What is the importance of friendship and mental health in pandemics?

Jun 30, 2023

In the last three years, there has been a significant rise in impaired mental health. Many have asked whether this rise is due to the COVID-19 infection itself or if it is a consequence of how officials managed the pandemic.

A close colleague of mine, together running NHS and academic departments without a cross word for fifty years, had suffered from mild dementia and COVID in a care home and, as a result, was isolated from seeing his family and friends for over a year, except through a window.

This was during the same period that I was a trustee of Actasia, working to prevent the cruelty and caging of wild animals. It is clear from conducting this work, that such cruelty impairs immunity and resistance and thus increases susceptibility to infection.

It should be taken into account when generating good policies to prevent mental illness. In preparation for future pandemics. I make a case for friendship as a therapeutic power for Mental Health and for enhancing immunity(1). The French Covid -19 Scientific Council have led the view that it should be a One Health approach embracing humans, animals and the environment, and I believe friendship can be applied to all three, as it was by St Francis of Assisi.

Professor Dunbar of Oxford's Experimental Psychology Department wrote three years ago that the single most important therapy for wellbeing, health and happiness is friendship(2). The balance between Science and Humanity can be reinterpreted as Care technology versus Care Attitude. Friendship has been argued to have the greatest therapeutic power for managing almost everything – it is a modern version of ‘love one's neighbour as oneself’ of Confucius and Jesus Christ.

This view is a consequence of my 50 years of experience managing leprosy, a disease famously managed by social distancing, and as a consequence of reading the works of the Father of Modern Medicine, Sir William Osler, whose therapeutic power was attributed to friendship by a then Minister of Health. Osler called for a friendly approach to treatment and campaigned for every health professional to be a knowledgeable scientist but always humane(3).

Dictionaries, encyclopaedias, and numerous sources underestimate friendship. Even the Wikipedia entry is lightweight compared to the many sources one can find in the personal library of Sir William Osler at Green Templeton College Oxford.

"Friendship is a relationship of mutual affection between people. It is a stronger form of interpersonal bond than an "acquaintance" or an "association", such as a classmate, neighbour, co-worker, or colleague.

In some cultures, the concept of friendship is restricted to a small number of very deep relationships; in others, such as the U.S. and Canada, a person could have many friends and perhaps a more intense relationship with one or two people who may be called good friends or best friends or other colloquial terms include besties or Best Friends Forever (BFFs). Although there are many forms of friendship, some of which may vary from place to place, certain characteristics are present in many such bonds. Such features include choosing to be with one another, enjoying time spent together, and engaging in a positive and supportive role to one another."

Friendship can take up any amount of our care attitude's emotions, sympathy, empathy, compassion, kindness, maintaining dignity, bringing cheer and joy and showing tenderness.

It is important for some sections of society, such as the armed forces or sports, to include camaraderie and esprit de corps as a balance for fierce instruction. Contemporary UK TV viewers will have seen how it underlies the discipline that took soldiers ‘over the top’ to their death in the battle of the Somme, in 1917.

In recent history, camaraderie allowed more than two thousand males and females to tolerate, with good humour, the confinement for nine months in the aircraft carrier Queen Elizabeth. They met danger with skill and alertness and great control over the sexual consequences of togetherness. They too had the experience of isolation because of an epidemic on board but managed to maintain esprit de corps.

Of relevance to how friendship was enhanced was the storytelling and acting out of the whole of the uncomfortable meeting with Neptune and his team, being hundreds of seniors battling against some 1600 young recruits as they crossed the equator! The latter had their chance to beat up the seniors in their mess while the usual respect for authority was briefly lifted but instantly restored once the game was over.

Storytelling in children's education, including play, pets, and toys, was part of Sir William Osler's therapeutic power. Aboriginals in Australia would include the influence of trees, ponds, and rocks.

Anyone familiar with those saving lives at sea will observe that lifeboat crews have great technological skills. However, it is friendship that steers them through dangers and deaths, after which they are still able to carry out the next call to sea with undiminished effectiveness.

The Welsh miners of the 19th century frequented the large chapels and choirs, which were almost the only power-generating esprit der corps to keep them churning out massive amounts of coal and steel.

It was singing that featured in the ‘Military wives choirs’ showing that family members left behind had an experience through friendship when weekly zooming their husbands reinforcing their good spirits.

Bertrand Russell noted even in 1931, "The new powers that Science has given to Man can only be wielded safely by those who, whether through a study of history or their experience of life, have acquired more reverence for human feelings and some tenderness towards the emotions that give colour to the daily existence of men and women(5)".

Today it is the new knowledge of how the forebrain and limbic region of the brain uses emotions to control our hormonal and nervous system's embrace of our bodies to enhance immunity and mental health in the context of One Health that makes one confident to recommend friendship as a key to how social distancing and masking is used in future pandemics.

For the control of a pandemic it is necessary to know the science underlying it as well as to embrace in a friendly way both individuals and communities with their beliefs and feelings, both traditional and recently acquired. Such an approach plays a great part too in the management of Neglected Tropical Diseases like leprosy in remote resource-poor regions. WHO will know that effective governance of all political parties in all countries requires that supporting the power of science must be embraced by a caring attitude of which friendship is the most therapeutic of all remedies to counter isolation and failure to bring people together in agreement.