Imagine a man named John. John has had his share of problems since graduating from high school. Despite a great deal of promise up until graduation, he has since been in and out of psychiatric hospitals with limited benefit. When John is in the hospital he receives basic care consisting of psychiatric medications to which he often objects initially and ultimately discontinues. The meds have been of modest-but certainly never complete-benefit in terms of positive psychiatric symptoms but have led to a variety of physical problems and troubling side effects (weight gain, metabolic syndrome, involuntary motor movements, and avolition). They have done little to improve other sources of John’s problems such as unemployment, unstable housing, lack of social support, and a life that alternates between boredom and intense anxiety and fear. He acknowledges that he has a diagnosis of schizophrenia but does not think schizophrenia is his major problem.