The problem always becomes one of Doubt.
I lose the sense of my role in the lives of my friends. Lose the sense that my job has some Purpose, or a Future. The horizon begins to look bleak and unprofitable and I lose my Way. I slow and slow until my ability to process with optimism grinds to a halt, and I'm left alone. Alone, in a wide flat landscape of isolation, vast distances between my self and the people I love. Do they love me? How much should it matter to them, what I think, or say, or feel? How much expectation is fair?
Doubt, and Shame.
How can I be so selfish when damned near everyone I know is struggling with considerable personal challenges right now? What can I possibly expect from people? What could the ones I love possibly do to convince me that I am needed, valued, desirable? Why do I need convincing? Why can't I get over it? How old AM I ANYWAY?
Flailing away in the hope that you will simply keep afloat, until someone comes and pulls you out of the ocean.