Taking Out the Trash

I'm watching the latest episode of Hoarding: Buried Alive on TLC.  This woman in Greensboro has refused to throw away any garbage in her house to the point that roaches and spiders - including black widows - have invaded to an unimaginable level.  She keeps talking about how her "condition" keeps her from cleaning it up, but it has forced her children to live in what basically amounts to a trash pile.  When the narrator describes it as a "long and difficult cleanup process" it has to be the secondmost understatement of the decade.  This is profound hoarding at its worst.

Looking at what is piled up in the house, I can't see one thing that isn't obviously garbage, whether it's toilet paper, empty plastic bags, empty coke bottles, feces, used sanitary napkins, and even used hypodermic needles (diabetes?).  I don't understand this kind of hoarding.  The complete lack of concern, the obvious laziness is mind boggling.  The homeowner even says "I don't give a s***," which is probably the biggest understatement of the decade.  She even lies down in bed and takes a nap while the workers shovel trash around her.  I'm not the most motivated person and I don't claim to have a complete lack of laziness, but I've always found the energy to throw out my sanitary napkins.  I really try not to judge, but I'm struggling to wrap my brain around why someone would just totally avoid taking out the trash.