Love is love - familial, romantic, fleeting or friendship. And love can be a bugger.

Across ten years of listening to clients, I've heard many speak at length about their friendships. One of the first things I ask suicidal clients is "are there are any friends in your orbit?". This is because friendships are pivotal to our sense of community and belonging in the world. Put another way, 'friendship is vital to human wellbeing because this form of human love gets under our skin quite as much as any other' Vernon, 2012 .

Mark Vernon, author of The Philosophy of Friendship, writes that 'the causes of social ills - from homelessness, to divorce and obesity - are variously cited as poverty, mobility or unhappiness. But new research from Gallup suggests something else is going wrong: friendship. It seems modern society has overlooked the importance of the relationship that Aristotle noted is 'more desirable in life than any other good thing' 2006 .

Exactly how important is friendship?

In his book, Vital Friends: The People You Can't Afford to Live Without, Gallup Director Tom Rath shares some hard facts: if your best friend eats healthily, you are five times more likely to have a healthy diet yourself. People say friendship is over five times as important as physical intimacy in marriage. Individuals with no real friends at work have only a one in 12 chance of feeling engaged in their job Rath, cited in Vernon 2006 .

Research published in the Sociological Review distinguishes between 'simple' and 'complex' friendships. The former is what we might think of as fun alliances that we don't expect to last. The latter, however, are a different ballgame. The study concludes that the ending of complex - or meaningful - friendships can be as painful as the breakdown of a romantic relationship.

For example, between the ages of 30 to 40 Mahdawi 2019 writes, is a 'natural time for friendship dynamics to change: people start focusing on advancing their careers and building families rather than socialising with pals.' This is a form of loss, plain and simple - or as may be the case, plain and complicated.

Institutional bias and societal norms

Mahdawi goes on to highlight that 'our culture is based around celebrating romantic and familial milestones: engagements, weddings, christenings. We are not taught to venerate or celebrate friendship in the same way we are romantic relationships. We are not taught that friendships can be just as complex, if not more so, than romantic couplings'.

The fact that there is no 'institutional life course' for friendships is underscored by Vernon 2012 . For example, in romantic relationships these may include moving in, children and possibly marriage/divorce. These institutions then form part of the support structures when there is difficulty. I would add that they give a language to communicate experiences and to be understood; both vital for mental health.

We are also in the cool and constraining grip of social norms. It doesn't seem to be the norm for friends - certainly in the UK - to have a session or three together. Is there fear of judgement? Or, not being in the mainstream orbit, does it not occur to friends that are floundering to hit up a therapist? Perhaps sidling up to your mate and saying, "how about it?" is way too vulnerable-making itself.

The fact that friends rarely arrive at my door together is a missed opportunity. Practically speaking, the task of working on relationships with only one party in the room is often bloody hard; and counter intuitive.

Furthermore, if we - and society in general - don't fully recognise the potential gravity of relationships between friends then we are missing a trick in unlocking better mental health for society at large.

A counter to cultural and societal constraints: phenomenology

During my training to become a therapist I learnt about phenomenology. I learnt that one of the best ways that I could support another is by letting them tell me the meaning of an experience for them. I aim to be aware of and bracket my own expectations or assumptions - sometimes affected by cultural/societal norms - so I am able to hear the entirety of another's experience, including of friendships.

There's no knocking Nietzsche: finding some peace in it all

Finally - in the meantime - if your love for a close pal has become tenuous, or lost altogether, perhaps the following from Nietzsche will soften the way. He talked about 'star friendships': serenity in being able to bow to the blinding beauty of what a friendship has been - a star friendship. And, about embracing present distance between two such souls as being part of the universe's natural order. He writes: 'We were friends and have become estranged. But this was right, and we do not want to conceal and obscure it from ourselves as if we had reason to feel ashamed. We are two ships each of which has its goal and course ... Our exposure to different seas and suns has changed us! That we have to become estranged is the law above us.'

Rakhi Chand is a verified welldoing.org therapist in E11, London