So You Have a Chronic Illness And You Feel Like a Terrible Friend...

If you live with chronic illness, chances are you've been there: staring at your phone, typing and deleting the same cancellation text about fifteen times. "Sorry, I can't make it tonight because..." and then what? Because you're in a flare? Because you've used up all your spoons for the week? Because the thought of pretending to be okay for three hours feels impossible right now?

So you settle on something vague like "not feeling great" and hit send, immediately followed by that familiar wave of guilt and shame. I'm such a bad friend. They probably think I'm making excuses. I'm so unreliable.

Sound familiar?

The Story That Plays on Repeat

In my therapy practice, I hear this so often. It usually goes something like this: "I've been a bad friend... I've not been able to meet up with them and I think they'll think I'm such a flaky friend..."

Or maybe it's the version where you were genuinely excited about plans and you'd been looking forward to them all week, only for a flare hits like a freight train the morning of. Suddenly you're not just dealing with pain or fatigue; you're drowning in guilt and shame about cancelling. And somehow your brain makes this massive leap from "I have to cancel tonight" to "I don't deserve friendships at all."

When Withdrawal Feels Safer Than Disappointment

Here's what often happens next: you start withdrawing. Not because you don't want friendships, lord knows chronic illness is lonely enough without that, but because the cycle of hope, cancellation, and guilt becomes too exhausting to bear.

I know this cycle intimately. When my own chronic pain was particularly bad, I fell into that "what's the point" thinking. Asking for accommodations felt like too much work. I felt embarrassed that I couldn't even manage a simple walk, so I'd have to ask to meet for coffee instead, even on gorgeous days when everyone else wanted to be outdoors.

The irony is brutal in that you withdraw to protect yourself from feeling like a bad friend, but then you feel even worse because you're not being a friend at all.

Withdrawing from friends when chronically ill

The Grief No One Talks About

There's a grief in chronic illness that touches every aspect of life, and friendships are no exception. There's real sadness in recognising you're not "that friend" anymore, whether that’s the spontaneous one, the reliable one, or the one who's always up for anything.

In our society, there's this expectation that you should just "get on with it" and adapt. But you can't skip the grief part. You need space to feel sad about the friend you used to be before you can embrace who you are now.

In therapy, I don't offer tools to "fix" this feeling… I offer space to actually experience it. Because you can't heal what you don't allow yourself to feel.

And here's the thing about that grief work: it requires the same curiosity and compassion you'd show a toddler learning to walk. We don't scold a child for only managing two steps before falling, we encourage them to try again. But when it comes to adapting to chronic illness? We're ruthless with ourselves for not figuring it out fast enough.

The Comments That Sting

We can’t forget the stuff people say that makes everything worse. The casual cruelty of "Oh, you're not sick again?" or friends discussing you in third person: "She'll not be able to go."

These comments stick. They reinforce every fear you have about being seen as unreliable or annoying. They turn your genuine health struggles into character flaws in other people's minds.

But here's what I want those friends to know: your chronically ill friend is doing their best. They still love you and want to be in your life, it's just difficult right now. Please, for the love of all that's holy, keep inviting them. They need to know they're still wanted, even if they can't always show up.

And maybe - just maybe - educate yourself about what they're going through. It's not their job to be your chronic illness encyclopedia, but a little effort to understand goes a long way.

The Practical Stuff That Actually Works

When clients ask me about boundaries in friendships, they're usually expecting some complex therapeutic technique. But honestly? It's mostly about honest, open communication.

Instead of apologising profusely and making excuses, try: "Thanks for the invite, that wouldn't work for me but I'd love to [offer alternative]."

When you've been AWOL because health stuff has been consuming your life: "I'm sorry I've not been in touch lately, health things have been a lot, but just want to let you know I'm thinking of you."

Or when you want connection but need it on your terms: "Would you like to come chill and watch a movie? I'm not up to much else but I'd love to see you."

It's about being honest without over-explaining. It's about offering alternatives when you can. It's about maintaining connection in ways that work for your reality.

And yes, this applies to friendships just as much as romantic relationships. Friendships need nurturing, especially as we get older and life gets more complicated.

The Hard Truth You Need to Hear

Here's an honest opinion that might be hard to hear: don't stay in sh*tty friendships just because they're all you have.

Just because you're chronically ill doesn't mean you have to put up with friends who make you feel worse about yourself. You don't owe anyone your friendship just because they occasionally tolerate your health challenges.

But equally (and just as important) chronic illness doesn't give you a free pass to be a sh*t friend either. You still need to show up in whatever way you can, communicate your needs, and put effort into the relationships that matter.

Building Confidence in Who You Are Now

The work isn't about becoming the friend you used to be…that person might be gone, and that's okay to grieve. The work is about building confidence in who you are now, with your current limitations and needs.

It's about recognising that friendship can look different and still be valuable. It's about setting new expectations for yourself that include rest, accommodation, and the occasional cancellation without the crushing guilt.

It's about understanding that the friends worth keeping will adapt alongside you. And the ones who can't? Well, maybe they were never really your people anyway.

The Bottom Line

You deserve friendships that add to your life, not drain your already limited energy. You deserve friends who understand that reliability looks different when you're managing a chronic condition. You deserve space to be authentically yourself, flares, limitations, and all.

Chronic illness is isolating enough without losing valuable friendships to guilt and withdrawal. Your worth as a friend isn't measured by your attendance record or your ability to keep up with abelist social expectations.

You're doing your best with what you've got. That's not just enough...it's everything.

If this has hit home and you’d like some support, please reach out. I’m here to support you when you’re ready.

Kirsty x