This paper examines some of the ways in which spirits and deities may be involved in mental illness in ethnically Tibetan contexts, resulting in symptoms such as confusion, aggression, and even madness. Whilst some such entities are discussed in the seminal Tibetan medical text, the Four Tantras (rgyud bzhi), in reality, Tibetan medical specialists are often not the first port of call for afflicted individuals and their families. Instead, lay Tibetans often describe ritual specialists as the best practitioners to consult, due to the “spiritual power” they are understood to possess, an understanding which reflects some long-standing beliefs about spirits and their relationship with Buddhism. However, in a contemporary Tibetan community, where such practitioners may no longer be available, we hear of afflicted individuals and their families often consulting a variety of medical and religious specialists from different traditions. Here I describe two narratives of spirit-caused illness in Darjeeling, India, which illustrate some enduring perspectives on spirits and their ability to cause illness, and explore some perspectives on related healing modalities within this community.