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Purpose The purpose of this paper is to discuss stigma and insensitive communication surrounding mental illness discourse amongst adolescents in the Polokwane Local Municipality against the background of a Foucauldian lens. Design/methodology/approach The literature reviewed included a discussion of perspectives on stigma and insensitive communication, contextualisation of the dual health–belief system in South Africa and the Foucauldian governmentality theoretical perspective. The methodology was based on a Foucauldian orientation and Geertz’ interpretivism. The methods followed to analyse the discourse were Foucauldian discourse analysis (FDA), coupled with Geertz' “thick description.” The data were collected from six focus group discussions, which consisted of a total of 36 informants. Findings The findings indicated the dominance of the biomedicine discourse, neoliberal rationalisations for self-care and the policy of deinstitutionalisation. Practical implications The implications for practice using an FDA approach combined with an interpretivist stance exposes the actions, institutions, possibilities for action whilst understanding core beliefs in a complex dual health and religious belief setting. The addition of Geertz’s interpretivism adds a cultural flare and insight, which adds to the depth of the analysis. Originality/value The complexity of beliefs, experiences and health choices calls for culturally sensitive discourse about mental illness and also highlights how discourse about individual conduct and self-care is embedded in the discourse used by adolescents.