Science Metaphors (cont.): Decompensation


1024px-Georges_de_La_Tour_Le_Tricheur_a_l'as_de_carreau_detail_des_piecesI suspect this isn’t really a science metaphor, but I got caught up in the word.

I had a friend who’s married to a hospital doctor, and he brought home many work-related words of interest:  “mother-of-record,” for instance, meant that he wasn’t going to be the one taking cupcakes to their kid’s class in the morning; “trichobezoar,” meant “hairball” and was a nice distraction from the one we found in the grocery-store salad. Then one day he came back with “decompensate:” somebody was decompensating all over the unit, he said.  “What’s decompensating?” I said.  “It’s when somebody just falls to pieces,” he said, “when they just lose it.”  “That’s a weird word,” I said.

“Compensation,” I thought, meant “payment,” like “compensation for pain and suffering,” or “zero compensation for blog posts.”  What’s falling to pieces got to do with it?

Woman-with-a-balance-by-Vermeer (1)I was a little bit right: the current usage is economic.  But the original meaning is a balance, a weighing.  The American Heritage Dictionary says the word comes from “pendere” — Latin for “hanging,” a hanging balance – as do “pendulum,” “pendant,” “depend,”  “suspend,” and “pensive.”  So “compensation” must mean a balance between a work and a payment, an injury and a recompense.  All this etymology is fine example of a liberal arts education and an interesting dictionary, but decompensating = falling to pieces?  Not a chance.

What did we do before Google?  “Decompensating” has a medical meaning: some organ, usually a heart or liver, that once worked well enough even if compromised, now doesn’t work any more, like “acute decompensated heart failure.”  It also has a psychiatric/psychological meaning, and that’s the one my friend’s doctor-husband meant: the mental strategies that once kept a person balanced and functioning well-enough now stop working, and the person is hearing voices and seeing visions and talking nonsense to all the nurses; or is curled up in a ball under the kitchen table and won’t come out.  That is, your heart maybe was a little sick but it compensated and got the blood going where it needed to; you’re maybe losing your internal mental map but you compensate and use a GPS.  So decompensating happens when you stop compensating.

I don’t like where this is going.  I’d take issue with the medical meaning and ask what if you’re perfectly healthy and some virus gets you – are you still decompensating if you weren’t compensating to begin with?  I’ll bet the doctors can’t answer that.  But I’m just putting off facing the implications of the psych meaning and they’re chilling.  I’m deeply afraid that decompensation really means that the only thing keeping me upright and moving purposefully is my continuing compensation, my counter-weight, my leaning back against the tug and the call of a life under the kitchen table.

Maybe it’s a metaphor after all: best keep the balance, dear.


details of Cheat with the Ace of Diamonds, by Georges de la Tour; and of Woman with a Balance, by Johannes Vermeer; both via Wikimedia Commons


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5 thoughts on “Science Metaphors (cont.): Decompensation

  1. Yeah, you might remember that comes from real life, years and years ago: a med student working in the back country of the Appalachians went on an ambulance call, got to the house, saw the old lady under the kitchen table, tried to pull her out but couldn’t because she was holding on to the legs with her fingers and toes, and found out that the medical emergency wasn’t her anyway, it was the man in the bedroom, the old lady just lived under the kitchen table. That stayed with me.

  2. Anne, have you run across the concept of allostatic load? It’s the idea that all of us live in a constant state of compensation, and both physical and mental distress can compromise that balance. It’s mainly used as a model for environmental and demographic determinants of health, but I like to think of each of us as a little gyroscope, using our stored energies to keep ourselves upright until there’s one knock too many and we decompensate and go skittering across the floor…

    Not the most cheerful thought, but there’s a little poetry there…

  3. No, I hadn’t run across that. And your gyroscope is indeed poetic and unsettling. Thank you.

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