Unpacking the Spoons

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Most of you have already heard the spoon metaphor by now. It was originally coined to describe what it’s like to have a chronic illness, although since then it has been used to describe mental illness as well. It’s an incredibly helpful tool, but I’d like to take a minute to expand on why those of us who have illness of one kind or another use up our spoons so quickly.

There is an invisible aspect to illness that most of us don’t talk about. It’s oddly taboo, particularly for mental illness. Let’s shed some light on it shall we (I’m going to confine this discussion to my particular mental illness because that’s what I have experience with, but I know that this type of thing is applicable to all sorts of different illnesses)?

When you’re mentally ill you have to think about more things than the average bear. While the spoon metaphor originally was meant to illustrate how much more difficult it is to do an average task if you’re chronically ill, chronically ill people are also always doing more work behind the scenes than most people. That’s because most places aren’t completely accessible to someone with a chronic illness or disability, and so we are always calculating what our capabilities are, whether we can access the things we need to, whether others will judge us, and so on.

Let’s look at some examples of things that I have to think about on a regular basis that most people are blissfully unaware of: (trigger warnings for ED and self harm):

1.Are my hands shaking? Will someone notice? How will I explain it if they do?

2.Will the clothes that I’m wearing expose any of my scars or current cuts? Am I going to be somewhere that I care?

3.Will someone use the word “purge” today? How will I deal with this trigger if it comes up?

4.Will someone talk about my body or eating habits today and how will I quickly escape the situation if that happens?

5.If I eat something, will my stomach be able to keep it down or will it get uppity because it’s not very good at digesting anymore?

6.Will it look suspicious to my family or friends if I go to the bathroom immediately after a meal?

7.If I stay at someone’s house, do I have my meds? I cannot stay at someone’s house unless I have my meds.

8.If others want to do a physical activity, will I be able to keep up? Will I start feeling faint?

9.Did I bleed on my sheets or my pajamas after I cut last night? Can I get that stain out? Did it get on my computer, and will other people notice if I bring my computer out? Also gross.

10.Can I leave the house today without overwhelming self-hatred based on how I look in these clothes?

11.How distracted will I be today by my body? If my thighs rub together while walking, will I still be able to keep it together, or will I start having some really bad thoughts?

12.Will there be calorie counts listed somewhere that I go today?

13.How do I get all my hours in at work and get to 5-10 hours of therapy a week? How do I explain to my boss and coworkers that I’m not lazy it’s just really hard to find good times for appointments?

14.I usually get tired at around 9:00 (probably from nutritional deprivation among other things). Can I go out and socialize tonight? How can I see my friends when I have a full time job and I can’t stay awake past 11? If I do try to go out, will I hit a wave of exhaustion unexpectedly?

15.Was that slight chest pain just some anxiety or other minor something, or am I finally getting the irregular heartbeat that is supposed to come with my eating habits?

16.What do I say if people bring up food habits? Fasting? (yes this has happened, e.g. how long have you gone without food). How do I keep myself from blurting out “yeah, I ate once a week for a couple months once”?

17. How much do I tell people?

18. If someone hugs me, will they be able to feel my fat? Will I be ok with it, or will I want to pull away (most of the time it’s pull away. Then I have to be polite)?

19. If I purge, will I smell like puke? Will I be able to get those nasty stains out of my clothes (yes, it gets everywhere. yes it is gross)? What happens if my boyfriend tries to kiss me?

20.How much of my day will I waste thinking about food and debating whether or not to eat and how much to eat? This varies from about 1 hour to my whole day, depending.

21.Sometimes I even waste my brain space wondering if what I expel from my body is the same as what I put into it (yes I am talking about poo).

22.How many layers should I wear? I’m always cold, but I can’t regulate my body temperature at all so I swing to really hot if I’m under blankets or layers.

23.Can I handle looking at myself in the mirror today? Will I look like a complete idiot if I get dressed and leave the house without a quick mirror check?

24.Will someone notice if I start poking at my wrists or my hips to feel the bones? Can I feel my bones? Am I too fat if I can’t feel my bones?

25.Have a fasted/restricted today? How long has it been since I last ate? How much did I eat? If someone tries to give me breakfast, how can I say no?

This was just a list I came up with off the top of my head. Imagine trying to get out of bed while thinking about all these things, plan your day while thinking about all these things, accomplish work while thinking about all these things. THIS is where the spoons go. The reason that doing simple tasks requires so much more energy and effort is not just the physiological difficulties of depression or illness (and yeah, those things often do come with some serious fatigue or pain), but also the fact that everything is inherently more complicated. You are constantly trying to protect yourself from whatever threat your illness brings. You have to plan ahead like nobody’s business. You have to be assessing what’s going on around you and what’s going on internally to make sure you’ll be ok.

With mental illness, many of these thoughts are intrusive, paranoid, and irrational. Unfortunately that doesn’t mean you can turn them off and that doesn’t mean that you’re expending less emotional energy by having them. Instead, you’re taking a lot of your executive function to refocus your brain on the task at hand. All the time. Over and over.

For many of us who are dealing with a low spoon count, we don’t even realize that this is where the spoons are going: all we know is that things feel hard. They feel exhausting. We’re more worn out than other people even when we’re doing what appears to be less. With mental illness, the thoughts can be so pervasive that you barely notice them anymore, except that you’re still managing them.

Again, the key appears to be patience with yourself and with others, as well as clear communication about what you’re feeling. Many of us don’t want to speak up about the things that are hard for us, whether because we don’t want to appear weak or because there is a strong taboo against them (most of the things listed above fall into this second category). If we can get better at telling others what we’re really feeling, maybe this whole spoons thing will start making more sense to everyone.