There have only been a dozen studies in the world literature which have followed patients across decades after their first admissions. Persistent findings of wide heterogeneity in long-term outcome functioning have broadened and challenged the pessimistic view of outcome held by many clinicians with short-term and narrowly defined caseloads. This report compares and contrasts three very long-term followup studies completed in the past 15 years which have also documented course as well as outcome. Ciompi's schematic representation of longitudinal courses has been augmented by data from the Vermont and Burghölzli studies and sheds new light on the underlying hidden heterogeneity within samples. Two case studies present vivid portraits of very different trajectories taken over time and illuminate the processes under scrutiny.