In this study the traditional and transitional nosology and etiology of the spirit disorder vimbuza was investigated by interviewing patients (n = 116) who were suffering from that condition. The illness concept was compared with western psychiatric classifications. As a result, 23 symptom descriptions were identified, 13 can be referred to as conversion or dissociation disorder and 7 to depressive neurosis. The remaining 3 symptom descriptions refer to an acute delusional or confusional state. Comparing the traditional and transitional symptom descriptions on the head and heart, a shift from the heart to the head becomes evident in the transitional or urban Malawian. The transitional etiology is the same as the traditional etiology, only that the transitional person more often refers to 'Too much thinking' and 'natural' than to 'bad ancestral spirits' and 'witchcraft'.