Physical and emotional pain are signalling and protective functions. In this clinical lesson, we describe the case of a patient with a psychotic disorder who had an episode of seriously disturbed pain awareness and experience, which caused severe delays in care and resulted in severe permanent damage. Due to his psychosis and lack of pain, the patient refused medical treatment and his leg henceforth developed mummification necrosis. Once admitted to a medical psychiatric unit, he was declared incompetent by his doctor and curator and his leg could be amputated. His psychosis adapted to the new situation, which he could then accept. This clinical lesson underlines the importance of awareness on disturbed pain and pain experience when it concerns a patient with a psychotic disorder, and that adequate medical treatment should not be ignored due to incompetence of the patient.