Ms. A, a 25-year-old single woman, had been hospitalized for the last 8 years. At the age of 14 years, she became socially withdrawn and developed thought disorder, odd behaviors, and angry outbursts. She stopped school, stayed home in her room believing that people in the street were laughing at her, and often intentionally injured herself. Outpatient treatment with perphenazine was initially helpful, but then she deteriorated, developing insomnia, auditory hallucinations, delusions, and aggression toward family members. These symptoms led to her first admission at the age of 16. Schizophrenia was diagnosed, and Ms. A was treated with haloperidol, carbamazepine, and ECT with some improvement. After discharge, she remained isolated at home. There were frequent aggressive outbursts without obvious precipitants. She would scream, throw objects, and physically attack family members. These outbursts were followed by remorse and apologies.