This article considers why whole-person care is often aspired to but remains problematic for psychiatry. One reason is that psychiatry wants to use ideas about the self in restricted senses rather than examine the idea as a whole. In particular, this includes wider issues that interconnect values to identity, which then ambiguously get raised in clinical practice, such as questions about who it is good to be. This issue is the context behind unresolved boundary disputes in mental health around well-being, spirituality, self-esteem and recovery, and reflects broader cultural tensions about the making of modern identity best understood in a historical context. It has impacts on service design, therapeutics and training. Suggestions are made about how the self can be approached in psychiatric practice.