The 12 Spoons Theory

by Eva-Lena Crothers Ericson

During 2024, I experienced two life threatening illnesses. The first of these was a massive unprovoked pulmonary embolism resulting in partially collapsed lungs, plus a string of DVTs in both legs. I went from being a strong, energetic massage therapist training to become a Pilates trainer, to suddenly having no energy. I was even finding it hard to speak.

It was very scary. Initially, I didn’t think about my new situation too much – all my energy went into just being and getting through the days. Every little thing got tough. We had just moved to a new house in a new city, and I couldn’t even deal with unpacking and getting organised again. Just the thought of opening and emptying a removalist box felt overwhelming and I had to go and sit on the sofa.

Through my GP, I got into something called Lung Physio: light group exercise done under the watchful eye of physiotherapists and nurses. It was an 8-week program where we met twice a week for exercising and once a week for tea and a talk. The talks were held by different health professionals on different topics: from medication to phlegm to diets. The talk that made most impact on me was on the 12 Spoon Theory.

The Spoon Theory came about when the American writer and blogger, Christine Miserandino, had dinner with a friend who had Lupus. The friend suffered badly from lack of energy and Christine wanted to find a simple way to explain how people living with chronic illness, chronic pain, and disability have limited energy resources and use up more energy on everyday tasks than healthy people.

Christine grabbed the 12 spoons she could find on the dinner table, making each spoon represents a separate unit of energy – either physical, mental or emotional. She gave her friend the 12 spoons and then started to take away one after the other, taking control of the spoons/energy like her friend felt the Lupus was controlling her life and energy. One spoon represented getting out of bed in the morning, 3 spoons represented a doctor’s appointment and so on. Soon Christine’s friend sat there with no spoons and started to realise that, with the limited energy she had in a day, she had to make decisions about how to spend that energy. If she held the spoons and could decide how to spend her spoons/energy she would be in control. All of a sudden, she was given more power over her life. She realised she actually had choices.     

Most healthy people start the day with an unlimited amount of possibilities and energy to do whatever they want, especially young people. For the most part, they do not need to worry about running out of energy by the end of the day. Healthy people don’t have to make choices about where and on what to spend their energy, something most people take for granted. The difference in being sick and being healthy is having to make choices or to consciously think about where to spend one’s energy that day.

For me this was a game changer. I quickly calculated my day and worked out that I was up to 15 spoons even before that meeting. No wonder all I wanted was to go home and lie down! Even though my condition was acute and eventually would go away, at that point in time my energy was certainly limited and there was a reason: my body and mind struggled with a lot. The exhaustion wasn’t imagined and there was no need to feel guilty about it, which in itself was also a burden I struggled with.

When I started to use the Spoon Theory, I started to be kinder to myself, I stopped feeling guilty, hitting myself over the head for being lazy or imagining how I felt. It gave me a tool to organise my days and, very importantly, a way to explain to family and friends how I felt. For instance, my friends started to ask me if I had any spoons left to go for a coffee or if we should wait till another day.

Of course, different people have different amounts of ‘spoons’ depending on the day or the illness but it’s still a useful tool.

Just getting out of bed, having a shower and getting dressed might use up 4 spoons. Driving during the day could use up, let’s say 4 spoons. The medical appointment takes 3 spoons and 4 going to work. That is already 15 spoons.

No wonder people with chronic conditions are totally exhausted!

If this is the first time you’ve heard of The Spoon Theory, I warmly encourage you to look it up. Hopefully it will give you a better understanding of what your clients with chronic illnesses are going through when they talk about how exhausted they are. It’s not in their head, there’s a reason for the tiredness … with that insight, you can help and support them with understanding, acceptance and empathy. You can give them the Spoon Theory as a tool they can use to choose what activities to do during a day so there will still be energy at the end of the day.

Conclusion

The Spoon Theory can be a useful analogy to understand and explain how people suffering long-term chronic fatigue or pain can adapt their lives to keep symptoms more manageable. It is all about the amount of energy it takes to live daily.

Oh, and my second illness? Well, that was also an acute episode that put me in hospital for almost 2 weeks. This time it involved diverticular disease which, I was told, I share with 60% of the Australian population. Armed with the Spoon Theory, I have more control over my energy and activities this time. I still have a long road to full recovery but at least I now feel in charge.

About the author

There wasn’t quite enough spoons for a photo and bio of Eva. However, we can confirm that Eva has been a member of AMT for over 20 years and throughout that time has been a much-loved, delightful presence at conferences and other AMT events. She gained her first massage qualification in Sweden in 1995 which places her in a rarefied camp of practitioners who legit studied Swedish Massage. Now we just need to know whether dad jokes subtract spoons. We really hope not.

Thank you Lena for this brilliant insight into living with chronic illness.