Physicians frequently note that patients with motor neuron disease (MND)/amyotrophic lateral sclerosis appear undistressed, and may even report a high level of quality of life, despite their evident severe disability. Sometimes this can be attributed to an associated frontotemporal dementia, especially when there is apathy, bland indifference, blunting of emotion or self-centredness.1 In others, depression is a feature, perhaps understandable to the observer or carer, and associated with despair and even a wish to hasten death. Understanding the process of psychosocial adjustment to chronic illness is an important aspect of holistic and palliative care during the course of the disease. It is a complex process that, perhaps surprisingly, does not depend …