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Attempts to distinguish religious from pathological psychotic states have received considerable attention in the recent literature. It has been proposed that the distinction can be drawn in terms of subjects’ evaluation of their experiences and ultimately outcome, conceived of as action enhancement or failure. Such an approach does not take in to account the contexts where the meaning of ‘good’ or ‘bad’ outcome are defined and hence are an overriding factor in subjects’ evaluations of psychotic experiences. This suggests a need to examine the contribution of these contexts to the process of evaluation. In this paper, and with reference to an illustrative case study, I attend to psychiatry—an authority on unusual experience and belief—demonstrating an essential conflict between religious experiences and the assumptions and procedures of psychiatric practice. It is argued that the theoretical commitments of psychiatric science, the values embedded in the social dysfunction criterion, and a deficient understanding of culture promote the pathologization of unusual experiences and contribute to the generation of negative outcomes. I conclude with a proposed solution: by adopting an open-ended process of communication with the aim of achieving a degree of linguistic resonance among the involved parties, clinicians would be fostering mutual change rather than one-sided judgment. This would increase the chances of securing agreement and would put us in a better position to plan noncoercive intervention. Implications of the proposed approach for diagnosis and management of risk are discussed.