Despite a growing prevalence of mental illness diagnoses and treatments, there remains remarkable interpretive diversity regarding the meaning of these diagnoses and their implication for mental healthcare. Humanities scholarship devoted to language, power and ethical cares of the self provides invaluable tools for navigating interpretive diversity in this domain. This scholarship suggests that ethical questions of informed consent regarding mental difference and disability go much deeper than the usual standards. Ethical questions of informed consent go back to the very language choices people use to narrate and navigate the mental difference or disability. Making these ethical choices between different ways of understanding psychic difference is fundamentally about making narrative and lifestyle choices. This article considers these issues in the context of the many interpretations of Vincent van Gogh's life and their ongoing relevance for contemporary approaches to mental difference and disability.