A patient who has an unequivocal psychotic illness within the schizoaffective spectrum is described. Over the course of the past 10 years she has convinced me that her way of looking at her own illness, particularly her refusal to take medication, has merits that cannot be dismissed as the overwrought workings of a disturbed mind. Her experience has helped me to understand that it is still possible to be an advocate of evidence-based medicine and yet accommodate the wishes of patients in a way that sometimes elevates personal patient-based evidence above that of external criteria. ( Int J Psych Clin Pract 2000; 4: 253 - 255).