why friendships fall apart after illness or injury - a woman with arm outreached short of the hand reaching down to her

It is terrifyingly easy to become socially isolated after a serious injury or illness.  It doesn’t happen to all people, as there are a lot of variables. The quality of the friends that you have before your trauma is one of those important details that will affect your friendships post-injury.  Friendships and social interaction are vital for everyone’s mental health, so maintaining connections with others is a very important part of your healing process. Having a chronic or severe illness or injury is pretty much guaranteed to break up most of the patterns and cycles in your life, including disrupting those patterns with friends.  These disruptions have the potential to ruin friendships, redefine relationships, and lead to you feeling isolated and alone.  They also can be used to shake up your relationships, potentially increasing how connected you feel with some friends, and showing you how important you and your friendship is to others.  Your actions and decisions, and those of your friends will determine how your life is affected.  Let’s try to keep those changes as positive as possible, okay?

How my friendships were impacted by my FND diagnosis

I had my first FND symptoms while I was in college. My friends there mostly supported me, helped me get to a neurologist and get treatment.  There was no real diagnosis(a vague ‘ its stress, take these pills, they might help’ was all I was told).  I was also in a very anxious headspace and leaned on my friends at school for support.  

The symptoms decreased dramatically in a few weeks, and within a month or so, seemed completely gone.  My friendships mostly continued undamaged.  I went for several years with minimal if any symptoms.  If they did happen, I told my friends that it was apparently an anxiety thing and reassured them the best I could.  

Many of my friends are and were aware of mental health concerns and many had dealt with mental health issues themselves, and so were quite understanding.  When my urgency symptoms(the primary FND/conversion symptoms I had after I lost my fishery observer job) occurred, I was living in New Jersey and had a very small group of close friends. 

Most of my friend group from when I was in high school had gone away to college, and several of them did not return to New Jersey after graduating. As I had studied in the Midwest, none of my friends from college ended up living near me after graduation.  

I was starting from a pretty small pool of friends – one of whom was my roommate, and another of whom was my boyfriend – and a third friend, an ex, who was also best friends with the current boyfriend. I had one or two additional friends who were unconnected to that circle of friends, who I had hardly communicated with since I had left for college six years earlier.

And that was it, that was my little circle of people I already knew and could see regularly.  

Winnowing my friend pool down before my FND symptoms – the effects of being neurodivergent

Thinking back, I have been neurodivergent for most of my life.  I was diagnosed with a fine motor disability before I started school, depression when I was 9, and lived through some sudden and severe losses at young ages.  

I did not have a lot of friends in school, but the ones I did have were empathetic and loyal and supportive. In that way, I was lucky, because I already had a very open and trusting relationship with the small group of friends I had.  

Besides having known one another for years(I was in sixth grade when I first made some of these friends), they had known me through a few depressive episodes, a brief period of self-cutting, my uncle’s suicide, and our choir director’s death from a heart attack. 

Two of the three friends who remained in New Jersey had lost a parent since I’d met them.  We had all been through emotional trauma and grief, and I had been supportive of them through their processes and they had been supportive of me through mine.

These were friendships that had already been tested and had made the cut. I would not wish these experiences on anybody, and I hope your history has not been as challenging as mine.

Social Signatures: human limitations in friendship, and how that is affected by a disabling condition

 A recent study indicates that each person has their own ‘social signature’.  The social signature is simply an indicator of the number of close relationships a person has, as compared to their list of social acquaintances.  

The practically universal trait is that all the people in the study(and presumably most, if not all, people) have more social acquaintances than close friends.  The interesting part is that each person in the study had a consistent number of ‘close friends’ who they communicated with regularly and intensely.

Who those friends were changed over time – with some dropping out of the picture(losing the friendship), and some shifting to a more distant relationship(becoming social acquaintances), but each person consistently had the same number of close friends.

After a severe trauma, it seems like emotional energy just slips away

Later in the article, he speaks about the three constraints on each person’s social signature, and how consistent each person’s social signature is.

  1. Time – no matter what, there are only 24 hours in the day, and there is a limit to how much of that time we have to focus on our friends, as opposed to working, sleeping, and so on.
  2. Emotional capital/energy – creating and maintaining friendships takes emotional energy.  We only have so much emotional energy to invest in our friendships – and changing that amount of emotional energy would require a large change in lifestyle if it is even possible
  3. Cognitive/mental capacity – our brains don’t have the capability to handle an infinite number of social connections – so at some point, we just aren’t capable of adding more friends. 

In our cases a big physical or emotional trauma(such as a severe injury or a chronic condition getting worse) is going to take a lot of emotional energy to process through, leaving less energy available for growing or maintaining friendships.  

Also, these traumas are going to abruptly disrupt most of the patterns and schedules in your life, which means your time availability will change – and the old patterns you and your friends were used to also get disrupted(you can’t exactly meet up after work if you aren’t able to go to work!).  

While it’s possible that you will end up with more time available, it’s less likely to be the same times as your friends’.  With lowered emotional energy, extra time being devoted to resting and healing, and many of your life patterns interrupted, it’s very difficult to maintain your social signature.

Why my condition had minimal impact on my friend pool

In my case, I had already been through a few transitions that reduced my ‘close friend’ connections.  

By moving back to New Jersey, I was physically separated from my college friends(who had mostly filled those ‘close friend’ slots while I was there). I was able to stay connected with them through email and later Facebook, but it was more challenging to have that close consistent relationship. 

I had traveled between college and working, so all of my friends were used to me being less accessible.  The job I had taken right before moving in with my roommate was going to involve a lot of travel, and so we were both expecting me to only be around on occasion, and instead, I was at home all of the time. 

So I was already a bit off-balance, friendship wise before my symptoms kicked in, and then when they did, I did not have the emotional energy to think about creating new friendships.  

I spent about 6 months trying to get diagnosed. My close friends stayed close, though I did not have the energy to think about making new or additional friends.  I do think it helped that my roommate and I were the only ones in our groups of friends who weren’t living with our parents, so our place was the obvious location for any get-together.

The other thing that I did that I think really helped was that I was willing to talk to them about what was happening and why I was behaving as I was or saying what I was.

For example, I let them know that I was feeling this need to pee all the time and that it was frustrating for me, and I was sure it also frustrated them.  I made sure to go to the bathroom right before we’d sit down to watch a movie, and if it was a larger group of friends, I’d just go when I needed to.

When I was hanging out with a friend, we’d usually pause the movie when needed.  I also did my best to make sure I asked my friends how they were doing and what was happening in their lives, so they knew that I cared and worked hard to not make my health stuff the center of our conversations.

It would center some of my one-on-one conversations, but I tried to stay focused in group conversations on enjoying my friends and being part of the discussion. It also helped that they were very considerate of my needs, so we were all pretty satisfied to do a lot of things in our apartment, or if we went out to go somewhere with an easily accessible bathroom and any other supports I could express my need for.

Because those lines of communication were so open, it was easier after my conversion disorder diagnosis to discuss what else was happening, and my additional needs.

Al’s accident: managing a sudden and severe injury

My partner Al went through a very different process when he broke his hip.  He has always been introverted and has a group of friends that have been with him for much of his life to one degree or another.  

Most of his conversations were over his gaming systems, and many of our social outings were planned group activities, such as birthdays or celebrating holidays with friends.  When he broke his hip, he posted about it on facebook, and his friends gave him words of support and empathy, and several friends came to visit him/us at the hospital.

He was in the hospital for nearly 2 weeks(his surgery was seven days after his injury, and then he needed a few extra days in the hospital to recuperate).  One or two friends went above and beyond and helped Al’s parents and me to rearrange the apartment, buy a new bed and other things that went with suddenly going from living on the second floor of a two-floor apartment and working full time to being borderline bedbound for 10 weeks to allow the bones to heal.  He also had several friends visit him in the hospital, some multiple times. 

After we got home, a few friends came by and checked in, but relatively quickly we were pretty much dependant on my family and his to help us through our transportation, food, and other needs.

In our case, we did have our families close by to help, and we didn’t make many requests of our friends.  Al was able to have conversations through his gaming system and stay in touch as much as he had previously – in a lot of ways things didn’t change much for his friends.

Once Al felt a bit better, we would occasionally make plans with friends – all going out for dinner, or people coming by our place to hang out.  I handled a lot of the necessary allowances, but in many cases, once Al told them about his limitations, they made sure to accommodate him.

Mainly it was things like he couldn’t sit or stand for long periods of time, so if we ate out, we needed to bring a pillow for him to sit on, try to find a restaurant that didn’t have a long wait, and at first he needed to sit in a taller-than-average chair.  

We spent time with fewer people since that made it easier to plan things. Al also would decide that certain things were just worth whatever pain he would experience, and so we’d plan for those events, trying to leave a time window before and after for him to rest.

How things are now – good friends knowing about our chronic conditions

Al and I celebrating that both our axes had made the board the same throw! Yes, I did hit the bullseye other times!

Al’s best friend celebrated his birthday last weekend and rented a space to celebrate at Stumpys, an ax-throwing venue.  We were renting the space for two hours and would have access to axes, throwing space, and targets. 

We knew that for two hours he’d be trying something he hadn’t done before.  We knew that it required balance and energy.  Despite needing a cane, his balance is now pretty decent again, and we agreed that it sounded fun and worth the risks! 

It went great, though he was hurting for a few days afterward from making unaccustomed motions and balancing differently from usual.

I must admit that I had a few sore arm and shoulder muscles myself and that my symptoms did kick up a bit while we were out.

Fortunately, our group of friends was understanding and value our friendship and company over whether or not I shake or rock a bit between throws, and over the fact that Al will likely be using his cane the rest of his life, and is living with chronic pain.  

We didn’t make a big deal over our symptoms, so nobody else did. They knew what had happened, when and how, and that he and I are now working on finding the cause for the osteoporosis – the reason why a relatively simple fall caused such a severe break.

I know that Al and I are pretty lucky in all this – even though my group of friends was relatively small, they were considerate and caring people who were aware of and empathetic to my needs.  In Al’s case, several of his(many of them now our) friends came out to support him right after he was injured and our friends were happy to include him in their plans as he was able to join back in, with no guilt or blame about his absence for months.

We are both grateful to have friends with this degree of understanding.  Friends like that can be hard to find sometimes.  

Conclusion: why friendships fall apart after severe illness or injury

Friendships are always a mutual decision, where both or all people involved have actively decided that they care about one another and want to both provide and receive help from one another.  

Each person only has the mental, emotional and structural capacity to have so many friends, and injury or illness is likely to reduce your mental and emotional capacity to focus on your friends and maintain those friendships.  In some cases that damage is long-term or permanent(with most chronic conditions, things can improve or worsen, but you might never return to that full capacity you might have had before your condition began), while in other cases that damage might be more temporary(a serious but short-term illness with minimal remaining effects might only put your out of commission for a few days or weeks.  A break, fracture or other injuries may be debilitating at first, but you recover over time, allowing your energy levels to bounce back).  

Either way, the patterns you have developed with your friends will be disrupted, and you will either make decisions that help your friendships survive your injury, or make decisions that don’t help keep your friendships alive.

The first decision will help you keep as many of your deeper friendships going as possible, and the other increases your risk of losing more friends and friendships. Usually, this is not a single choice, but a whole collection and range of decisions.

The power to nurture your relationships is inside of you, and I hope that you are able to harness your energy to help you maintain and nurture the important relationships in your life!

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