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.