CHICAGO: Severe domestic squalor is not a distinct medical condition, but rather is described as a living environment that has become so unclean, messy and unhygienic that people of a similar culture would find cleaning and clearing essential.
Over the years there have been various theories on what causes squalor – including that it was linked to personality disorders.
But a recent Australian study, the largest of his its kind, has come to a new conclusion that has huge implications for how cases of squalor should be treated.
It tested 69 people living in squalor and found almost all the participants had frontal executive dysfunction. Brain damage, in other words, through dementia, head injury, alcohol abuse, stroke and other causes.
The Melbourne researchers believe people’s indifference to their living conditions stems from that damage to the frontal part of the brain, which controls planning, self-control, social interaction, judgment, problem solving and, crucially, insight.
It may be a hard to believe that a person living amid their own excrement would not realise there was something wrong with that. But that is exactly what typically happens in many cases of squalor – they don’t see what others see.
In trying to explain this absence of insight, the study’s co-author Associate Professor Steve Macfarlane recounts his first squalor case.
The patient was an animal hoarder living in country Victoria who had become unpopular with his neighbours by rattling up and down the street at 3am with a shopping trolley full of cans.
The man’s eight cats would go to the toilet in the house. His solution, which he considered perfectly adequate, was to cover the droppings with kitty litter and leave them there in piles.
The cat hoarder had congenital hydrocephalus, a swelling of the head through the build-up of fluid in the brain. “If you turned the light off and put a torch against [his skull] it would glow red, because it was fluid filled,” Professor Macfarlane said. “So that was his frontal lobe impairment.”
Squalor does not just appear overnight, but develops over many years, perhaps decades, in layer upon layer of food left to rot, spider webs that thicken in corners and all manners of animals that come and go.
“One of the tragedies is we’re still stumbling across people living in squalor which has obviously taken decades to accumulate and people are left to get to that point,” Professor Macfarlane said.