Spiritual models of illness causation are common in Africa. This article reports an investigation of some clinical correlates of patients who believe that their problem has a spiritual cause. A cross-sectional survey of random attenders at primary health care clinics and traditional medical practitioners (TMP) in Harare (n = 302) was performed. Interviews included eliciting of explanatory models, indigenous and etic psychiatric measures. Spiritual models of illness were held by half the subjects. Patients who hold this model had higher levels of mental disorder and were more likely to have a mental illness as judged by the patient, care provider and psychiatric measures. The symptoms of such patients resemble the construct of anxiety. Such patients are more likely to consult TMP and to have a chronic illness. Spiritual models of illness may represent an indigenous model to explain the distressing symptoms of nonpsychotic mental illness. Including them in training of primary health care providers may improve the recognition of mental illness.