Chronic Illness and Friendships

We as humans know how important our friendships are. We are social animals. We thrive in social environments; they are necessary for mental health and wellness. But chronic illness and pain does affect our friendships. This isn’t just my opinion and lived experience; it’s a proven research topic. In fact, the outcome of this research shows that immediate and extended family tend to step in and bridge the gap as friendships fall away due to extended chronic illness and pain. People with chronic illness simply cannot physically do the things their friends want to do to connect, such as go out and socialise but also don’t have the ‘spoons’ (spoon theory is a metaphor for energy you have to give in a day) to give to a friendship.

If you step back and think about it… if you are in discomfort and pain 24/7, you may not be as good a friend as someone may think they deserve. Unfortunately thanks to our illnesses we are going to cancel on our friends, forget things (thanks to brain fog) and not want to make ourselves vulnerable to the things I am about to list below.

Losing friendships throughout your lifetime is a natural. It happens for so many different reasons. Moving, change of circumstances, maturing, trauma, and just because we change. That’s ok. It’s life. But it hurts. And as people with chronic illness and pain one of the things to be aware of is that our friends and family can hurt us because friendships and relationships are one of the things that are affected by our health and illness. Especially illnesses that are chronic because we don’t get better and that is something the people around us struggle to understand. 

If we think about friends of people with chronic illness many psychological issues come into play. Sadly, one has to be realistic to understand the dynamics as these help our communications and explanations. In this way understanding the psychology at play can protect us. If we can explain what’s going on and have open and honest dialogue with our friends and family that can foster good relationships because they understand more about our condition. It can be ‘boring’ to only hear about ailments. A close friend said to me, during a spat, a year into my symptoms… “All I hear about is your headache.” That was 13 years ago… she is still my friend. (To be clear she’s wasn’t wrong…I’m also bored with my Trigeminal Neuralgia, I’m not going to lie! It is boring! It’s 13 times more boring now! I hope this friend now understands more about my condition through me explaining more. Now that we know what it is I hope so at least.)

The Just World Hypothesis – friends will naturally assume that you must be doing something wrong to cause your symptoms. This is a common thought trap or type of cognitive distortion. Its hard to believe that bad things happen. That we just get sick for absolutely NO REASON. In my case a vein decided to grow around a nerve in my brain. What? Why? Just because… nonsense there must be a reason.

This is human nature and needs to be discussed openly and honestly. It is a cognitive mechanism that is psychologically protective – you see if the patient is doing something wrong then they are safe from the same fate – I will be talking more about this is in future blog posts and Instagram posts.
The typical example is how often we as chronic pain sufferers get asked if it’s all in our heads. With trigeminal neuralgia I can honestly answer “yes it’s a demyelinated nerve caused by a vein crushing it” it is in my brain so “yes, it is my head… its in my skull!”. It is actually physical not psychological. The amount of times I have had to explain this is actually probably embarrassing but it has to be done. 

A common one that I get asked as a psychologist is if chronic illness is caused by Psychological Trauma.  If there is no physical cause and the illness is UNEXPLAINED there is merit to this but not if there is a named diagnosis. For instance, in my case, I have Trigeminal Neuralgia caused by a vein (I am unusual as its usually an artery). Psychological trauma cannot grow a vein and strangle a nerve. There is a physical cause. And sadly, the greatest psychological trauma of my life was having pain from Trigeminal Neuralgia that no pain killer relieved. 

In terms of evolutional psychology, the research suggests that society does ostracise the weak and sick (pack mentality) and this we see in the news often with the abuse of the elderly and disabled. The worth of those not seen as able is everywhere. Its nasty but humankind sadly does unconsciously view the unwell as a burden.

The unconscious belief that the chronically ill and in pain are somehow doing this for attention seeking is another irrational and illogical belief. People distance themselves from the chronically ill (that they view as attention seeking and therefore they withhold their attention) and hold onto this myth without thought. The chronically ill and in pain are one of the most isolated groups in society so again the lack of logic is astounding. It is ableism really and again a complicated topic. I believe everyone as an amount of  inherent ableism within them until they are LESS able, then things change QUICKLY.

And this is the crux. No one, unless they live with the daily pain and discomfort of chronic disease, will understand this. To find the few friends that do stay with you, that understand and can step out of the typical illogical thought traps is to find gold. An exercise we psychologists will often do with clients and one I do with all clients, no only my chronically ill clients is to look at those friends who are there for you, and chose to invest in those, and disinvest in those who aren’t there for you. Those who want to be in your life… are in your life.  Grieve and let go of the ones who you have outgrown. Because this pain and illness has given you that gift of insight to show the ones who have fallen prey to the short sighted cognitive thought traps above and that is a gift indeed. 

Views of Chronic Illness and Pain Warriors from My Instagram page @kim_traicos
• ‘I lost some of my best friends, because talking about my pain was being negative.’
• ‘Not being able to drink and party while being in your 20s was considered boring.’
• ‘I isolated myself because I didn’t feel safe enough to be honest and felt like a burden.’
• ‘I’ve become more isolated. I don’t want to burden others with my issues.’
• ‘People assume because I don’t talk about it that it doesn’t exist anymore.’
• ‘People are ok with acute issues but chronic ones get old very quickly.’

References

Almeida, Ines. Social responses to pain behaviours: the role of friendship on the adaption to chronic pain. 2020 University of Lisbon.

Bernandes, Sonia and Almeda, Ines. ‘Friend or Foe? A Thematic Analysis of Adult Friendships and Chronic Pain Adjustment.’ Pain Management Nursing 24 (2)

Forgeron, Paula Anne. My friend’s don’t really understand me. Examining close friendships of adolescents with chronic pain. 2022 Dalhousie University.

https://www.psychologytoday.com/gb/blog/chronically-me/202305/chronic-illness-and-friendship

Friendship for those living with chronic illnesses