The Diogenes syndrome is characterized by compulsive hoarding of objects such as books, newspapers, or garbage. It occurs in three major categories of individuals:
- Elders with degenerative neurological disease
- Younger individuals with lifelong mental illness
- Individuals who display habits of hoarding or over collecting
Diogenes Syndrome is considered a variant of the disorder of self-neglect, a condition that most often affects the elderly who live alone. Characteristics of self-neglect include living in squalor, inattention to personal hygiene, and failure to seek and/or to follow medical advice.
Folks with Diogenes Syndrome may have magazines and newspapers stacked to the ceiling in every room in the house or boxes of trash, balls of rubber bands, piles of tin cans, and/or every piece of mail they have received in the last 10 to 20 years.
Diogenes syndrome in entertainment
One famous story of self-neglect and hoarding is the story of the Collyer brothers, Homer and Langley. In March 1947, police entered their Harlem mansion to investigate reports of a dead body in the home. Indeed, they found Homer Collyer dead from starvation in the midst of decades of compulsive hoarding. The house was filthy and in ill repair. It was rigged with a series of booby traps.
Two weeks after finding Homer’s body and after the removal of more than 130 tons of stuff, the body of Homer’s brother, Langley was found. He apparently had been asphyxiated when one of his own booby traps had crushed him under mountains of debris. This story was made into a play, titled “The Dazzle,” that I saw a number of years ago in New York.
Another play, the Broadway musical “Grey Gardens,” tells the story of an Edie Bouvier Beale and her mother, Edith (first cousin and aunt of Jackie Kennedy Onassis), who were found living in a squalid 28 room mansion among scores of flea-infested cats and raccoons and towers of dirty cans.
Although these stories have been made into plays that entertain and engage audiences, there is really nothing funny about Diogenes Syndrome or self-neglect in the elderly. In fact, these conditions may be the result of untreated medical conditions, such as dementia, psychosis, or depression, and they are often associated with poor outcomes up to and including death.
A commentary in the September 26, 2007 issue of JAMA points out that self-neglect is the most common cause of reporting to adult protective services in the U.S. The authors, Carmel Dyer, MD and associates, state that “self-neglect, often discounted as a harmless peculiarity of old age, is actually an independent risk factor for early death.”
Self-neglect behaviors include behaviors such as the following:
- Failure to discard mail, newspapers, magazines
- Failure to clean the home
- Lacking electricity and other utilities
- Piling garbage inside the home
- Ignoring serious medical issues
- Neglecting to refill prescriptions
- Lying in their own excrement
The commentary points out that “until recently, many healthcare professionals did not pay attention to self-neglect by vulnerable elders believing these behaviors are simply a lifestyle choice.” But a prerequisite of making lifestyle choices is the ability to make sound decisions. Many seniors with self-neglect have cognitive impairments that impair judgment and ability to make sound and safe choices about how to live and care for oneself.
The commentary calls for more research into the area—a typical conclusion in any peer-reviewed medical journal. But it also points out that clinicians and others working with elderly need to be aware of the serious health impact of self-neglect. Yes, it is pretty funny to read about someone living with 55 cats or mountains of old newspapers, but the consequences can be deadly. To wit, the Collyers and Bouvier Beale.