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This article traces the history of Cuba’s first and only Spiritist mental clinic, founded in the 1940s in the central province of Camagüey and shut down by the revolutionary government in the 1960s. It analyzes the history of the clinic with respect to the virtual absence of institutional psychiatric care outside of Havana in these decades, but also in the context of a more enduring problematic: the persistent preference shown by Cubans for religiously grounded forms of mental healing. Namely, “In the Shadow of the Double” explores the broader geography of mental care within which Spiritists defined the uniqueness of their healing practice, vis-à-vis both institutional psychiatry, to which they theorized a relationship of strategic complementarity, and other forms of religiously grounded healing, which they disparaged as “backwards” and even dangerous. It is precisely this liminal status within the psychotherapeutic marketplace, I argue, that made their healing practice uniquely appealing to some, but also vulnerable to revolutionary atheism and public health extension after 1959.