<p>This article exposes some culturally contingent foundations of self-illness ambiguity, wherein psychiatric patients struggle to distinguish their authentic selves from their diagnosed conditions and to determine which is in control. In cultures where the self is experienced as fairly fluid and situational, with its causal force downplayed, “losing control” or “not knowing who one is” may carry less significance. Clinicians, however, may accentuate self-illness ambiguity by uncritically subsuming Western ideals of selfhood, such as aspirations toward independent individualism—perhaps contributing to the pathologization of culturally unfamiliar temperaments. Cultural environments, in turn, may range from supportive to hostile depending on how specific self-construals are valued within them, selectively exacerbating distress, and psychiatric frameworks may misinterpret such outcomes as internal disorders. The article finishes by urging a reevaluation of mental illness models to better account for cultural variability in self-understandings.</p>