The Paniya tribe of Wayanad, Kerala, suffer from a range of health issues related to their experience of marginality. They have indigenous forms of healing; however, the use of biomedicine has increased. But, lack of time and resources means that the broader dimensions of health and well-being remain unaddressed. The socio-economic causes of illness are reconfigured into medical terms for management in the clinical setting. Ultimately, the struggles of the marginalized are rendered invisible, and primary medical aid has become a conduit through which ideology and modes of practice are transferred. However, the Paniya use biomedicine in an attempt to negotiate new forms of identity. Symbolic parallels between the 'rituals' of medicine and manthravady (black magic) facilitate movement between the two. However, specific practices within the manthravady ritual draw on deeply embedded cultural idioms that caution against the coercive influences of dominant groups and help the Paniya make sense of their place in the contemporary world.