Mental health could be an explanation that can point to what kind of treatment or coping skills are needed, but treatment and skills are very much needed. I have serious issues cleaning too, I’m schizophrenic and often “hear” objects speaking to me, telling me not to move them or that something terrible will happen if I do, even if it’s literal trash I struggle to throw it away. Having this did mean that it took me a long time to build skills and to find the right medication combo but it absolutely didn’t mean that I was destined to live in squalor. Compassion should be shown, being ill is quite different from being lazy, but being ill doesn’t mean you’re stuck in a hamster wheel forever. If the wife refuses to get help or look into why she’s struggling so that she can address it, that tips her into AH territory.