The Spoon Theory written by Christine Miserandino


Please take the time to read Christine Miserandino’s personal story and analogy of what it is like to live with sickness or disability.

Click HERE to download “The Spoon Theory” in PDF format.

The Spoon Theory

by Christine Miserandino

My best friend and I were in the diner, talking. As usual, it was very late and we were eating French fries with gravy. Like normal girls our age, we spent a lot of time in the diner while in college, and most of the time we spent talking about boys, music or trivial things, that seemed very important at the time. We never got serious about anything in particular and spent most of our time laughing.

Cartoon image of Christine Miserandino holding a spoon
As I went to take some of my medicine with a snack as I usually did, she watched me with an awkward kind of stare, instead of continuing the conversation. She then asked me out of the blue what it felt like to have Lupus and be sick. I was shocked not only because she asked the random question, but also because I assumed she knew all there was to know about Lupus. She came to doctors with me, she saw me walk with a cane, and throw up in the bathroom. She had seen me cry in pain, what else was there to know?

I started to ramble on about pills, and aches and pains, but she kept pursuing, and didn’t seem satisfied with my answers. I was a little surprised as being my roommate in college and friend for years; I thought she already knew the medical definition of Lupus. Then she looked at me with a face every sick person knows well, the face of pure curiosity about something no one healthy can truly understand. She asked what it felt like, not physically, but what it felt like to be me, to be sick.

As I tried to gain my composure, I glanced around the table for help or guidance, or at least stall for time to think. I was trying to find the right words. How do I answer a question I never was able to answer for myself? How do I explain every detail of every day being effected, and give the emotions a sick person goes through with clarity. I could have given up, cracked a joke like I usually do, and changed the subject, but I remember thinking if I don’t try to explain this, how could I ever expect her to understand. If I can’t explain this to my best friend, how could I explain my world to anyone else? I had to at least try.

At that moment, the spoon theory was born. I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said “Here you go, you have Lupus”. She looked at me slightly confused, as anyone would when they are being handed a bouquet of spoons. The cold metal spoons clanked in my hands, as I grouped them together and shoved them into her hands.

I 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. The healthy have the luxury of a life without choices, a gift most people take for granted.

Most people start the day with unlimited amount of possibilities, and energy to do whatever they desire, especially young people. For the most part, they do not need to worry about the effects of their actions. So for my explanation, I used spoons to convey this point. I wanted something for her to actually hold, for me to then take away, since most people who get sick feel a “loss” of a life they once knew. If I was in control of taking away the spoons, then she would know what it feels like to have someone or something else, in this case Lupus, being in control.

She grabbed the spoons with excitement. She didn’t understand what I was doing, but she is always up for a good time, so I guess she thought I was cracking a joke of some kind like I usually do when talking about touchy topics. Little did she know how serious I would become?

I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of “spoons”. But when you have to now plan your day, you need to know exactly how many “spoons” you are starting with. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out 12 spoons. She laughed and said she wanted more. I said no, and I knew right away that this little game would work, when she looked disappointed, and we hadn’t even started yet. I’ve wanted more “spoons” for years and haven’t found a way yet to get more, why should she? I also told her to always be conscious of how many she had, and not to drop them because she can never forget she has Lupus.

I asked her to list off the tasks of her day, including the most simple. As, she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon. When she jumped right into getting ready for work as her first task of the morning, I cut her off and took away a spoon. I practically jumped down her throat. I said ” No! You don’t just get up. You have to crack open your eyes, and then realize you are late. You didn’t sleep well the night before. You have to crawl out of bed, and then you have to make your self something to eat before you can do anything else, because if you don’t, you can’t take your medicine, and if you don’t take your medicine you might as well give up all your spoons for today and tomorrow too.” I quickly took away a spoon and she realized she hasn’t even gotten dressed yet. Showering cost her spoon, just for washing her hair and shaving her legs. Reaching high and low that early in the morning could actually cost more than one spoon, but I figured I would give her a break; I didn’t want to scare her right away. Getting dressed was worth another spoon. I stopped her and broke down every task to show her how every little detail needs to be thought about. You cannot simply just throw clothes on when you are sick. I explained that I have to see what clothes I can physically put on, if my hands hurt that day buttons are out of the question. If I have bruises that day, I need to wear long sleeves, and if I have a fever I need a sweater to stay warm and so on. If my hair is falling out I need to spend more time to look presentable, and then you need to factor in another 5 minutes for feeling badly that it took you 2 hours to do all this.

I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons. I then explained to her that she needed to choose the rest of her day wisely, since when your “spoons” are gone, they are gone. Sometimes you can borrow against tomorrow’s “spoons”, but just think how hard tomorrow will be with less “spoons”. I also needed to explain that a person who is sick always lives with the looming thought that tomorrow may be the day that a cold comes, or an infection, or any number of things that could be very dangerous. So you do not want to run low on “spoons”, because you never know when you truly will need them. I didn’t want to depress her, but I needed to be realistic, and unfortunately being prepared for the worst is part of a real day for me.

We went through the rest of the day, and she slowly learned that skipping lunch would cost her a spoon, as well as standing on a train, or even typing at her computer too long. She was forced to make choices and think about things differently. Hypothetically, she had to choose not to run errands, so that she could eat dinner that night.

When we got to the end of her pretend day, she said she was hungry. I summarized that she had to eat dinner but she only had one spoon left. If she cooked, she wouldn’t have enough energy to clean the pots. If she went out for dinner, she might be too tired to drive home safely. Then I also explained, that I didn’t even bother to add into this game, that she was so nauseous, that cooking was probably out of the question anyway. So she decided to make soup, it was easy. I then said it is only 7pm, you have the rest of the night but maybe end up with one spoon, so you can do something fun, or clean your apartment, or do chores, but you can’t do it all.

I rarely see her emotional, so when I saw her upset I knew maybe I was getting through to her. I didn’t want my friend to be upset, but at the same time I was happy to think finally maybe someone understood me a little bit. She had tears in her eyes and asked quietly “Christine, How do you do it? Do you really do this everyday?” I explained that some days were worse then others; some days I have more spoons then most. But I can never make it go away and I can’t forget about it, I always have to think about it. I handed her a spoon I had been holding in reserve. I said simply, “I have learned to live life with an extra spoon in my pocket, in reserve. You need to always be prepared.”

Its hard, the hardest thing I ever had to learn is to slow down, and not do everything. I fight this to this day. I hate feeling left out, having to choose to stay home, or to not get things done that I want to. I wanted her to feel that frustration. I wanted her to understand, that everything everyone else does comes so easy, but for me it is one hundred little jobs in one. I need to think about the weather, my temperature that day, and the whole day’s plans before I can attack any one given thing. When other people can simply do things, I have to attack it and make a plan like I am strategizing a war. It is in that lifestyle, the difference between being sick and healthy. It is the beautiful ability to not think and just do. I miss that freedom. I miss never having to count “spoons”.

After we were emotional and talked about this for a little while longer, I sensed she was sad. Maybe she finally understood. Maybe she realized that she never could truly and honestly say she understands. But at least now she might not complain so much when I can’t go out for dinner some nights, or when I never seem to make it to her house and she always has to drive to mine. I gave her a hug when we walked out of the diner. I had the one spoon in my hand and I said “Don’t worry. I see this as a blessing. I have been forced to think about everything I do. Do you know how many spoons people waste everyday? I don’t have room for wasted time, or wasted “spoons” and I chose to spend this time with you.”

Ever since this night, I have used the spoon theory to explain my life to many people. In fact, my family and friends refer to spoons all the time. It has been a code word for what I can and cannot do. Once people understand the spoon theory they seem to understand me better, but I also think they live their life a little differently too. I think it isn’t just good for understanding Lupus, but anyone dealing with any disability or illness. Hopefully, they don’t take so much for granted or their life in general. I give a piece of myself, in every sense of the word when I do anything. It has become an inside joke. I have become famous for saying to people jokingly that they should feel special when I spend time with them, because they have one of my “spoons”.

© Christine Miserandino

*We have English, Spanish, French and Hebrew translations of “The Spoon Theory” available.

You may NOT publish or re-print this article without the written permission of Christine Miserandino and Thank you.

Now you can purchase small and large poster prints of “The Spoon Theory” from our Online Store! These posters will make a perfect “get well gift, or friendship/ I understand gift.” We also think it would make a perfect addition to any doctor’s office, or support group meeting room.

The Spoon Theory Large Poster – $22.99

The Spoon Theory Small Poster – $18.99

Most importantly, get one for yourself!

  • Valerie Finnigan

    And don’t forget to inhale some of that love. You need that, too.

  • bookwrecker

    This explains things so much easier than I ever have been able to. Thank you.

  • Tiffany_Michelle

    Thank you! I never knew how to explain to people who always say I don’t look sick. Have even had someone call the police on me for parking in a handicap spot (even though I had a permit to do so), because I dont look like what a disabled person looks like.

  • Valerie Finnigan

    I once came to the office without my usual five layers of SPF makeup, and someone commented that my color looked great, and I had a nice, rosy-cheeked glow. I said, “actually, that’s not a good thing, but I’m glad you think my malar rash is pretty.”

  • Melissa Anne Limbaugh-Blevins

    I meant Sjogren’s, sorry. It’s the brain fog!

  • Melissa Anne Limbaugh-Blevins

    I have Hashimotos and Sjigren’s and it’s the same. We look OK on the outside, usually, but physically and mentally we are a mess.

  • ChannelSixtyNine69

    It’s really a waste of time answering anti-vaxxers. Their ignorance knows no bounds.

  • ChannelSixtyNine69

    Can you prove what you have written. Please provide a link so I can see for myself. These have to be studies done over a long period of time and verifiable with rigorous scientific oversight.
    My guess is, you can’t, so I won’t bother waiting for your response with the link I asked for. And you’re right, I won’t take your word for it.
    As for rubella, do you realise what happens to the foetus if the mother gets infected?

  • Brad

    Thank you for this. One thing though.. you may want to consider “spoon analogy” instead of “spoon theory.”

  • Lisa Snider

    Thank you. I’ve had MS for 20 years. The last four have been hard – physically, mentally and emotionally – and the spoon theory perfectly sums up my days. I sent it on to my husband so he can better understand.

  • Dennis

    WOW! What an impactful explanation. I am a strong healthy middle aged man, and usually keep my emotions in check, I cried sitting in my office while I was eating lunch reading this. I will admit, I have taken my health and everything I do on a day-to-day basis for granted over the years, I think this one article will change my cavalier attitude on this and give thanks that I am so fortunate.
    You are such a brave person, not to mention an exceptional writer, I thank you for sharing this.

  • This was me. I am so sick of me trying this then that. I need to accept who iam.

  • ruhrow

    Oooooook, I am going to run very, very far away from this, because I STILL don’t quite get your point, but I do see that this discussion will involve a lot of poorly understood medicine, poorly understood posts, and all around confusion.

    Best of luck with your health.

  • Julianne Sobel

    I posted something yesterday. Basically that someone without Lupus would never be able to empathize or understand us. That the Spoon analogy would give people false hope. I want to say, I Apologize!! I your story to my Husband. He offered to bring me some spoons and shared that it helped him understand my Lupus better than in our entire 20 year marriage!! So it Did Help! I can’t believe it. I am dumbfounded how this parable worked. Kudos to you.

  • Julianne

    I have Lupus and my son also has Lupus. But my Lupus might not have been activated if I hadn’t have had breast implants in my 20’s. And my son’s Lupus might not have been activated if he hadn’t taken minocycline for his acne. These are external agents that can cause auto-immune disease in a small subset of genetically susceptible individuals. “Creator”, who started this thread, seems to blame the victims here. It’s our own darn fault we have Lupus because we we so stupid and vain. My point is: Most of the thread is in response to the the dangerous anti-vaccination movement because of Dr. Wakefield’s phony self-serving research regarding vaccines and autism. I would still re-vaccinate all my children and plan to vaccinate grandchildren. BUT…listen up…I am a neuropsychologist and have poured through the literature. There may be a grain of truth here… My point is this, Creator, why are you Blaming the Victims, if that’s what you truly believe. Why add Insult to Injury? Why aren’t you out there Advocating for Us?!

  • ruhrow

    I can’t even tell what you are trying to support with your argument.

  • Julianne Sobel

    There is some mounting evidence in the scientific literature that external agents, including medications, and possible even vaccinations, could trigger an auto-immune response in certain susceptible individuals. However, even if that were to be true in a small number of cases, why would anyone in their right mind blame the individual who developed the auto-immune disease. Shouldn’t your rage be directed at Big Pharma or somewhere? And if the drug companies are Guilty, is it due to a cover-up?, conspiracy?, failure to warn, negligence?. Are you mad that we didn’t want to get the mumps, measles or hepatitis? Are you angry because we didn’t believe medical quacks? Shame on you!!!!

  • Julianne Sobel

    My father was 85 years old before he could empathize with the fatigue of my lupus. I wish I had told him about the “spoons” before then. One afternoon he finally came over and plopped on the couch and said, “Wow, am I tired!” And I said, “Right! You see! That’s how I’ve been feeling for 30 years!”. Dad was stunned. He absolutely had no clue. People who don’t have this kind of fatigue can’t empathize. We can get a little support and sympathy. But can we get them to walk around carrying a dozen spoons with them everyday? Get them some heavy spoons to carry around with them too, just to make it more realistic. Oh, and after getting rid of each spoon, take at least a 15 minute break to recover from the effort it took to do whatever task that spoon represents.

  • Trish Bash

    Thank you.

  • Rachel

    Thanks from a nurse. You have helped me understand my patients better. I am looking forward to using this as a teaching tool for my new chronic illness patients and their families. I love this especially for mental health. I can’t say enough. Just…Thank you…

  • Drea

    Thank you for this. I have been having a really hard time trying to explain this to people, and why I flake out so much. I think this will be very helpful

  • Eileen P. Franklin

    I have never heard illness explained so well. I felt so understood.

  • Debbie Jamieson

    I Wholeheartedly Agree Laura!

  • Debbie Jamieson

    I totally agree with you Betty but couldn’t find the words to say without expressing anger!
    Thanks for speaking up.

  • Lucateal

    To me, the surprising thing here is that there are apparently people who don’t feel like they have a limited amount of ‘spoons’ and have to pick and choose what they spend their energy on carefully. It’s hard to imagine what that might feel like.

  • Minya

    Dearest Christine.
    I found this article a long, long time ago. I took it to heart back then, because I was an introvert, and already back then had lived with backpains for twenty-odd years.
    Earlier this month I was finally diagnosed with fibromyalgia, which makes so much sense as to how little spoons I usually have.
    Thank you so much for explaining my own situation for me, long before I knew what it really was. You made my life easier when I could explain a day in spoons, and you still make my life easier now that I can explain an invisible, chronic illness with the help of spoons.
    Thank you.

  • Lolana

    I was really really well until 5 years ago and then everything changed. Now I understand this so well, and I never did. It can be terrifying too, and the fear also saps energy. Trying to manage this has been the greatest challenge. Thank you for this xx oo

  • Kelly Bryant

    My heart goes out to you. Stay strong, please.

  • Betty Miliano

    While you (and everyone else) are entitled to your own opinions, you are not entitled to your own facts… What you are presenting as ‘fact(s)…are not…it is an opinion…and that, too, is simply wrong…

  • Betty Miliano

    Me, too…????

  • Sue Marie

    Anyone reading this that’s new to CFS, nothing can be more important than this. The longer you try to keep up, the worse your prognosis will be. You have to be selfish and keep yourself as well as you can.

  • Robin Whitesell

    Evelyn…Great response to Janis. I’m so appalled, I could not think of a way to respond other than to just ignore her as her smugness & arrogance is just cruel and unnecessary. For someone (Janis) to go out of their way to make such a comment makes me wonder why she herself is even involved in a thread for chronically suffering people… Fear & ignorance often go hand-in-hand. My heart is sorry for hers.

  • Scenario

    The spoon theory is a very good way to explain how chronically ill people live their lives. I’ve got Crohn’s disease along with a few other chronic illnesses. When I wake up in the morning, I rate how I feel from 0 to 5. 1 = minor symptoms, 3=bedridden, 5= go to hospital. I have to decide how many spoons I have by how I feel.

    One of the main problems with chronic illness for me is fear.

    Over the years, I’ve had multiple times on a level one day where I’m doing something that really needs doing and I get on a roll and use up my spoons and keep going anyway. But the cost of one really productive day is sometimes three useless weeks, a week where I’m bedridden and another few weeks to recover.

    Every few months, I get a few zero days, where I have no symptoms at all. These days scare me because I don’t have any idea how many spoons I have. I want to just push myself into doing things that I haven’t done in years now that I have the chance but do I want to risk a flareup where I will be in serious pain and useless for weeks. Is one or two days of freedom worth weeks of pain?

    I find myself limiting myself because it seems better to have a month doing a quarter of what I used to be able to do in relatively minor pain vs a few days at full power and a few weeks of being useless and in serious pain.

  • Marciamallow.

    I think you replied to the wrong person.

  • joie

    That’s literally just your personal opinion. Doesn’t make what I’m saying incorrect by any measure. I used those words because they are indeed the correct words to use. Believe what YOU want.

    Good day.

  • ruhrow

    The problem is, you’re discussing medicine as if it is a BELIEF system, when in fact there are certain things that are demonstrably true and things that are demonstrably false.

    Do doctors know everything about health? Of course not. Beyond the fact that most of them work with a full team of people because they know that there is more to health than can be addressed by a single person with a single lifetime of education…there are some questions that we just haven’t found answers for yet. But there are studies out there demonstrating which treatments work, which don’t, and what risks come along with either option.

    Feel free to practice your own faith – because that’s what your ‘treatment plan’ boils down to – with regards to your own health. We live in a free country. But please, stop using words like ‘evidence’ and ‘proven’ in your proselytizing…you’re diluting their actual meaning.

  • joie

    U should get a complete blood panel done and see if ur vitamin deficient anywhere.

    Then correct that by taking non gmo vitamins and see how you feel. That helped me majorly with everything I’m dealing with.

    Curcumin for pain. Herbs are a wonder.

  • joie

    There’s plenty of evidence of what causes cancer, autoimmune disease, & autism. . Gerson isn’t the only one with that theory. He’s not the only one who tested it either. Doctors in other contries have tested his theory & found it to be true as well as doctors who live in the US.

    And all of the patients gerson treated were NOT On chemo prior to his treatment. Even if they were, we know that’s def not what healed them.

    Despite everything, disease begins in the gut. It’s pretty clear because it also has been proven. There are more than enough people who have had autoimmune issues that they cleared up by changing their lifestyle and diet amongst other things. It’s not a miracle cure , it’s a lot of work. It takes major dedication.

    I have a friend who has been chelating her autistic son, she tested him and had heavy metal toxicity. After a lot of strict treatment from his mom under a ND, he started speaking, singing, reading. . . Things other he couldn’t do before

    I believe . . . Just not in doctors. They aren’t here to cure. The proof is in the cured lol. I’ve had my own personal instances where doctors tried to stray me from natural medicine. It’s easy to say things don’t work when u don’t wanna take the time and make the effort to follow them precisely as directed. It’s even easier to believe they don’t work when a MD lies to you telling you they won’t.

    Anywho, Best of luck to everyone. I’ll be working to manage my lupus with a plant based diet. Because my goal is to be free from toxic medication, lupus and it’s symptoms… the only way to a achieve that is by not creating inflammation in my body with the foods that trigger lupus symptoms. .

  • ruhrow

    Wakefield (the man who published on vaccines) was not in the US; it was not a US issue.
    Gerson was not published because his theories were not scientifically rigorous and did not demonstrate that his treatments worked. All of the patients’ stories that he cited involved people undergoing medical treatment (chemotherapy), so there was no way to tell what caused their improvement. Subsequent attempts to demonstrate his ideas have simply been unsuccessful, even when undertaken by proponents of his ideas.

    There are real life examples of drug company finances affecting cancer care: for example, some treatments are FDA off-label because it took so long to gather the evidence for them that their patents expired, so nobody is going to pay the FDA fees (see Exemestane). Others, such as Ipilimumab and Pembrolimumab, are similar drugs made by different companies…so we may never see anyone pay for a trial to demonstrate which works better.

    If you want to talk about how the patent and drug research system could be made better, there’s plenty of fodder, especially in cancer care. But it’s not because anyone is suppressing theories, it’s because drug development is expensive, our patent system is convoluted, and there are no easy, magical, quick-fix solutions to any of this.

    I know that it’s easier to think that there is a miracle cure out there and the drug companies are blocking it, because that means that there is an answer; it means there is a way to cure all cancer and we just need to get the word out. But you can’t believe something just because it’s comfortable to hear. Cancer and autism are both things that we need to learn to deal with as they come, using actual evidence.

  • Laura Robertson

    Wow, Janis. I could say a lot of things to your comment, which is obviously based in a lack of knowledge and compassion. You must be very rich in spoons to spend time and go out of your way to make someone else feel very badly.

  • for maybe the 50th time in my life, I have linked to your lovely story. thank you for giving me the power and the words. I appreciate this more than you know.

  • joie

    And max gerson was banned in the us from publishing his material about what cures cancer.


    The people who get the money from these treatments can easily blacklist anyone. I’m sure.

  • Brenda Budd

    I’ve been chronically I’ll since I was a teenager. My life has been so hard, and I never was able to adequately explain or express how my life felt to anyone. It’s been difficult with people saying “Just get up and do SOMETHING”, as if I didn’t want to!
    I would love to be well and have no illness.
    So when I first read this years ago, it touched my soul, like I wasn’t alone in my walled in world anymore.
    And if for only me, I say to myself, it’s OK if I can’t do everything. It’s. Ok.

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