ABSTRACT
Amyotrophic lateral sclerosis (ALS) is unique in the combination of possibilities it extends for suffering. It is the classic nightmare in which you want to run and your legs won't move, to speak and you can make no sound. Although with good medical management patients are almost free of physical pain, ALS reactivates earliest fears and angers. Its assaults on the psychological defenses are much like those of advanced aging: powers diminish, dependence increases, life style changes, friends and relatives withdraw, and death comes near. The emotional tasks of aging need to done prematurely, out of context; they are compressed, exaggerated. No other disease presents patients with a view of themselves as dying by increments, assailed by repeated, visible losses of function and by progressive inability to make them understood. Death is no longer a sometime thing. It come, predictably, echoing early childhood fear of separation and abandonment and overlaid with realistic anxiety about who will assume the patient's responsibilities.
