Medicalization & the sociocultural roots of hoarding disorder

Kaila Bolton outlines some of the benefits and disadvantages of medicalizing hoarding behaviour while discussing the economic and sociocultural context associated with this disorder.


Walking into Thérèse’s apartment, it’s difficult to move around the small space cramped with objects. Thérèse identifies as a hoarder – or as she prefers to call herself, a “Queen of Chaos”. As I survey the jewellery, books, yarn, boxes and the wide variety of things that cover nearly all available surfaces and have begun to pile up on the floors, I start to think about Thérèse’s hoarding behaviour in the broader social context of capitalism, material wealth and normative cycles of object acquisition and disposal.

Hoarders are people who are considered to engage in unusual and socially unacceptable (or pathological) cycles of object acquisition, accumulation and disposal. Since the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, hoarding is officially identified as a distinct diagnostic category instead of a sub-dimension of the category for obsessive-compulsive disorder. This new, distinct classification for hoarding disorder and the criteria used to identify it reflect a significant step in the further medicalization of hoarding behaviour.

Medicalization refers to a process whereby non-medical phenomena are increasingly referred to in medical terms. While there are many positive aspects to medicalization, it can undermine the prospect of developing a holistic understanding of certain mental health issues by neglecting the large-scale sociocultural environments that influence and affect mental health.

Medicalization has increased interest among neurobiologists and neuropsychologists in the study of the biological and psychological correlates of hoarding behaviour. This is important, because more research on the topic will lead to a better understanding of hoarding disorder and the development of more strategies to help those afflicted with the disorder, should they request or require it. Medicalization has also created opportunities for increased public acceptance of the cognitive-behavioural model of hoarding as a potentially pathological and compulsive disorder. This is also important, because it encourages people to consider hoarding disorder as a mental health issue in addition to a behavioural issue.

Photo Credit: Kaila Bolton. Image Description: Thérèse pictured in her apartment.

Notwithstanding these benefits, the medicalized lens through which hoarding disorder is increasingly viewed has led to a focus on hoarding as an individual problem as opposed to a collective one. Such a focus could lead to disregarding the broader social context in which hoarding behaviour manifests itself. Medicalization places responsibility for hoarding behaviours, and the burden of addressing them, squarely on the shoulders of the individuals identified as hoarders. In doing so, it absolves our societies of collective responsibility for having created, and for perpetuating, the conditions in which this type of behaviour emerges and exists.

As philosopher Rachel Cooper explains, “twenty-first-century-style hoarding can occur only within a very particular cultural niche.” This cultural niche exists in high-income Western countries where capitalism and consumerism are at their most extreme. As a Western capitalist society, we have created a sociocultural environment that values an unfettered cycle of consumption and disposal of material goods. This cycle pushes people to dispose of objects at the first signs of wear and tear, and to consume new objects by updating their wardrobes at the end of every “season” and upgrading their tech gadgets as soon as new models become available.

People who are labelled as hoarders have, for a wide variety of reasons including other mental health correlates, deviated from the acceptable norms at one or both ends of the consumption and disposal cycle. While it’s important to address their needs in terms of therapy and support through the medical system, it’s also important to recognize and address the fact that Western capitalism creates the perfect environment for hoarding behaviour to flourish.

The medicalization of hoarding behaviour can, and should, occur. But medicalization should occur within a holistic context that also prompts us to recognize and confront the sociocultural niche in which this behaviour emerges. Ultimately, medicalization is a short-term solution. A long-term solution also requires a reconfiguration of the unequal, and environmentally damaging cycles of accumulation and disposal promoted by Western capitalism.

As Thérèse has expressed to me many times, it is mentally painful for her to see objects that are still useful thrown out in the trash – this is one of the reasons she takes things out of garbage and recycling bins and brings them home with her. In many ways, our communities and our planet would be better off if more people experienced the same mental pain as Thérèse at the thought of the waste created by our current consumption and disposal patterns, in particular if this pain was experienced by those running big corporations and sitting in government. And while there is no single approach to understanding and addressing hoarding disorder (or for that matter the world’s environmental crisis) a wider analysis including the effects of consumer capitalism should be present alongside the process of medicalization of hoarding disorder for a more holistic approach.  


Kaila Bolton has an MA in visual anthropology from Aarhus University and is a graduate of the Documentary and Non-Fiction Media program at Seneca College.

Her film “Queen of Chaos” features Thérèse as she battles with her conflicting needs to both surround herself with things and declutter her apartment. It premieres at the 2020 Atlantic International Film Festival from September 17-24. More information can be found, and tickets purchased, here.

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