This chapter examines the relationship between trance, possession, and madness in both classical and ritual performance traditions of Keralam. Through detailed analysis of Kathakali, Kutiyattam, and ritual practices such as Teyyam and Guruti at Chottanikkara, it explores how altered states of consciousness are performed, understood, and codified within specific cultural frameworks. In classical forms, trance is achieved through disciplined training and the cultivation of body-memory, enabling the performer to temporarily merge with the character while maintaining control—distinguishing it from possession. By contrast, ritual performances frame possession as divinity embodied, where the performer becomes a vessel through which the god is believed to act. The chapter traces how trance is induced through rhythm, affective intensities, and narrative immersion, while also considering the social and embodied complexities of these states. It underscores the ambivalence surrounding madness as a category, showing how it is variously framed as disorder, divinity, or transformation depending on context. Ultimately, the chapter highlights the cultural specificity of trance and possession in Keralam, showing how they reconfigure the boundaries of self, performance, and perception without necessarily aligning with Western medicalised understandings of madness.