The quality of your friendships could be affecting your wellness

How are you when it comes to friendship? Is there someone with whom you share your life’s joys and disappointments? Can you count on this person to always be loyally by your side, or only in fair weather emotionally? Is your relationship one of unconditional trust, or do each of you often withhold facts and feelings from the other? Such questions are not only intriguing to ponder – but according to mounting evidence from psychology and medicine – their answer holds a key to our wellness, vitality, and longevity.

Though behavioral medicine is reaffirming the link between close social relationships and wellness, Aristotle addressed this topic millennia ago in his major work on ethical conduct and character virtues, Nicomachean Ethics. In a highly influential formulation, Aristotle distinguished among three types of friendship: those based on utility, pleasure, and virtue. Those comprising utility were essentially business relations, based on mutual tangible benefits, such as money or power. Friendships based on pleasure were predicated on fun interests, such as attending sporting events or concerts together. For Aristotle, virtuous friendship was the highest of the three types of friendship. It involved emotional concern and compassionate care. In his view, friendship based on virtue has the greatest impact on human wellbeing in everyday life.       

In the Middle Ages, Aristotle’s outlook was extended by the influential rabbinic scholar-physician Moses Maimonides. For instance, in his Guide for the Perplexed, Maimonides asserted, “It is well known that one requires friends all his lifetime. When one is in good health and prosperous, he enjoys the company of his friends. In times of trouble, he is in need of them. In old age, when his body is weak, he is assisted by them.” 

Though Maimonides was esteemed as a healer, no medical specialties existed in his day. It wasn’t until the late 19th century that scientific personality study began with the work of investigators like Sigmund Freud. Curiously, though Freud was a prolific writer, he had virtually nothing to say about the role of friendship as a positive force for men and women. Also, in his sweeping theory of neurosis, he didn’t explain how the ability to make friends is either acquired or impaired during childhood.

Though Freud ignored the topic of friendship, his colleague Alfred Adler had much to say. After witnessing the horrors of human aggression while serving as an Austrian Army physician during World War I, Adler developed his influential concept of social feeling. He argued that humans have an inborn capacity for caring and love, but that this capacity is weak unless strengthened during childhood by family members, teachers, and other school professionals.

Adler achieved international renown for his writings on how to nurture social feeling in children and adolescents. In teaching personality diagnosis, he emphasized that the presence of friends is an important indicator of a child’s emotional wellbeing. Arguing mainly from clinical experience rather than research data, Adler warned that friendless youngsters were at high risk for mental health problems, and that professional intervention was necessary to teach them social skills. In some ways, the new specialty known as positive psychology can be traced back to Adler’s seminal work in fostering social feeling through family therapy and school guidance.

Friendship and behavioral medicine

Since the advent of behavioral medicine in the 1970s, investigators have closely studied what is known as social support. From the inception of this field, researchers have differentiated instrumental from emotional support. Instrumental support involves tangibles such as money, food, cooking or housecleaning, while emotional support relates to intangibles such as empathy and advice. Increasingly, research has come to focus on one specific aspect of social support: the confidant relationship. The select individual(s) whom a person trusts in sharing important personal matters is sometimes referred to as a confidant. As Dr Julianne Holt-Lunstad of Brigham-Young University and colleagues observed in their review of cardiovascular disease and psychosocial factors, “There is reason to believe that certain relationships may be more important than others (and that) perceptions of closeness within a specific relationship may be a particularly important… factor contributing to our understanding.”  

Over the past 30 years, behavioral research has verified a measurable link between the presence of a confidant and individual wellness. The range of studies has been wide: from drug abuse and depression among American teenagers, to preventive healthcare among young Mexican men. Such studies consistently indicate that people who report not having a trusted friend engage in virtually all forms of risky and self-destructive behavior. Research has also demonstrated that people who report a confidant have better overall health and are less likely to suffer from a variety of chronic medical problems, such as cardiovascular impairment, hypertension, and asthma. They also show greater psychological resiliency and less vulnerability to depression. In an investigation of obesity and functional health conducted in Britain, Dr. Paul Surtees and colleagues estimated that the presence of a confidant added five years to women’s life-expectancy and four years to men’s.

Specifically, how does having a confidant exert such an enormous influence on our wellness? Researchers are still a long way from precisely answering this question, but most believe that it involves both direct and indirect effects. In a direct way, the presence of a close friend enables us to receive both empathy and guidance from someone who is familiar with our personality quirks, yet cares about our happiness. Having a confidant thereby enables us to make more effective decisions in domains such as work and family – and thus reduces our vulnerability to the stressors of daily life. Indirectly, the ability to share personal feelings with a trusted individual makes us less likely to engage in unhealthy behaviors generated by anxiety, such as smoking, over-eating, substance abuse, and a sedentary lifestyle. In this regard, the presence of a confidant “buffers” us from our own tendencies to seek out unhealthy avenues for relief from inner turmoil. In today’s increasingly fast-paced society, stress is unlikely to disappear soon, so having a trusted friend becomes ever more important for our daily wellbeing.

6 tips for sustaining a confidant relationship

1. Be authentic and communicate clearly. No matter how likeable you are, nobody can be empathic and helpful if you’re vague about your feelings. “I’m depressed about my job” is much clearer to your confidant than “Something is bothering me lately.”
2. Avoid narcissism. Be sure to reciprocate a true exchange of feelings. In other words, be a good listener and not just a good talker. Show genuine interest in your confidant’s own life events.
3. Prevent “caregiving fatigue” in your confidant. Be selective about what you unburden – and especially how often. Constantly complaining about your smallest emotional hurt is unproductive.
4. Express gratitude, for no one likes to feel used or exploited by others. By definition, a confidant isn’t your hired therapist or physician. Thankfulness can be demonstrated in many ways; find the most relevant for you.
5. Elicit direct feedback from time to time. Don’t be afraid to ask your confidant whether you seem to be learning from mistakes and heeding advice – or are just going around in circles. Be willing to act on what you hear.

Every relationship needs balance, so sure to share your life’s joys as well as sorrows. Laughter and levity buoy somberness and seriousness. Schedule some fun activities together; both you and your confidant will be re-vitalized.

Dr Edward Hoffman is an adjunct associate psychology professor at Yeshiva University in New York City. A licensed clinical psychologist in private practice, he is the author/editor of more than 25 books in psychology and related fields. Dr. Hoffman is the recent co-author with Dr. William Compton of Positive Psychology: The Science of Happiness and Flourishing, and serves on the editorial boards of the Indian Journal of Positive Psychology and the Journal of Humanistic Psychology. You can write to him at columns@whiteswanfoundation.org