A healthy conception of oneself is central to coping effectively with the day to day stresses of modern living. The onset of any neurological disease, with either actual visible deficits or potential future disability, threatens the integrity of that concept. This paper explores the concept of self-esteem. Alterations in self-esteem occur as a result of both internal or personal expectations and external or societal expectations. Manifestations of an altered self-esteem include self-negating verbalizations, reduced social interactions, lack of eye contact during interaction, and verbalization of feelings of guilt. While the focus of this paper will be the individual with Multiple Sclerosis, the concepts discussed are applicable across the spectrum of neurological disease.