What on earth do you mean by ‘spoons’?

You may hear the chronic pain and fatigue community talk of ‘spoons’. For instance, ‘I have no spoons’; ‘I need more spoons’; ‘sending spoons’. But what on earth does this mean, and why do so many people need more of them?

In 2011 I discovered the Spoon Theory by Christine Miserandino. I‘ll give a brief summary here, and my interpretation of it using some examples. The idea is that all tasks in our day-to-day lives cost us a little mental and physical energy, but for some people the same tasks cost much more. Imagine you have a pile of 12 spoons. Now list all the tasks you might need to do in a day, such as take a shower, eat breakfast, get dressed, vacuum the house, go grocery shopping, cook meals and so on, then assign one spoon to each task. Suddenly your 12 spoons don’t go very far - that small list used 6 spoons already!

Now break your tasks down into smaller micro tasks. Let’s take having a shower; what does that consist of? It might include getting out of bed and to the bathroom; undressing; showering for X number of minutes to wash your hair, face, body and feet; shaving your legs; wiping down the shower; towel drying yourself; brushing your hair; getting back to the bedroom; getting dressed and drying your hair. You may have thought of other things. Now give each one of those micro tasks a spoon. My list came to 14 spoons - that’s 2 more than we had available at the start of the day, and all we’ve done so far is take a shower and get ready! For someone with chronic pain and or fatigue, showering can be extremely exhausting and they may need a nap afterwards to recover. So they often have to choose between taking a shower or doing something else.

Now imagine you have to make your 12 spoons last all day every single day. How do you decide which tasks are most important? What if you have several tasks you must complete in a day but not enough spoons? You might try to push through to get things done, but in the process you’re borrowing spoons from tomorrow. When tomorrow comes, you have more tasks to complete, so you borrow from the next day. Until one day you realise you’ve run out of spoons - you’ve burnt yourself out - and now you need to spend 3 days in bed recovering to generate more spoons while those tasks continue to pile up. And what if you wake up with a cold or fever tomorrow? You’ll really need those extra spoons you borrowed to help you recover.

A relatively healthy person might only need 1 or 2 spoons to do all the micro tasks involved with taking a shower and getting ready in the morning, but someone living with long-term conditions that cause chronic fatigue or chronic pain might find the same task takes many more spoons, and they need to conserve their spoons for what’s most important to them. It might be they can’t afford to shower or do their hair, because they need to save their spoons to go grocery shopping and cook a meal. When we’re fit and well we take for granted things that seem so simple, like walking to the bathroom, taking a shower and drying our hair. But for someone living with long-term health issues and disabilities, these activities take so much more energy and time, and have to be planned carefully.

When we have to plan activities of daily living, such as washing, dressing, cooking, eating and cleaning, in order to preserve enough spoons to live day-to-day, we often find there aren’t enough spoons left to do things that make us happy, like meeting friends for coffee, taking our children to the park, or starting new hobbies. This means we end up in survival state, and not living life to the fullest. But there is hope - this is where occupational therapy can help!

An occupational therapist can help you work out what tasks you need to do and those you’d like to do, based on the occupations that are important to you. These might include your activities of daily living as well as hobbies, socialising, education, work, riding a bike, driving a car and everything in between. Together, you’ll create a plan and slowly build up to where you’d like to be, using techniques such as assessing, prioritising, pacing, and breaking bigger tasks into micro tasks which can be split up across the day or week, or perhaps divided out between family members or carers who may be able to help with things such as cooking, cleaning or grocery shopping so you can preserve your energy to do other things. In addition, occupational therapists might prescribe tools and equipment to help you to do the occupations that are important to you, and help you learn to listen to your body and recognise when you might need to take a break so to conserve those spoons for later.

Occupational therapy helped me when I was at my very lowest, spending days in bed due to burnout and repeating a boom-and-bust cycle day in, day out. I’ll be forever grateful to the occupational therapists that helped me slowly climb back up the mountain and to a level where I can manage my spoons much more effectively. Thanks to my OTs, I was able to complete my studies with the Open University, find voluntary work and paid work, start new hobbies, take up some of my old hobbies again, and spend quality time with my family and friends. Occupational therapy helps you adapt to be able to do the things you want and need to do, and teaches you how to manage your spoons so you can continue doing them!