[Health Column] The Aesthetics of Letting Go

Seongwon Noh, Professor of Psychiatry, Hanyang University Hospital

It is spring. Although the lectures are online, the new academic year and semester have started at the university. At the campus, professors who retired at the end of February have left the school, and in March, new professors have begun their work. It is a bit chaotic but also a fresh atmosphere. This is a routine that repeats every spring.

In the meantime, I had the opportunity to move my office to a different floor after four years. There are piles of documents accumulated over time. While moving, I organized and found endless items to throw away. Things I had treasured, thinking, "Someday I will look at this. This is a really important document, so I must keep it," are stacked up. Occasionally, there is the joy of discovering something I had been searching for like a treasure hunt, but looking back now, most of these items could have been discarded. In fact, they should have been thrown away long ago. The table has regained its original purpose, and there is now space on the desk to open books. Moving to a new room feels much more spacious. It must be because I only kept the necessary items...

In modern psychiatry, compulsive collecting and storing is recognized as an independent disorder called "hoarding disorder." It is also known as "compulsive hoarding." The core symptom of this disorder is collecting and being unable to discard items that have no use or value. The home becomes filled with such items, limiting activities and causing significant distress and functional impairment. There is a strong emotional attachment to the items that cannot be discarded, and a fear of losing important information contained in the possessions.

Commonly stored items include newspapers, magazines, old clothes, bags, books, mail, and documents, but all kinds of objects can be involved. Living spaces filled with hoarded items can no longer be used for their intended purposes. There is no space to cook in the kitchen, no place to sleep on the bed, and chairs are piled with items so that they can no longer be sat on. Items are piled up messily in spaces that originally had specific uses, creating clutter piles. This ultimately leads to highly unsanitary and hazardous environments. For example, one might get injured by tripping over clutter, food can become contaminated due to poor hygiene, people can get infected, and sometimes electrical appliances can break down, increasing the risk of fire.

People with hoarding disorder store items with the intention of ownership, and they experience distress when faced with the fact that they must discard these possessions. Therefore, if items accumulate passively or if discarding possessions does not cause distress, it is not hoarding disorder. The most common comorbid condition with hoarding disorder is depression, found in half of the patients. Anxiety disorders are also observed in 25% of cases.

So why does this disorder develop? Research indicates that genetic factors play a role, and hoarding symptoms can also appear in patients with brain injuries. Personality-wise, indecisiveness is characteristic. Hoarding disorder can occur throughout a lifetime. Symptoms often begin in early adolescence, start to interfere with daily life by the twenties, and cause clinically significant impairment by the thirties. Symptoms tend to worsen with age.

There is a saying that you can only fill what you have emptied. To accept something new, space is needed. Looking at the emptiness in my office, I feel motivated. I want to do something. Maybe that is why, without realizing it, today too I find myself heading toward a small but spacious area. During times like these when we spend a lot of time at home, let's look around our homes. Are we living surrounded by things we should throw away? While we are at it, let's also look inside our hearts. What needs to be let go is not only expired old food. If we release old thoughts in our minds, there might be room for new and vibrant ideas to come in.

Seongwon Noh, Professor, Department of Psychiatry, Hanyang University Hospital