By Janet Coulter MSN, MS, RN, CCM, FCM
Have you heard of the “Spoon Theory? I was recently at a family gathering and the discussion revolved around “spoon theory.” I must admit I knew nothing about this, and I found the conversation very interesting, enlightening, and intriguing! Enter the Spoon Theory—a concept that might just shift how to think about chronic illness and energy management When I returned home, I decided it was time to educate myself on” Spoon Theory.” Spoon Theory” is a metaphor used to describe the limited energy resources available to individuals living with chronic illnesses or disabilities. It was created by Christine Miserandino, a blogger and lupus patient, in her 2003 essay titled "The Spoon Theory", which was originally published on her website, But You Do Not Look Sick.
The story originated when Miserandino was trying to explain to a friend what it feels like to live with a chronic illness. She took spoons from a nearby table to represent the energy units she has in a day. Each task, such as getting out of bed, showering, preparing food, going to work or socializing, required using one or more "spoons." Healthy people might start the day with an unlimited number of spoons or the ability to generate more energy when needed. But for someone with chronic illness, spoons are finite and once they are gone, they’re gone. There may not be enough spoons for all of the day’s activities. They may wake up every day with fewer spoons than they need. And unlike someone who can grab an extra coffee or push through the afternoon slump, they cannot borrow spoons from tomorrow without paying for it—sometimes dearly—with a flare-up, exhaustion, or days in bed.
In this metaphor each spoon represents a measurable unit of energy. Daily decisions become strategic, because once the spoons are used, there are no more for the day. Activities that healthy individuals take for granted—like cooking, commuting, or even chatting—can be draining and require careful planning.
The” Spoon Theory” has become a widely adopted concept among individuals living with chronic fatigue syndrome, fibromyalgia, multiple sclerosis, lupus, long COVID, and other invisible or energy-depleting illnesses. People who relate to it often call themselves “Spoonies.” The theory offers a language to express what can be hard to explain—why someone might cancel plans, need to rest after a seemingly easy activity, or look fine but feel completely exhausted.
For professional case managers, understanding the “Spoon Theory” can help us empathize for patients who may struggle with activities of daily living despite appearing physically well. It can also be instrumental in developing individualized care planning by acknowledging that a patient’s physical and cognitive energy may fluctuate from day to day. We can increase patient autonomy by validating the need for pacing and energy conservation strategies. When someone learns about the “Spoon Theory,” it can be a game changer. It validates their experience. It helps them set boundaries. It gives them permission to say “no” without guilt—and “yes” when it matters most. And that can empower our patients. By telling our patients about “Spoon Theory,” we can facilitate communication, by giving patients a shared vocabulary to express their limitations without needing to overexplain or justify their fatigue.
Case management interventions include asking different questions. Instead of focusing solely on what a patient can do, ask how much energy it costs them to do it. Two patients may both be able to walk to the bus stop, but for one, it is no big deal. For another, it could be they are only outing of the day.
Second, we can adjust expectations. This does not mean lowering standards - it means building care plans that reflect lived experiences. Maybe that means coordinating home health aides, encouraging the use of energy conservation strategies, or advocating for assistive devices and rest breaks at work. As case managers, we can also advocate for appropriate accommodation in the workplace or school.
In addition, we can educate caregivers and families. The “Spoon Theory” is a simple, relatable way to help loved ones understand why someone might cancel plans last minute or need extra help with what seems like a basic task.
Summary
The “Spoon Theory” may not apply to everyone’s experience particularly those with mental health disorders or neurodivergent conditions, where energy use is less predictable. But the beauty of the “Spoon Theory” is that it gives language to an often-invisible struggle. And as case managers, language matters. It helps us connect. It helps us advocate. It helps us understand. As case managers, we recognize the importance of prioritizing patient goals, since even small tasks can be significant victories for someone managing a chronic condition.
The Spoon Theory is a powerful, person-centered way to conceptualize the energy limitations many people with chronic illnesses face. For case managers, it is not just a metaphor—it is a reminder to ask, listen, and plan in ways that respect the lived reality of those we serve. At the end of the day, case management isn’t just about managing tasks—it’s about seeing people. The “Spoon Theory “ invites us to do just that. To pause, to consider, and to ask: How many spoons do you have today? Because sometimes, the most compassionate care begins not with a checklist, but with a conversation.
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Bio: Janet Coulter, MSN, MS, RN, CCM, FCM is President of CMSA. She is a transplant case manager with a wide variety of experiences including educator, administrator, team leader, and Director of Case Management. Janet holds a Master of Science in Nursing from West Virginia University and a Master of Science in Adult Education from Marshall University. She has published many articles in CMSA Today and the Professional Case Management Journal and served as a reviewer for the Core Curriculum for Case Management Third Edition. She has served as President-Elect of CMSA, Chair of the CMSA Today Editorial Board, Chair of the Nominations Committee, and Vice-President of the CMSA Foundation board. Janet was the recipient of the CMSA National Award of Service Excellence and Southern Ohio Valley CMSA Case Management Leadership award and was recently inducted as a Case Management Fellow from CMSA.