Spoons and Pacing

If you have a chronic illness or know someone with one, you've probably heard of the spoon theory. The term was coined by Christine Miserandino to explain her experiences with Lupus to her friend. She used spoons as a metaphor for units of energy because they were in a diner at the time of their conversation and spoons were readily available to use as a visual aid.

Healthy people have enough energy to get through a normal day without considering every step of every task. A chronically ill person has a limited amount of energy, or spoons. If you only have 10 spoons for the day rather than an endless supply, you run out pretty quickly. In a normal morning you might

• Get out of bed (-1 spoon)

• Brush your teeth(-1 spoon)

• Get dressed (-1 spoon)

• Make breakfast (-1 spoon)

• Eat breakfast (-1 spoon)

• Brush your hair (-1 spoon)

• Shower (-1 spoon)

• Dry off (-1 spoon)

• Dry your hair (-1 spoon)

At this point you have 1 spoon left for the rest of the day, and it's still morning. How are you going to get your kids to school or make it through a day of work? How are you going to eat lunch and dinner? On a good day you might have 20 spoons, but on a bad day you might only have 5.

Since there is no cure or treatment for M.E., all we can do is try to manage our symptoms. One type of symptom management is pacing. It's similar to spoon theory in that we have to estimate our baseline, or the number of spoons we have for the day, and then leave some spoons in reserve. You can think of pacing as energy conservation. Just like a long distance runner will pace themselves rather than sprint at the start, we need to pace ourselves in a much slower way. We can pace ourselves by doing a task slowly, using shortcuts, and taking a break between tasks. Often we have to say no and not do things, even if we really want to.

I pace by aiming to do 50% of what I think I can do. That's not very much considering that mild M.E. already means I can only do half of what I could do prior to onset. For me pacing means I have to aim for 20-25% of what I could do when I was healthy. Previously I wrote about items that help me, anything that helps me conserve energy is part of pacing. I have my Fitbit set to buzz if my heart rate exceeds 100 so I know to stop and rest if I'm doing anything strenuous. If it isn't an emergency I either do it very slowly, ask Daniel for help, or decide if it really needs to be done right away. I've also started outsourcing housecleaning and a few days worth of meals.

Pacing takes time to accept, and to put into practice. When I pace myself I build up to a good day. On my good days I want to do something because I always fear that it could be my last good day. Also, I'm a big believer in trying to take care of my mental health and part of that is having a bit of fun. But if I don't pace on a good day and do too much, it leads to a crash that can last for weeks. Chronically ill people never get to take a break from pacing or counting spoons. That doesn't mean we don't get to have any fun, but we usually can't do things spur of the moment and we may have to cancel plans. It does mean that the things we can do become that much more special.