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Key points
- Friendship is an important antidote to loneliness.
- Chronic illness presents challenges to making and maintaining friends.
- Flexibility, openness, and authenticity can mitigate these barriers to friendship.
“I get by with a little help from my friends.” —The Beatles
Earlier this month, U.S. Surgeon General Dr. Vivek Murthy issued an advisory regarding our nation’s “epidemic” of loneliness and isolation. Noting that loneliness “has been an underappreciated public health crisis that has harmed individual and societal health,” Dr. Murthy stated that “our relationships are a source of healing and well-being hiding in plain sight—one that can help us live healthier, more fulfilled, and more productive lives.”
Friendship—defined as “an active and freely chosen platonic relationship between two equals” (Moensted et al., 2023)—plays an important role in reducing loneliness and improving overall physical and mental well-being. In our friendships, we feel a sense of belonging. We laugh with friends; we support and are supported by our friends. We feel less alone and more connected to the human race due to our friendships.
Chronic illness affects the ability to make and maintain friendships (Moensted et al., 2023). Without a doubt, friendship’s benefits are important to people who live with chronic illnesses. Isolation and loneliness are often sequelae of living with illness, and friendship is particularly necessary to bridge that gap in connection. However, the conditions of living with illness can present challenges to friendship.
Bodily limitations can interfere with social connection.
Illness symptoms, including pain and fatigue, are often managed in private. Thus, typical ways of enjoying friendship—doing planned activities outside of the home together—can be challenging for people living with chronic illnesses. Further, symptoms often are unpredictable, necessitating the cancellation of plans. Many chronically ill people become hesitant to commit to plans with friends, knowing that they may well have to cancel. Their fear of being viewed as “flaky” and disappointing leads them to withdraw, which can cause friends to stop inviting them to activities.
Even when people living with illness are able to keep plans with friends, there’s often a high labor cost. A woman living with multiple sclerosis puts it well:
“I don’t think that people realize that actually getting myself ready and getting to the event, I’ve already used up half of what I’ve got for the night. I don’t think people see that as an effort. Able-bodied people don’t see . . . how much it actually takes out of me to shower and get ready and dressed and physically get to an event. They don’t appreciate the fact that I’ve actually already been hard at it for a couple of hours before I’ve even stepped foot across the threshold” (Moensted et al., 2023).
Informing friends about the high cost of social participation can be beneficial. When we tell a friend, “It’s not that I don’t want to see you; it’s that getting out is really difficult,” we make space for a dialogue about how the friendship might shift to accommodate chronic illness. Video calls, quiet evenings at home, and text messaging are ways to stay connected that may be less taxing for people with chronic illnesses. Able-bodied friends may be agreeable to these alternative ways of being together.
The vulnerability inherent in chronic illness can create barriers to friendship.
One of the pleasures of friendship is the joy of being valued by another. We wish to be seen as competent, likable, and pleasant to be around. When our friends see these qualities in us, we can see them in ourselves.
However, much of living with illness involves acknowledging the less pleasurable parts of ourselves. “All I do is complain,” says a man living with a spinal injury. “I don’t know how anyone can bear to be around me.”
“I’m not that much fun,” says a woman living with an autoimmune disorder. “I’m always either exhausted or in pain.”
People living with chronic illness struggle with whether their reality—much of it the antithesis of positivity—can and should be shared in friendships. They feel a “sadness of being unable to share hidden pain and suffering of living with chronic illness with friends, and the loneliness this evokes” (Moensted et al., 2023). They believe that the price of connection is the muting of their chronic illness experiences. This leaves them lonely within the connection and lacking much-needed support.
Moving towards authenticity
We live in a society where positivity, action, and independence are valued above vulnerability, stillness, and interdependence. We also live in a society where loneliness is killing us. Is it possible that we who live with chronic illness can be leaders in reframing what it means to be connected?
Research shows that many people who live with chronic illness fear that the reality of their illness will not be acceptable in friendships (Moensted et al., 2023). They believe that the pain and suffering they experience—their vulnerability—must be hidden away or at least substantially minimized in order to have friends. But why must this be so?
We who live with chronic illness don’t have a monopoly on vulnerability. Almost certainly, the able-bodied people we call friends have their own sorrows that they may hesitate to share with us. What if our bravery in moving toward authenticity isn’t a deterrent to closeness? What if it’s instead a relief to those around us, freeing our friends up to be more vulnerable with us?
For many people living with chronic illness, this movement toward authenticity is a powerful factor that organizes their relationships. They report having fewer friends but deeper friendships. As one study participant reported, “Putting up a front to please other people . . . I’m not doing that . . . and I feel a lot better for it. I found out who my real friends were. And I did lose some people, but I gained others, and I’m perfectly at peace with that” (Moensted et al., 2023).
Questions to think about
Have you lost friends due to your illness? What was it about your illness that challenged these former friendships?
Have some friendships deepened due to your illness? What caused that increased intimacy?
What qualities do you look for in a friend? What qualities do you bring to friendship?
If your illness has limited your usual ways of being together with friends, have you found other ways of enjoying friendship?
If authenticity feels challenging, are there small ways that you can reveal more about your illness experience?
References
Moensted, M.L., Lewis, S., Willis, K., Dubbin, L., Rogers, A., & Smith, L. (2023). Friendships, connectedness, and (in)authenticity for those with chronic illness: Trading in one social gain for another. SSM - Qualitative Research in Health 3 (2023) 100246.
