In 1999 I was preparing for the Royal College of Psychiatrists’ membership exams. I remember reading up on schizophrenia and going through the list of Schneider’s first rank symptoms. The way the disorder was described struck me as odd from the very start. I looked at the list and thought two people with completely different symptoms—no overlap at all—could both have the same disorder. They could also have the exact same symptoms, but one person could have developed them in their teens and the other person in their 50s; no problem.
I dismissed this thought as an idle musing and went back to revising. At that time I was working at an inner-London rehabilitation ward that catered to patients who had a history of homelessness. It was then that I met Jacks and Mr B. I spent a lot of time with them, talking to their families and friends, and interviewing them about their experiences. I did my best to see things from their point of view. Their presentations resonated with my intuition. Here is what I believe their experience of their illnesses was like. I don’t presume to speak for them, but I will use their language rather than that of the diagnostic manuals.