Spoon Theory: How Counting Spoons May Help You Manage Chronic Illness

If you have a chronic illness, chances are you’ve grappled with limited and erratic energy. 

You may rise one morning feeling calm and capable. You can work, tend to your home, and maybe even socialize. But another morning? A pain flare, brain fog, and fatigue make even the mildest task demand extreme effort.

Such inconsistency can make planning to meet life’s daily demands seem hopeless. Explaining energy ebbs and flows to loved ones who may not have the same considerations can feel impossible too.

If you can relate, spoon theory is here to help.

How does the spoon theory work?

Spoon theory is an analogy that describes what it's like to live with a fatiguing chronic illness. It can help you explain to others your limits and boundaries around what you do each day.

Everything you do requires energy, from brushing your teeth to having a deep conversation. Spoon theory uses spoons to demonstrate how much energy such tasks require. 

Getting dressed, taking medication, or watching television may use one spoon. Running errands, working, or visiting a relative may take four or more.

According to spoon theory, people without a disability or chronic health condition wake with enough spoons to tackle the expectations of their day. They can tend to their body, home, job or studies, and social plans and not worry that they’ll run out of energy. 

But a person with a chronic health condition or disability may wake with a limited number of spoons. Symptoms like brain fog, confusion, pain, and headaches can use up those spoons throughout their day. 

If they try to use more spoons than they have, they may collapse, exhausted and unable to do anything more. Or they may pay for the overuse by having even worse symptoms and fewer spoons the next day.

Where did the spoon theory come from?

The original spoon theory came from chronically ill blogger Christine Miserandino. Miserandino has lupus, an autoimmune disease. In 2003, she sat in a diner with a friend. Then the friend asked: “What does it feel like to be sick?”

“How do I explain every detail of every day being affected and give the emotions a sick person goes through with clarity?” Miserandino pondered on her blog.

She grabbed spoons from tables, gave 12 to her friend, and asked her to describe an average day. As the friend listed activities, Miserandino took spoons from her. The spoons represented the amount of energy each activity required, she explained. 

The more spoons used, the more the friend had to ration those she had left. By 7PM, her friend was out of spoons. And she hadn’t gotten to do all she would have had she unlimited spoons.

Miserandino explained that she made such choices and sacrifices every single day because of her chronic illness. Her friend better understood how it felt to live with such loss. And readers with similar conditions found community through the spoon theory story.

Spoon theory and mental health

Spoon theory originated as a communication tool for those with fatiguing chronic illnesses. Some people have also adopted spoon theory to explain how mental health issues can limit your capacity for day-to-day activities.

Here are some examples of how spoon theory can be applied to mental health conditions and people who are neurodiverse: 

• Stress: A task performed under stressful circumstances may require more spoons than the same task completed in a calm and supportive environment.

• Depression: Someone with major depression may wake feeling so weighed down that they don’t have enough spoons to shower or eat. 

• Anxiety: A racing heart rate or difficulty breathing may quickly exhaust someone’s body and leave them with few spoons.

• Autism: Navigating the sensory overload of a grocery store or busy school setting may require the majority of a person’s spoons for that day.

How do you practice spoon theory?

Spoon theory uses a customizable mathematical metaphor. Knowing your benchmark spoon level can help you prioritize tasks. And sharing your spoon process may help your loved ones understand how you cope with energy limitations.

Using the spoon theory for pacing

Pacing is a practice where you space out activities and rest between them. Ideally, pacing keeps you from burning too much energy at one time. It also helps you reserve energy for prioritized tasks.

There are many ways to practice pacing. It can include doing less of an activity than you’d want but still enough that you enjoy it. Or you might break larger projects into smaller tasks that you can do over a few days. 

To self-pace using spoon theory, first calculate the number of spoons you have on an average day. Your spoon estimate can help you schedule tasks and avoid overexhaustion. 

For example, how many of these sample activities can you do without exacerbating symptoms like pain, brain fog, big emotions, or fatigue?

• Taking medications: one spoon

• Getting dressed: one spoon

• Watching TV: one spoon

• Taking a shower: two spoons

• Reading or studying: two spoons

• Doing light housework: three spoons

• Making and eating a meal: three spoons

• Working: four spoons

• Visiting a friend or relative: four spoons

• Going to a healthcare provider appointment: four spoons

You may recognize specific people and experiences as most worthy of your limited spoons. On average days, you can prioritize those. 

On high-symptom days, acknowledging that you’re out of spoons may help you limit activities that make your symptoms worse. It may also help you practice self-compassion so you can focus on resting and recharging.

Using the spoon theory for communication

It can be challenging for loved ones to understand the shifting limitations of fatiguing chronic illnesses. Once you’ve figured out how to explain spoon theory, you can use spoons as a sort of shorthand language with others: 

• “I don’t have enough spoons to do that today.”

• “I pushed too hard and ran out of spoons.”

• “I have this already scheduled. So I won’t have enough spoons to do that.”

• “Can you help me with this? It will save me some spoons so that I can enjoy doing that with you more.”

• “I have to cancel our plans for today. I used too many spoons yesterday, so I don't have enough for today.”

How do I know if I'm a spoonie?

Anyone coping with a chronic illness, mental health condition, or disability may identify as a spoonie. Chronic fatigue is not a symptom of all diseases and long-term disabilities. But those that limit energy include:

• Autoimmune diseases like lupus, multiple sclerosis (MS), and rheumatoid arthritis (RA)

• Post-viral and post-bacterial illnesses, like myalgic encephalomyelitis (ME), post-treatment Lyme disease syndrome (PTLDS), and long COVID

• Fibromyalgia

• Chronic migraines

• Autonomic dysfunction, like postural orthostatic tachycardia syndrome (POTS)

• Mental health conditions, like depression

• Neurodevelopmental differences, like ADHD and autism

• Chronic pain

If you identify as a spoonie, here are some ways to find community with others:

• Follow social media hashtags: #Spoonie, #SpoonieLife, and #SpoonieSupport are common tags for those sharing information and experiences.

• Join spoonie circles: Read and comment on blog posts, join chat groups, and attend virtual social events to make new friends.

• Explore spoonie-themed merchandise: Stickers, apparel, jewelry, and other items can bring a little spoonie sentiment or humor to tough days.

Are there any shortcomings to spoon theory?

Many people with chronic health conditions navigate irregular symptoms and means of relief. Because of the complexity of this, critics of spoon theory argue that it is an inadequate analogy.

• Spoon theory assumes that every task requires a set amount of spoons. But on a low-pain day, someone may need one spoon to scramble eggs for breakfast. On a high-pain day, that same task may use up three or four spoons. This inconsistency can make it hard to visualize future task prioritization. It may also confuse healthy people who don’t understand fluctuating disabilities.

• Spoon theory doesn't take into account unforeseen factors that deplete energy. A person may wake relatively energetic. Then, a traffic jam, shifting weather, or unexpected interaction wipes them out. Pain and fatigue may flare with no identifiable cause too. This lack of control contradicts the idea that spoon rationing is a reliable form of self-pacing.

• Spoon theory mathematics imply that you can save spoons for future events. If you average 15 spoons a day but use only 10, you should have 20 tomorrow. But chronic health conditions aren’t always so predictable. You likely will still need to be flexible with your energy levels day to day.