In this article, we examine the clinical encounters of people diagnosed with a severe mental illness (SMI). Drawing on more than 1-year of ethnographic research and interviews in Indonesia, we show that instances of moral self-reflection occurring in the process of acquiring and appropriating clinical insight emerge at the intersection of heterogeneous discursive regimes. When biomedical notions of health and illness dominate these discourses, they reimagine pre-existing notions about spirituality and religion. Furthermore, consenting to psychiatric notions of health and illness can create common ground and a sense of shared experience, leading to grassroots movements for the empowerment of the mentally ill, self-help groups, and other support structures. At the same time, these processes can increase uncertainty and be generative of a culture of blame, as individuals are caught in overlapping and at times contradictory moral systems that each have the potential to strip patients of their moral status.
