Every year on the 20th of October we celebrate World Mental Health Day, an occasion to raise awareness and spread education about a topic that is still a taboo for many people. In the course of the last two years the pandemic has affected all of us in many and difficult ways and, according to a survey by the ISS (Istituto Superiore di Sanità), the levels of anxiety, stress and depression in the population have been higher than normal among people of all ages. In this extremely difficult situation, it is hard to find effective coping mechanisms and to be able to share our own struggles and difficulties with those around us. That is where the spoon theory comes in.

“The Spoon Theory” is the title of an essay published in 2003 on the site “But You Don’t Look Sick” by Christine Miserandino, who suffers from Lupus, a chronic autoimmune disease which causes the immune system to attack healthy cells. The author writes about taking her medicine in a diner with a close friend, who asked her what it was like to live with her illness. She tried to explain the need for her pills and the frequent pains, but the friend didn’t seem satisfied and Miserandino found herself lost. “How do I answer a question I never was able to answer for myself? How do I explain every detail of every day being affected, and give the emotions a sick person goes through with clarity”: she writes in the essay. That was when the theory was born.

Miserandino grabbed as many spoons as she could and gave them to her friend, saying: “here, now you have Lupus”.

With this, she explained that “the difference in being sick and being healthy is having to make choices or to consciously think about things when the rest of the world doesn’t have to.” A healthy person doesn’t have to count their spoons, because they have an almost unlimited amount, and they can use them in whichever way they like. Someone with a serious medical condition only wakes up with a limited number of spoons, in this theory twelve. Every activity takes up some spoons, depending on how strenuous it is. The quantity of spoons a certain action requires varies depending on many variables, for example for some showering may take only one spoon, while for others it could be three. On a general day, where there are no influences on a person’s energy other than their illness, activities like getting out of bed, taking medications, surfing the internet only take up one or two spoons, leaving ample space for other activities. However, when one has social plans, an exam, a doctor’s visit, they expose themselves to the risk of running out of the spoons they may need to do essential activities, like eating or bathing. That may be the reason why someone with depression cancels plans at the last minute because they realize they don’t have nearly enough energy for it. Being chronically or mentally ill means always being aware of how much energy you have, to avoid finding yourself stuck in a situation that is too draining. Often when exposed to unavoidable tiring situation, people are forced to use more spoons than they have, but this strategy only leads to an accumulation of tiredness that can result in being completely drained for days on. That is why it’s extremely important, for both healthy and unhealthy people, to acknowledge that “spoonies” cannot be expected to function the same way others do.

This essay was, at the beginning, applied only to people with chronic conditions, like the one the author had. In time, however, it has been recognized how incredibly useful it can be for people with mental illnesses. Now there are hundreds of thousands of people who identify as “spoonies”.

This theory offers a way for patients to be understood by others in a frank and simple way. Of course, everyone is different and, even between people who have the same diagnosis, the number of spoons one needs to do a certain activity. Being able to identify as a “spoonie” can be extremely beneficial to someone suffering from a mental or a chronic illness. It helps to understand ourselves better and to accept our bodies’ and our minds’ limits, reducing the feeling of guilt and the heavy cultural burden to just “tough it out”.

The Spoon Theory is meant to help outsiders to understand what it is like to live with illness and to support patients towards our journey of self-compassion and acceptance. If you have a mental or a chronic illness, this theory could help you reflect on how you can learn to coexist with your conditions without pushing yourself to the limit and it could also be a tool for your loved ones to support you better. Mentally and chronically ill people are still extremely misunderstood, considered lazy, unmotivated, or bored, even by those people who are supposed to cure us or manage our symptoms. We can change that by opening a vulnerable and sincere conversation, breaking the stigma, destroying the taboo, and making sure that everyone knows how much strength and courage it takes to live with only twelve spoons a day.

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