This case report describes a chronically psychotic man presenting signs of a movement disorder exacerbated by neuroleptic treatment and repeatedly diagnosed as tardive dyskinesia. However, this movement disorder differed from classical tardive dyskinesia both in the nature of specific symptoms and in their relationship to neuroleptic treatment. Closer examination revealed evidence of neurological disorder preceding the earliest neuroleptic treatment. Although the nature of this disorder remains unclear, serious doubt exists whether it properly deserved a diagnosis of tardive dyskinesia, which opened the way for medicolegal dispute. The numerous ramifications of tardive dyskinesia speak for restrictive use of this diagnosis and for clear diagnostic criteria.