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I have a very good friend who lives 200 miles away, so we don’t get together as often as we would like. I am particularly conscious of that now, as her husband has Parkinson’s disease, which has advanced rather quickly, imposing the marked and miserable symptoms of shaking, impaired balance, slowed-down movement, and problems with memory.

Their previously fun social life—they were one of several local couples who used to meet up regularly for meals and even often went on holidays together—has dwindled to a halt, and my friend has found herself in a virtually full-time caring role, including much ferrying to and fro for hospital appointments.

Not a natural carer, the transition was challenging for her, but what has hit hardest is the failure of her local friends to rally around. Although all are within walking distance or a short car drive from each other, only one now ever pops in or calls.

“You really find out who your friends are when something like this happens,” she said grimly.

Her words came instantly into my mind when Rosalie, a new client, said almost exactly the same thing. Her husband has an ominous degree of memory loss and she is extremely fearful about their future, her overwhelming anxiety tipping her into depression.

“No one wants to be around you when you aren’t fun anymore,” she said. “They are nervous about how to react to either of us.”

Happily, this was partly depressive all-or-nothing speak—they are still lively people and still have two or three friends who have remained strongly supportive—but it is probably true that others struggled to know how to be with them, and gave up.

There may be a few reasons for this. I have written before about several people who had suffered personal tragedies. What had most helped them to cope and what had been most hurtful? What hurt was the good friends or neighbours who stopped calling or phoning or actually crossed the street to avoid them.

No doubt those people were embarrassed, rather than deliberately cruel, and just didn’t know what they could do or say that would be helpful. But the end result, experienced as rejection, was extremely painful for the sufferers in question.

In such situations, we can be too preoccupied with the significance of our role in the situation. I recall research showing that people who are reluctant to reach out to someone in need tend to focus on how competent the support they are offering seems (considering it not competent enough), whereas receivers are more focused on the warmth it conveys.

“Our experiments suggest that undervaluing the positive impact of expressing support could create a psychological barrier to expressing it more often — and could leave both recipients and expressers of support less happy than they could be,” the researchers concluded.¹

We may even be fearful of embarrassing the other person, as other research, published a few years earlier in the same journal, found out. These researchers recruited participants to write an email expressing gratitude to someone who had touched their life in a meaningful way, explaining in it why they were grateful, what the person had done, and how it had affected them. After sending their emails, the participants completed a questionnaire reporting on their own experience of writing them and predicting their recipients’ responses.

Interestingly, it appeared that writing the letters was overall a positive experience, which lifted the writer’s own mood. But the writers significantly underestimated how pleasantly surprised recipients were to receive the emails and read the contents, and very much overestimated how embarrassed the recipients would feel about doing so.

The researchers concluded that such false expectations could be a barrier to expressing genuinely felt gratitude.² Unscientific though my extrapolation may be, it seems highly likely to me that false expectations of people’s embarrassment about their circumstances (such as having a husband with Parkinson’s or cognitive impairment or sinking into deep depression) might well be what stops good friends or neighbours from staying in touch when their concern is needed most.

And probably, like the participants in the study, they underestimate how good they themselves may feel after reaching out.

As we teach, using language to convey empathy is so important. Sometimes leaving a dish of food at the door is the too-easy option. What people in difficult circumstances need to know is that they still matter to us, even if we can’t do much to change things. And, when that is recognised, it is so much easier to enjoy staying friends.