The isolated burial of Bad Dürrenberg is one of the richest Mesolithic graves in Europe. Although it was excavated in the 1930s, new spectacular anthropological and archaeological evidence has emerged during a recent re-study. Firstly, we present here the results of an anthropological re-evaluation of certain features of the skull base and the foramen magnum. Our work has clearly established that the observable features are caused by an anatomical variation that also includes an atlar anomaly. This developmental variation possibly caused various neuropathological symptoms. The Bad Dürrenberg burial consequently represents a unique case of the possible interpretation of abnormal behaviours in a shamanistic fashion in a prehistoric context. Secondly, we have identified the LSAMAT phenomenon (Lingual Surface Attrition of the Maxillary Anterior Teeth) in the adult individual of the burial. The activities leading to this condition are unknown so far. Thirdly, a split roe deer metatarsus among the burial goods was identified as being involved in the preparation or application of red pigment. The lack of polish and other use wear make it likely that it was produced and used as part of the burial ritual. Copyright © 2006 John Wiley & Sons, Ltd.