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, some friends and relatives withdraw, and death comes near. The emotional tasks of aging need to be done prematurely, out of context; they are compressed, exaggerated.