What Is "Spoon Theory"? And Why Is It Important?

Source: Teodor Drobota / Unsplash

Twelve years ago, I remember a conversation with my neurosurgeon during a follow-up visit after an accident-related sacroiliac joint fusion surgery, where I subsequently also broke several vertebrae. I don't recall the exact details, but I do remember his comment really stuck with me:

"Healthcare regulations are the bane of my existence. I have paraplegic patients who are denied disability benefits, but I've got other patients with chronic back pain who get approval. We know who is more disabled. Go figure." I have no clue why he made that comment (since I had no plan on applying for disability). But I did walk away from that visit feeling ill at ease.

From a daily living-functional perspective, it made sense, as mobility impairments and accommodations are visibly hard. But in my gut, I couldn't help but feel as if he was missing something that I couldn't yet articulate. It wasn't until years later that I realized I was now a person in the second category of people he mentioned: a chronic back pain sufferer with unpredictable good days and bad days—trying to go about my daily life the same way I had before my accident.

It was hard. I got discouraged. I began to realize that I had taken my abilities for granted all these years when life felt carefree and things came easily. Ableism was not yet a widely used term, so the narrative I had internalized (which originated in the medical model of health) was that I must, somehow, now be irrevocably broken.

But I was wrong.

Many people live with invisible disabilities, such as fibromyalgia, depression, autoimmune diseases, chronic pain, and other life-impacting chronic symptoms that can be tough to predict. In the chronic illness and disability world, it can be challenging to convey how symptom fluctuations impact daily life, including mood, energy, and social plans. Until recently, the concept of dynamic disability₁ was elusive. But a new term is helping change that. Enter the concept of spoon theory.

Spoon Theory

Writer Christine Miserandino coined the term "spoon theory" years ago while explaining to a friend what chronic illness feels like. She grabbed a handful of spoons to make her point.

"In the theory, each spoon represents a finite unit of energy. Healthy people may have an unlimited supply of spoons, but people with chronic illnesses have to ration them just to get through the day."₂

"I start each day with 12 spoons, but depending on how I feel, the spoons are used differently. On a high-pain day, a relatively simple task of showering or getting ready for the day can take four spoons. On a low-pain day, that same task might take just one spoon. I have to balance what I need to do every day with how much energy I have. And when the spoons are all used up, there's no replenishing them."₃

I'm a leg amputee, and that disability (my prosthetic leg) is quite visible. My chronic back pain is not visible. On high pain days my back issues are far more disabling than my leg, yet by societal norms, my leg amputation "qualifies" me as having a significant physical impairment.

The belief system that my disability needs to be visible to be acknowledged and validated is steeped in the ableist framework I've been trying hard to shake now for many years. I now realize that it's not society's acceptance or non-acceptance that renders my situation more or less disabling. It's my personal experience of dealing with pain and limitation that does. This can be hard for folks to understand.

I'm not one to judge others' conditions because I generally believe everyone wants to do the best they can, given their physical or emotional circumstances. While all people and situations are different, I know how challenging it can be to live with an unpredictable condition—regardless of what it is.

Having symptoms that wax and wane, and trying to live in a world that doesn't always accommodate the dynamic nature of our bodies and minds certainly can be frustrating. But advocates and pioneers who have formulated language to describe these circumstances have certainly made it easier to explain what it's like to live with chronic conditions.

Chronic Pain Essential Reads

10 Things Not to Say to People With Chronic Pain or Illness

5 Mindfulness Techniques to Help Cope With Chronic Pain

The Essentials: Rest, Priority, and Limit Setting

Learning to say "yes" to some things and "no" to others is an important self-care tool.

Source: Nathan Dumlao/Unsplash

Living with a dynamic disability or unpredictable chronic condition requires the juggling of life's multiple challenges. I like to think of rest as a time for creating, resetting, and discerning how to best utilize my spoons, with the realization that my energy reserves can change at any given moment.

Variables such as weather, unforeseen flareups, and the rise and fall of work and family obligations require a fine attunement to our bodies and surroundings, as well as an ability to be open and honest with our friends, colleagues, and loved ones. This can feel counterintuitive, especially if we've spent much of our lives responding to others' needs or jumping at opportunities to be involved in activities and projects.

For me, staying healthy has required making my wellness routine (including exercise, a healthy diet, and yoga) a priority. That said, most of us also need an income, so we need to work. We have children and aging parents, homes, yards, and projects. There is no end to the potential spoon usage, so each day needs to be met with a careful appraisal of what's most important, how to prioritize, and how to set limits for the onslaught of people and other issues that beg our attention.

While my workout routine may seem trivial or even self-absorbed, I know that my body needs movement to feel better. Yes, dinner needs to get made, laundry needs to get done, and the house needs cleaning, but these things need to take a back seat to my wellness routine. As I tell my family, My body's need to function well has its payoff for everyone around me. An investment in my own well-being is also an investment in those I care about.

Learning to say "no" to some things to say "yes" to others is an important lifelong skill. While the world doesn't stop spinning for any of us based on our unique personal needs, pain, and limitations require a sense of self-compassion. Spoon theory can be a tool in our lifestyle toolbox to help others understand the need to exercise self-care and self-compassion.₄ It can also serve as a model for others to do the same.