This paper traces how Christian representations of madness and moral choice impacted Anglo-American healthcare in the 19th and early 20th century. Theological associations between autonomy and self-management framed modern psychology as a moral endeavor and the management of psychiatric conditions as control of the will. Normalcy, sanity, and health function not only as absence of psychosis, but also as lack of dependency. Using ethnographies of group therapy, I examine how self-management models for mood disorders require individual and self-reflective capacities which are outside the grasp of a person with a mood disorder. Rather than reflecting lived experiences of people with psychosocial disabilities, many self-management strategies assume a self-governing and independent moral agent. I argue that distributed agency and participatory decision-making better describe how people with psychosocial disabilities display agency, structuring moral choice as a collaborative event rather than an individual capacity.