Lindsay Karp’s account of living with multiple sclerosis stress flares is a precise, unsentimental record of what the condition actually does to a body in motion: it collapses the nervous system at exactly the moments when the nervous system is most needed. The piece, published by Business Insider, traces several years of stress-induced flares through family emergencies, a cancelled holiday, a bar mitzvah, and a spouse’s cancer diagnosis, and it raises a question that clinicians and patients alike grapple with: when stress is unavoidable, how much can leaning out actually help?
What Multiple Sclerosis Stress Flares Actually Look Like
Karp describes the mechanism in direct, experiential terms. In 2019, when her son’s preschool director called to say he was bleeding and she needed to come immediately, the adrenaline that got her to the hospital also triggered a flare. Her legs, already unreliable, grew shakier; her nervous system, she writes, ‘collapsed from the weight of fear’ over the following hour. In December 2015, anticipatory stress about an upcoming holiday caused a more gradual decline: in the days before departure, her body weakened progressively until she could no longer walk, and the trip had to be cancelled.
The bar mitzvah episode in the autumn of 2024 follows a similar pattern. The excitement and anxiety of a significant family celebration settled into fatigue and weakness, so that on the morning of the event she describes herself as ‘a depleted version of my already disabled self.’ Then in March 2024, her husband’s unexpected colon cancer diagnosis triggered another stress-induced flare while she was trying to be his support.
What Karp is describing maps closely onto what clinicians distinguish as pseudo-relapses. According to Temple Health, pseudo-relapses are flare-ups of existing MS symptoms that tend to fade relatively quickly and can often be traced back to a specific trigger, whether stress, a urinary tract infection, another illness, or exposure to heat. They differ from true relapses, which involve new or worsening neurological damage and typically last longer. The practical consequence is the same: the person experiencing the flare loses function, sometimes for days, sometimes for weeks.
The Bidirectional Problem That Makes Stress Management So Difficult
One of the complicating factors Karp’s account illustrates is a dynamic that goes beyond simple cause and effect. Everyday Health notes that the relationship between MS relapses and stress may be bidirectional: stress may contribute to the development of a relapse, and a relapse may itself cause stress. For someone already managing a debilitating disease, the loop is difficult to interrupt. Karp’s cancelled 2015 holiday is a clear example: the stress of worrying about how her body would react to activity induced the very flare she feared, confirming the fear and generating further stress.
This bidirectional quality is what makes the ‘lean out’ strategy she describes both rational and limited. She has hired help for household cleaning, reduced volunteering commitments, declined to overbook her social calendar, and is working on separating herself from relationships and situations that strain her unnecessarily. These are, by any measure, reasonable adjustments. They address the stressors that are within her control. They cannot address the stressors that are not: a child bleeding, a spouse’s cancer, a once-in-a-generation family milestone.
The MS community has long recognised this ceiling. Stress-reduction strategies, from mindfulness to activity pacing, appear in most disease-management guidance, and the National MS Society includes stress management among its standard recommendations. But Karp’s framing is more honest about the limits than much clinical language tends to be. She is not seeking to eliminate stress; she is seeking to tolerate its consequences without becoming numb to the experiences that generate it.
Acceptance as a Clinical and Personal Strategy
The distinction Karp draws at the close of her account is worth holding onto. She writes that she refuses to become numb in order to calm the disease. Emotional blunting might reduce the physiological stress response, but it would also remove the engagement with family life that gives the management of MS its purpose. Her body’s response to stress, she writes, is ‘a reminder that I’m alive and thriving despite this disease.’
For those following MS management closely, the account is a useful corrective to any assumption that symptom control is primarily a matter of compliance or lifestyle optimisation. Multiple sclerosis stress flares occur in response to events that are, by definition, outside a treatment protocol. The next step for Karp, as she describes it, is continued work on the internal boundary: accepting that stress-induced symptoms will recur, managing the controllable sources, and staying present for the moments that matter.