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Understanding Squalor Syndrome

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Squalor Syndrome: What It Is and Why It Happens

Squalor Syndrome: What It Is and Why It Happens

Squalor Syndrome

What? Squalor syndrome (also called Diogenes, Havisham, Plyushkin, or messy house syndrome) is a condition where people elect to live a squalid life of deprivation amongst their own garbage and filth.

Why? It is not known exactly why they are like this. The difference between these people and those stricken by poverty is that they have other options but still live this lifestyle.

Who? It's found mostly in the elderly, but also in the young. Individuals who are unable to take care of themselves and find themselves in squalor do not have this syndrome. The difference is choice. However, saying someone "chooses" this lifestyle might not be entirely accurate. Their mental illness makes it impossible to live a normal life. They can get help to manage their symptoms, but they will always have the disease.

Senile Squalor Syndrome (or Diogenes Syndrome)

Squalor (aka Diogenes) Syndrome is a behavioral disorder that affects older adults who live socially withdrawn lives amongst rubbish, vermin, and filth. This syndrome involves self-imposed squalor and neglect that is not due to financial misfortune or physical limitation. These individuals are mostly (but not always) older people who are isolated from friends and family, usually because they purposely estrange themselves from others. Sometimes, their aloof or negative behavior begins when they are young. It can be classified as primary or secondary.

  • Primary: Primary Diogenes Syndrome has no mental disorder component.
  • Secondary: To be considered secondary, the person will also be diagnosed with dementia, extreme grief, schizophrenia, or a mental disability.

They don't want help.

Needy individuals living in squalor who don't have the disorder are glad to get help from anyone to relieve them from their situation, whereas people with Squalor Syndrome will need intervention and careful handling since they won't be receptive to help.

Signs of Senile Squalor Syndrome

  • They refuse assistance. Their attitude is that this is the way they live and no one should interfere with it.
  • They isolate themselves from people. Their situation prevents social calls. People are kept at bay by their uncooperative hostile behavior and lack of hygiene.
  • This might include dirty clothes, overgrown nails, uncombed dirty hair, decayed teeth, and body odor.
  • Because of their lack of cleanliness, the homes are full of bugs and rodents. Vermin and smells can travel, especially in apartments or to close neighbors. Bed bugs, fleas, roaches, and rats can migrate and cause havoc on the unsuspecting neighborhood.
  • They try not to call repairmen and avoid doctors.
  • Money is hoarded and not spent, even on basic needs. There are newspaper accounts of homeless people found with bank books showing they had money, yet they were living a piteous life on the streets.
  • The windows will usually be kept covered to prevent people from seeing inside and calling the authorities.
  • The person with the syndrome will be very uncooperative, preventing any meaningful response and alienating the neighbors further.
  • They usually do not seek medical or any other type of help. If they have a known illness, they may not take their medication, don't trust doctors, and believe they know better.
  • They usually have hoarding tendencies.
Hoarding and Squalor Syndrome are not the same, but they sometimes coincide.

Hoarding and Squalor Syndrome are not the same, but they sometimes coincide.

Living With Squalor and Other Hoarding Syndromes

Hoarding also occurs in concert with Squalor Syndrome: Approximately 10% of hoarders present with Squalor Syndrome. One leads to the other, depending on the type of hoarder they are. After the hoarding gets out of hand, it can become a squalor situation.

Hoarding vs. Squalor Syndrome: What's the Difference?

  • Some compulsive hoarders do not live in squalor. Granted they live among clutter, but some do take care of themselves somewhat.
  • Some hoarders try to keep their living areas as clean as possible and their collections neat and orderly until they get overwhelmed.
  • Ill health can be, but isn't always, a contributing factor in hoarders losing control of their stockpiles.
  • Some hoarders try to hide the fact of how they live so when they face the public, they try to look presentable. People living with Squalor Syndrome are noted by their bad hygiene and motley look—they don't even try to look presentable.
  • Hoarders might also be sociable and spend some time away from their home.
  • They may be unable to part with their possessions yet unable to manage them anymore.

With Squalor Syndrome, the operative word is squalor and in compulsive hoarding, the operative word is hoarding. But of course we see people with both.

It seems that the hoarding aspect of Squalor Syndrome garners the most attention. Individuals who do not hoard can live under the radar because their behavior does not impact on others as much. Even though they live in filth, their squalor is not as noticeable to outsiders.

Animal Hoarders

The animal hoarders we see on the news seem to have Squalor Syndrome due to the proliferation of feces and vile living conditions. There are plenty of people who keep a lot of pets that do it safely and cleanly—these do not fit the criteria of Squalor Syndrome or hoarder.

Early Signs of Social Breakdown

As with anything else, prevention is the best medicine, and if someone starts to show early signs of the syndrome, this would be the best time to help. But that is not possible in the overwhelming majority of people as they are only brought to the attention of authorities due to abnormal behavior.

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Social Breakdown Syndrome is another term used for individuals who live in squalor. There can be many early signs of this problem. Aloof antisocial personality is something that can be seen early on; an unkempt appearance and untidy housekeeping might also be early signs.

Independence vs. Antisocial Behavior

These individuals usually are not close to any family and don't have any significant relationships with anyone else. The majority live alone and are widowed, divorced, or single. In some situations, this person would be labeled "fiercely independent," a person whose privacy should be respected. In some cultures, this behavior would be excused as "just the way they are." They don't consider themselves lonely and seem not to worry about their self-imposed isolation.

When Others Are Involved

What is true is that some are married or live with others, and this might help in preventing them from being totally isolated. Even within the house, they will isolate themselves from the rest of the household.

However, if these people are in control of others (like a dependent adult, child, or an animal), then they too are condemned to live in this manner. This is considered an abusive situation.

What can you do for a person who lives in squalor?

What can you do for a person who lives in squalor?

Is There Help for People Living With Squalor Syndrome?

There is no cure but there is help. Social services sometimes get involved with court orders to spend the person's money on necessary items. They might be put under a guardianship to force them to get medical care or repair their home from safety or sanitation violations.

Who can help?

If family is available to help, then they should be encouraged to try to keep in contact. If not, then local community members could fill the social gap.

Should they be removed from their home?

It is best for all if they can be helped and still reside in their own home.

What if intervention does not help?

Unfortunately, it is shown that even after an intervention, the prognosis is not good and most continue with the same behavior. However, a few can learn to function reasonably. Their home and person will never be clean but "reasonably" clean. We can't expect a complete cure, but we can hope for enough compromise to prevent their house from being condemned or their eviction from an apartment.

Will placement in a longterm facility or nursing home fix the problem?

If the circumstances call for placement in a longterm facility, they will bring their behavior with them. Refusal to take medication and refusal to wash or change clothes is common. Socializing with the other residents is something they have a hard time doing. Being verbally aggressive to staff and other residents prevents them from being liked. They tend to be aloof and disinterested in the activities that are offered. Their mortality rate is grim in nursing homes.

What if they are released from the nursing home?

If they go back into the community, they usually continue to live as before unless someone is monitoring them. The idea is to focus on the important things like washing and bathing, changing clothes, brushing their teeth, taking their medicine. They might need help with meals and cleaning.

How can I help?

It's important that the people who want to offer support have realistic expectations. This person will never reach what we consider "normal" standards, but they can make some improvements in order to stay independent.

Inside The Collyer Brothers House

Inside The Collyer Brothers House

Famous Hoarders With Squalor Syndrome: The Collyer Brothers

The Collyer brothers were hoarders and misers who had Squalor Syndrome. In March 1947, the Collyer brothers were found dead in their New York apartment, surrounded by over 140 tons of hoarded items. They had spent many years collecting massive amounts of stuff that cluttered their Manhattan mansion with tons of garbage. They were self-abusive, as they did not take care of themselves or seek medical care. Instead, they self-treated.

They lived in a self-imposed isolation of fear amongst their mountains of papers, car parts, dusty furniture, and vermin. They were afraid someone would steal their "treasures." Robbery attempts were cited as one of the reasons for the burglar trap inside the mansion that killed one of the brothers.

A Case of Squalor and Self-Neglect

While I worked for a hospital, there was a patient well known to us with COPD who had extremely bad breathing problems. COPD is a progressive breathing disease brought on mostly from long term smoking. He kept many dogs in his home and his clothes had fleas and ticks on them. He was presenting to the ER more and more because of his breathing.

Since he was known at the hospital, they would take care of his clothes and de-flea him if he needed to be admitted to a floor. I remember one time for whatever reason he was admitted without those precautions being taken and he infested the ward with fleas and ticks.

We assumed at the time that he was that way because his illness (COPD) made it hard for him to take care of himself, although his wife looked almost as bad as him and she did not seem to have any debilitating illness. He was instructed on methods to help his breathing, including cleaning his environment. He did not follow the instructions so he kept ending up in the ER.

Staff from the home care division did not like going to his house because of the flea infestation and clutter in his residence. This is also a problem with the social withdrawal of these individuals. People are repelled by their unhygienic behavior and look. They can smell bad and bring fleas, ticks, and roaches into any environment they go to. There are instances where they are told that they are not welcomed places because of fear of infestation and making other people uncomfortable.

His health suffered because of the living conditions. It is well-documented that indoor pollutions like dust mites and cockroach and mouse droppings can trigger an allergic reaction in COPD patients. His environment had more triggers than most yet he couldn't improve the situation.

The Oldest Story of Squalor Syndrome: Diogenes the Cynic

Diogenes of Sinope (412 BC - 323 BC) was a Greek philosopher who, among other things, was famous for walking around in daylight shining a lamp into peoples' faces looking for an honest man.

He was part of the Cynic school of thought, whose name comes from the Greek word meaning "dog." Plato is said to have called him Diogenes the dog. Apparently people would make fun of him, bark, and call him a dog. Diogenes is said to have responded by asserting his preference for dogs over humans. Some artwork show dogs with him or him depicted as a dog.

Diogenes was said to have detested extravagance, among other things. He ate very little and believed one should be self-sufficient and live as naturally as possible, which for him included begging and stealing from others. He was said not to have worn much clothes but the ones he did wear were coarse and filthy. He lived on the street and is described as being "shameless." Accounts have him doing private things in public places, which dismayed onlookers. He was very opinionated and never shied away from expressing any of his opinions. He was never one to isolate himself and stay aloof.

This is the person whose name is given to describe Squalor Syndrome. Most think the name is inappropriate for the syndrome.

More Famous Cases of Hoarding and Squalor Syndrome

Ida Mayfield Wood (1838-1932). She lived many years at the New York Herald Hotel with her sister and her supposed daughter. They had clutter in every room, piled to the ceiling. They lived on very little and hoarded every penny. In 1931 when a relative had her apartment searched, it was found to contain hundreds of thousands of dollars hidden in boxes and pots and pans. She did not trust banks and was distrustful of people, fearing they would steal her money.

Eliza Emily Donnithorne (182? -1886) is also known as the Australian Miss Havisham. The story goes that she was engaged to be married in 1856. When the groom failed to show, she took to her room, insisting that the wedding feast remain untouched. Although she was a pretty and social young lady, she is said to have never left her home again. She lived in her wedding gown and let the house fall down around her. There are various similar versions to the story including a Charles Dickens connection. He is said to have heard about her and based the Miss Havisham character on her. There are no facts to back up most of this story but it is still very popular.

Quentin Crisp (1908-1999), was a British writer, eccentric, and actor who prided himself for living in squalor, saying that "cleaning would be a terrible effort." He lived in Manhattan's East Village in a single room that was filled with dust and grime, including the "filthy dressing gown" he wore while home. He became famous after writing The Naked Civil Servant, a memoir.

Edith Ewing Bouvier Beale (Big Edie) and daughter Edith Bouvier Beale (Little Edie) were the cousins of Jacqueline Kennedy Onassis who lived in a crumbling Long Island, N.Y. estate called Grey Gardens. The former socialites lived among raccoons, multitudes of cats, and junk. They were brought to the attention of the public first by a magazine article in 1972 and by a documentary in 1976. In 1972, Mrs. Onassis paid to fix up the place and clean out the garbage. The house was sold a couple of years after the documentary upon the death of Big Edie.

The Collyer Brothers, Langley and Homer, lived in a home in Manhattan cluttered with 100 tons of papers, car parts, bicycles, chandeliers, and anything that could be carried in their mansion. The gas was shut off and they had no heat or hot water. Homer went blind and had a stroke in 1933. He was not followed by any doctors but Langley devised a treatment which included 100 oranges a week and resting his eyes by keeping them closed. Langley died when he tripped on one of his homemade booby traps (set to catch burglars) and massive amounts of junk fell on top of him. His dependent brother died soon after without care, probably from dehydration.

Howard Hughes (1905-1976). It is said as a child, his mother was overly concerned about his environment. In adulthood, he showed signs of obsessive compulsive disorder by being unduly interested in the size of the peas that he ate. He had numerous plane accidents culminating in the last fiery crash in 1946 that changed him forever. Some claim, without proof, that his later deranged behavior stemmed from stage three syphilis.

A once social and public person, he became more isolated from people, including his wife, actress Jean Peters. From about 1961 until 1971 when they divorced, they were living apart. She said she had not seen him for a few years before their divorce. By 1968, he had become quite reclusive, living in seclusion except for hired people he had control of. There were doctors on staff, but he did not listen to them. He was addicted to various pain killers stemming from his plane accident. He became bedridden from a fractured hip and continued to live in squalid conditions despite the fact that he was a germaphobe and worth billions of dollars. Even in his relative isolation he still involved himself in political pursuits.

When he died, it was ruled as kidney failure. He was dehydrated and malnourished. X-rays showed there were broken-off hypodermic needles in his arm. His nails were long, his hair was long, and he had a long beard. His height in his youth was 6"4" and at death he weighed only 90 pounds.

  • Squalor Survivors
    In the Squalor section we have a scale for assessing the seriousness of a squalor problem, and information on hoarding. The Stories section contains the real-life experiences of people who lived in squalor (some are now free of squalor, some are stil
  • Squalor Syndrome: Living Happily Among Cats, Fleas and Filth
    Those who live with the syndrome manifest personality traits like reclusiveness, suspiciousness, obstinacy and other isolating tendencies. There are often precipitating events -- such as physical illness, deafness, blindness and bereavement -- that m
  • Diogenes syndrome
    More info on the rare syndrome.
  • Extreme Phobias: The Collyer Brothers
    Homer Collyer (1881-1947) and Langley Collyer (1885-1947) were two US brothers that became famous because of their reclusive and hoarding lifestyle.
  • Collyer Brothers Park
    The brothers spent their retirement secluded in the brownstone they owned at West 128th Street and Fifth Avenue, now the site of this park.
  • Cops find man isn't dead, just a slob
    The awful stench coming from a Queens apartment on Monday was so bad that cops thought they would find a body inside
  • Diogenes the Cynic
    Gives a pictorial account of the ancient Greek Diogenes whom this syndrome is misnamed. Diogenes did not have Diogenes syndrome.

Poll On Squalor Syndrome

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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