是对孩子的一种虐待。除了基本需要被忽略之外，囤积者的孩子在成长过程中往往不注重整洁，要么他们会寻找自己的私人空间以远离混乱。有些人成年后会变成洁癖，害怕再陷入相同的模式中。利兹说，时至今日，我也不剪优惠券──我母亲过去常会为了优惠券而留着整张报纸，如果有什么东西一年左右还没用坏，我就会扔掉。

    许多家庭仍然苦苦思索如何对付囤积者，他们拒绝改正，甚至不承认自己有这个问题。他们不希望干涉年迈的父母或长大的兄弟姐妹的生活，但他们担心这样会导致安全方面的风险恶化。有些人也听够了专家要求对囤积者保持耐心和理解的建议。

    专门治疗囤积症的心理学家通常建议患者家人不要自己收拾东西的标准强加到所爱的人身上，或是替他作出决定。这些专家还建议不要强行清理，理由是囤积者可能马上会去囤更多东西。旧金山心理学家汤普金斯（Michael A. Tompkins）在他的新书《挖掘》（Digging Out）中告诫患者的家庭成员，应当接受他们可能永远无法阻止囤积行为的事实，而将重点放在"减轻危害"上，如消除迫在眉睫的隐患。他还让家庭成员就过去违背囤积者意愿进行清理的行为向所爱的人请求原谅。他建议，告诉亲爱的家人，不会再出现这种情况了。

    2005年成立的全国性组织囤积者子女（Children of Hoarders）的发言人纳尔逊（Elizabeth Nelson）说，至于指责受害者，我不会为清理我母亲那一团乱请求原谅。这个组织主要帮助家庭共享资源和经验。

    有些职业组织者受过与囤积者打交道的培训，但同心理学家一样，他们往往也赞成缓慢而耐心的办法，而有些家庭对此感到灰心。

    新墨西哥州Anderson Organizing Systems的老板安德森（Kit Anderson）试图通过承诺不抛弃，甚至在未经允许的情况下不碰囤积者的任何物品来取得他们的信任。她说，虽然开始进展缓慢，但这个过程最终会加快。安德森说，我们有一些独到之处。安德森是全国慢性失范研究组织（National Study Group on Chronic Disorganization）的主席。

    一个技巧是找到捐赠囤积者关心的物品的办法，尤其是如果他是因失去亲人感到悲痛而囤东西的话。另一种方法是让囤积者收集同一类别的所有物品，然后决定他到底需要多少。

    但这个过程可能需要几周甚至几个月时间，职业组织者的收费从每小时45美元到200美元不等。

    心理学家还建议，让囤积者进行全面的心理健康评估，以帮助了解驱使这种行为的可能原因。有时，抗抑郁药也会有用，或至少可以减轻与拥有的物品分手带来的一些痛苦。