Accounts of the nature, cause, and course of mental illness and self‐labeling are explored as interdependent domains with a cohort of individuals diagnosed as having major psychiatric disorders. Explanations and descriptions of mental illness and propensities to self‐label are shown to be interrelated in a multidirectional, multidimensional manner. Normalizing talk and illness accounts that are both patterned and diverse, and both stable and variable over time, pervade the discourse of individuals in the cohort. Sociocultural factors, particularly social race, gender, and type of illness explanation, have a stronger association with self‐labeling than clinical factors, such as formal diagnosis. The concepts of “illness‐identity work” and “illness‐identity talk” are developed as a means for exploring self and sickness among persons with chronic illnesses.