Spoon theory, bipolar and self management: how it all fits together

Every seen Spoon Theory mentioned in blog posts, or noticed the Twitter hashtag #spoonie, and wonder what it all meant? When I first became aware of the concept, I erroneously assumed that it only applied to people with physical disabilities; but lately, as I have been working with an NHS psychologist on self management strategies for bipolar, Spoon Theory has become more and more relevant to me. I’m not going to try and outline the theory here – goodness knows I made a mess of trying to explaining it to my Psychologist. You are much better off reading this explanation by the theory’s creator, Christine Miserandino, so please take a few minutes to read Christine’s very clear article before reading on about its application to bipolar.

So, here are what I take to be the key points of spoon theory:

• As Christine illustrated by giving her friend an arbitrary number of spoons, we don’t get to pick our Spoon Quotient. It is simply allotted to us according to the condition(s) we suffer from.

• The number of spoons we have may vary day by day, according to external factors or internal fluctuations in our condition.

• Each time we make a choice during the day, we will spend at least one spoon.

• As our spoons are limited, choosing to spend a spoon on Activity A may well reduce or even eliminate our ability to take part in Activity B later that day.

• Living according to one’s spoons is necessarily a limited life, and is therefore an excellent metaphor for the limitations inherent in a life with disability, compared to the much less restricted lives of the non-disabled.

Spoon theory is probably applicable to any disability, but is especially useful for fluctuating conditions because it brilliantly encapsulates the way that a disabled person’s level of capability can change from day. Sometimes diminished spoon reserves are completely out of someone’s control, a matter of unstoppable degeneration, weather-related exacerbation of a condition, aging, or a reaction to a poor night’s sleep. For people with bipolar, small fluctuations may occur on a daily basis, but we also experience much bigger shifts in our illness occurring across days, weeks or months as we move between mood states. Our choices and actions on can therefore result in dwindling spoons not just later in the day, but in accumulated spoon shortages weeks, or even months, later. This most emphatically does not mean that all deteriorations in our condition are “our fault” – our actions are just one of a range of factors influencing our experience of the illness, along with life events, the medications that we take and their side effects, access (or otherwise) to therapy, the level of support and trust in the relationship with our doctor, the quality of support from family and friends, whether the sun is shining, and so forth. But it is undeniable that there are actions we can take, or avoid, to give us the best chance of preventing depleted spoons levels.

One of the things I have kicked and fought against over the past year is exactly this concept of self-management. Reading the CBT books, recording symptoms on mood trackers, and discussing the concept with my psychologist, I have often felt overwhelmed and angry. Why should I have to restrict my week by “timetabling” in beneficial activities, like a school child? Why should I have to stop myself doing exactly what I want when I am hypomanic, when hypomania feels like payback for the years of depression? Why should I have to use a mood tracker, why should I have to constantly monitor and assess my every happy day to see whether I am going high? Why can’t I stay out late, have more than one drink, knock back unlimited caffeine? Why can’t I just fly off on holiday without making a careful sleep and medication schedule? Other people don’t have to do these things! It’s so unfair!

That’s right. Being disabled is UNFAIR. Having to watch my spoon usage, when non-disabled people don’t have that worry, is inherently unfair. Now I’ve got over the Kevin the Teenager approach to disability, and begun to accept the unfairness of my situation, I’m beginning to learn that whether I practice self-management or not is totally up to me, but it is the only aspect of my disability I have any real control over. It’s a question of spoon conservation. I can watch out for behaviours that use up my spoons too quickly and make a choice to address them; I can deliberately undertake activities which I think will protect or boost my spoon supply. I don’t have to do this, but if I choose not to, I have to face the likely outcome of having insufficient spoons at a later date.

Bipolar people tend to be excitable. We get overconfident and overoptimistic when we get high. We spend money we don’t have on things we don’t need, and sign ourselves up for commitments we cannot keep. We fritter away the good will of our nearest and dearest by behaving badly. And just as we are squandering our money, and our time, and our family and friends’ goodwill, we are squandering our spoons. Hypomania convinces me that I have spoons in abundance, spoons to spare, spoons running through my fingers in a never-ending supply of shiny. In an up phase, I want to help everyone I know who is depressed, anxious, suicidal or simply going through a tough time. “Call me ANY TIME! Day or night!” I tell the friend with the new baby who won’t settle. “Email me if you can’t get me on Twitter, and I will email STRAIGHT BACK!” I tell a friend who is struggling with low mood. I put my name down to be a service user rep on another committee, agree to take part in two more research studies. I promise to write something by Friday for someone’s magazine. I make arrangements to take a lonely neighbour out for a coffee, for which I will, of course, pay. It’s nice that I want to help everyone and be supportive, but it’s the equivalent of slamming my entire wage packet on the bar and shouting, “Landlord: DRINKS FOR EVERYBODY!” – only it’s not my cash, but my spoons with which I’m being over-generous.

The trouble is that, like many bipolar people, when I’m hypomanic I find it very difficult to imagine that one day the spoons will run out (along with the cash, the energy and the good will). No matter how many times I’ve experienced it, I can’t make myself believe that my elated high will at some point tip over into agitated anxiety and panic, leaving me crying in terror over my empty cutlery drawer. Or, if not the horror of mixed mood, I may find that I have become depressed again, a state in which simply moving from my bed will cost me almost a whole day’s spoons. When I was becoming really ill this time last year, instead of pulling back I kept pushing myself alone on a tide of anxious energy. I kept saying yes to work tasks, kept running around London meeting lots of friends, kept singing in three choirs a week. I rarely allowed myself enough sleep and usually crashed out into a protracted nap on Saturday afternoon, the only unstructured slot in my entire week. And this went on until I found myself almost entirely spoonless, staring out of the window for hours on end because watching TV or reading or going outside were all beyond my means. I was operating a boom-bust spoon economy.

What I need to hold in my head is that there are things I can do to average out the spoon count. I have a choice to behave in ways which blow my spoon budget if I really want, but I then have to accept that it will more than likely cause spoon austerity measures in the near future. Self-management is about undertaking what I think of as spoon-conserving or spoon-promoting activities, while choosing to avoid or limit the really spoon-sapping choices. I am currently working on my Wellness and Recovery Action Plan (or WRAP), which begins with listing all the beneficial activities I know will help me hold onto my spoons – exercise, going outside, meditation, taking my medication, talking to a friend, etc. I have the freedom to ditch those activities if I like, but choosing to do them daily will be a spoon-positive move which will stand me in better stead in coping with the factors which are outside of my control.

Some activities might have both spoon-positive and spoon-negative elements. For example, last week I went into central London on public transport to meet a friend for dinner. Travelling into town on the noisy Tube network at rush hour was certainly spoon-negative; however, seeing my friend and having a genuine and heartfelt discussion about a range of topics, including mental health, was most definitely spoon-affirming. Overall, the evening didn’t quite work out almost spoon-neutral – I felt tired and drained the next day. But the interaction with my friend was so worthwhile that it was absolutely worth spending some spoons on.

And for me, that’s what self-management is all about. Accepting limitations. Making smart choices. Being a grown-up.

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About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
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20 Responses to Spoon theory, bipolar and self management: how it all fits together

  1. I love this theory, I think I’m a visual learner! Although I’m still not managing my spoons very well, as you say it sucks and there are so many other wonderful, fun things that could be done. I also loved your phrase a boom-bust spoon economy, I think that is a very apt description. Thanks for sharing. 🙂

  2. Corcora says:

    Thanks so much for this post and the link to the Spoon Theory. They both resonate like a … Well, like a big box full of rattling spoons! I love your description of crying over an empty cutlery drawer…it might even make me smile next time I am there. Good luck with your spoon conservation. Save our Spoons!

  3. That’s exactly what we need! A Save Our Spoons SOS movement! Sounds so much more important and urgent than “self management” (YAWN!). Even today I find I have been giving out lots of love and energy to friends. Which is great, BUT I had to force myself to return to spoon preserving activities this afternoon or that cutlery drawer’s going to hanve tumbleweed rolling through it soon!

  4. LaFletcher says:

    I’m a believer in Spoon Theory, and I use it to explain things to people a lot: “Sorry, I can’t make drinks tonight; I ran out of spoons.” For the most part my friends have heard of spoon theory and are really supportive, and the friends that haven’t get sent the original article with a brief explanation of why it applies to me and my MH and then they are really supportive. I’m so grateful that I have lots of lovely friends who react to “Having a ‘I Just Can’t’ day, sorry” with kind comments and offers of tea! Or maybe I’ve just gotten really good a brutally weeding unsupportive people from my life. 😉

    As for CBT, oh my god YES. When I first got sent to a therapist and Mind Oxford for therapy and support with my MH, they wanted me to use CBT to start tracking my (quite dramatic) mood shifts and major anxiety attacks. I HATED it! I rebelled against it SO HARD because I just could not be arsed and I was like “this is all pointless!!!” But once I (grudgingly) started to faithfully record my activities, thoughts, and moods and reflect on what the evidence was showing me (patterns started emerging that I didn’t expect, based on my weekly activities/work schedule/trip plans), I started to be able to better prepare myself for sudden, unplanned activities and deal with them okay. Even now that I’m not longer in treatment/therapy for MH, I use some of the CBT methods I learned to track mood patterns and “debrief” myself, especially when I have a bad day. So, I’ve been converted to the value even though at the beginning I felt JUST like you do! 😉

    Also, *hugs* ❤

  5. flofflach says:

    a very application of spoon theory! I have found it a very useful concept for physical and mental health issues, and shared it with a friend who is a coeliac and has a lot of health problems. It seems an altogether better things to say – are you sure you have enough spoons than are you doing too much etc!
    CBT therapy drove me bananas at first, the activity mood chart thing! What I discovered is a lot of blankness, refusing to feel anything. And those times that I am supposed to really do nothing in, rest etc…but i realise now that it does work. And making less negative thoughts seemed far beyond possible at first. I was also seeing a physiotherapist for the physical side of things, that was hard too – it was about trying to stay level about everything, not doing a 50 minute walk because I felt zingy and maybe less pain, because the next day when I’m not like that it will feel like a failure not to achieve it again.
    It all builds well into the spoon theory. I’ve thrown in some buddhist mindfullness practice to help me through a really bad patch! [Well someone suggested it as things were so bad]. There is something very rational about it that mixes well with the cbt and spoon theory.
    I have been using moodscope.com and have found it very useful [was suggested by same person who suggested the buddhist stuff! online friends are great]
    My 6-8 weeks of NHS cbt now nearly over and my therapist is going to make a case for a longer period of CBT or CAT, but the waiting list is ONE YEAR!

    Thank you for sharing your thoughts.

  6. Thank you for introducing me to spoon theory! This is so applicable to bipolar. I can’t wait to start using this language with myself and my support system.

  7. showard76 says:

    I didn’t have time to click through at the moment (crazy busy life and moving home) but I will definitely have a look when I have more time, sounds interesting! Thanks for sharing 🙂

  8. That all rings so true. I was fortunate to have my own psychiatrist for three years & he was a marvel. His favourite reminder to me was – “people with Bipolar Condition would be the first to volunteer for an Arctic expedition or a trip to the moon, but they should be the last to be considered. They need to lead calm lives” Meh – don’t want to hear that, want to empty all my cutlery out of the window and then play dead for a week …

  9. crazyinpink says:

    So true. I’ve been trying to self-manage and though I’ve heard about spoon theory I’ve never truly appreciated it before. Living with a long-term condition that people don’t always see is frustrating enough of itself, let alone having to allocate your spoons just to get through the day. Thank you!

  10. OMG omg omg… forfeited spoons due to unsustainable borrowing for soup enterprise…NHS (National Hired Spoons) reluctant to offer bailout loan due to poor credit rating – have suggested business diversification to reduce spoon dependancy.

  11. Joan says:

    wow. this meant so much to me today, you have no ideea.

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  15. Carolyn says:

    Knowing you are bi-polar, your medications should be leveling you out. I’m perplexed that you’re having such manic highs and depressed lows. Seems like you may need a different treatment.The extremes you’re describing sound like a non-medicated person at the total mercy of their disorder.

    • I hardly know where to start with this comment, so I’m going begin by assuming you’re just genuinely ignorant about the topic, and not taking the piss. Because that is SO not how it works. How many bipolars have I met who were on meds and were asymptomatic as a result? Hmmmm I think – one. One person in three years’ social networking. Only the mildest cases are magically “levelled out” with meds.The rest of us plough on, trying different meds, trying different doses. I’ve been on top whack of antipsychotics AND top whack of lithium and had the worst symptoms of my life. Sorry that you’ve bought into the myth about bipolar’s “controllability” with meds, because a myth it definitely is. Here’s a research-based article I wrote a while back that gives the true picture https://purplepersuasion.wordpress.com/2012/11/21/completely-controllable-the-truth-about-the-bipolar-controllability-myth/

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