This study examined the relationships between insight, severity of symptoms, diagnosis, locus of control, quality of life, and engulfment among 25 patients with a DSM-III-R diagnosis of schizophrenia and 33 patients with a diagnosis of bipolar disorder. Engulfment is the extent to which a person identifies with the patient role. Severity of symptoms and engulfment were significantly associated with insight. These results are consistent with the notion that poor insight is associated with severe illness. The association between development of deviant or sick roles and awareness of illness warrants further attention.