This project is situated at an intersection between psychoanalytic theory, psychiatry, disease, capitalism, and the colonial project in British-occupied Egypt. It focuses on pellagra, a condition that today’s medical community understands to be caused by a nutritional deficiency in niacin (Vitamin B3). The sources for my project are Egyptian government records such as the “Annual Lunacy Division Reports,” contemporary scientific and medical journals, and other publications that were produced by both British and Egyptian doctors and psychiatrists. Pellagra afflicted a significant number of patients in Egypt’s state mental asylums. These patients were primarily fellaheen from Lower Egypt who, in the switch to perennial agriculture, shifted to maize cultivation as the staple of their diet. Throughout the British occupation, colonial psychiatrists argued that pellagra, described as a “disease of poverty,” was the leading cause of insanity in Egypt. Additionally, “pellagra insanity” was the most common type of madness that the doctors diagnosed in asylum patients classified as “criminal lunatics.” The European medical community was in an open debate about the exact cause of pellagra. The fellaheen who suffered from the condition also had their own understandings of what was happening to them. Pellagrous patients reported that they were possessed by devils, heard the voices of saints, were victims of sorcery, had poison in put in their stomachs, and other symptoms that Western psychiatry would pathologize as schizoid. My paper takes these accounts seriously, rather than dismissing them as anecdotal, unimportant, or merely bizarre. I approach “pellagra insanity” with a Lacanian psychoanalytic lens, arguing that although subaltern voices cannot be “written-in” to the colonial archive, it is possible for the truth of a situation to be articulated in moments when the consistency of the world is “tripped up” by a failure of language—an encounter with what Lacan calls the real. I read both the doctors’ observations and the patients’ descriptions of their experiences as coeval. That is, they are equal in their contradictions, slips, and gaps and in their potential for revealing something true in these instances of lack. This project asks what is revealed when the fellaheen are taken as literally as their doctors. Such a reading means thinking of pellagra as actually caused by a form of malevolent sorcery: perhaps that of an invasive global capitalism that extracted the lifeforce from Egypt’s fellaheen, changed it into surplus-value, and left them with poison in their stomachs.