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A friend's illness can sometimes provoke unconscious and irrational responses.

Someone might be so upset by a friend's illness they withdraw from the relationship or behave unhelpfully.

Examining how you handle your own illnesses can bring awareness to your feelings about a friend's.

When a friend falls ill, avoid reactivity by letting them guide your response.

I’m at a stage of life when friends fall ill as a matter of course. That didn’t used to happen. People I knew ended up in the hospital, yes, certainly during the AIDS epidemic, which called upon friends to respond personally and politically. Otherwise, hospitalizations were rare events, like when my then 40-year-old husband’s appendix burst at an economics conference in a Russian backwater. Now, illness is a routine part of my friendship network’s weekly news: Who got diagnosed with what? Who’s confronting some chronic condition? Who’s bereft? Sickness has become so integrated into our social lives that my peers and I are getting a crash course in who we are when friends fall ill. The answer seems to be surprisingly complicated.

Illness is emotionally demanding. It just is — for some people more than others. Where one person can take it in their stride, others react strongly, sometimes irrationally. That’s true, too, when we ourselves get sick. But at least then our behavior doesn’t necessarily affect other people we love who can be feeling very vulnerable. Even among those who can respond comfortably to a friend’s infirmity, caregiving styles can vary enormously, from sending flowers to making soup, or from taking a friend for treatment to inviting them to recuperate on a hospital bed in your living room. Two of my friends did this for a third friend, taking her into their 3 room/one bath apartment. They’re the lucky ones who are at ease with illness. But I’ve noticed that other people are not, which sometimes includes myself.

In my experience, most everyone expects to respond with love and care, but when the time comes, some withdraw from a friendship entirely, or, without realizing it, act out their discomfort in ways that burden rather than help the patient. This is where the psychological component comes in, and where the difference between responding and reacting to illness is important.

Responding is a conscious and emotionally regulated opening of the heart to another’s tribulations. Reacting, on the other hand, happens when a friend’s illness provokes an unconscious and often disproportionate emotion. It may be that seeing a friend helpless or frightened is too upsetting. It may be that a person’s own grief, anger, or fear about their friend’s illness feels overwhelming. Maybe they just can’t face losing that friend, or they can’t face death. Instead, they disappear at a friend’s time of need. At the other end of the reactivity spectrum are friends who try to take control, dispensing unasked-for medical advice, telling the patient to see this doctor, or take that potion. In an effort to reassure themselves that this illness won’t befall them, they may assert that the sick person should have exercised more or taken some supplement, implying that it’s their fault that they fell ill. What’s up with all of this? How does reactivity subvert our loving care for our friends?

Illness seems like a microcosm where we can watch the unconscious at work. It’s not just that we have to cope with the practicalities of our friend being ill, it’s that we get pulled into our unconscious feelings about illness. To bring these feelings into awareness, it’s instructive to look at how we handle being ill ourselves. I tend to get depressed when I’m sick, even if I just have a cold. As my friend Katherine says, it's like I’ve lost my wings. Illness scares me. OK, I’ve had some bad experiences with illness, starting with watching my young father waste away and die. If I’m aware of that, though, I can avoid projecting that depressive view onto my friends. When I'm the one who's sick, I can just struggle privately. But when my friends are sick, I have to respond, not react, and that means understanding their experience of illness, letting them guide me in how to be with them through it. I have to listen carefully. I have to empathize.

When my friend’s husband fell very ill, she didn’t need the practical help or emotional buoying I would have wanted. Taking care of the practicalities is her strength and also what reinforces her strength. Emotionally, she’s sturdy, feeling times of sadness, of course, but without veering into depression, panic, or numbness. As I resisted projecting my own needs on her (or feeling bad because she politely refused my soup), I realized that listening was what she needed. She needed someone she could describe her day to, a witness to what she was going through. Another friend, high in spirit but nearly immobilized by a chronic condition, prefers to enjoy some normalcy with me — sharing a meal, talking about books and movies, her interests and mine, as if nothing cataclysmic had happened in her life. As if we were just us. And for that time we spend together, we are.

With both my friends, we laugh about the crazy reactions that illness has provoked, like someone telling them their cousin had the same diagnosis and was dead two months later. Apparently, there’s a lot of that. Or the friend who says, “I know you’ll be fine. I feel it.” As if that should take care of the matter.

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It is hard when friends fall ill. We want them to be well, to be happy, to be themselves in just the way they were, so that the friendship will be as it was. Change is subversive. Illness is even more so with the suffering, loss, and helplessness that so frequently accompany it. At the very least, we can use our awareness of the psychological angle to “do no harm,” as physicians pledge. Perhaps we can even be among the lucky ones who keep our friends company in that uncharted territory that is illness.

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