This explores the phenomenon of auditory verbal hallucinations (AVHs) as an example of entanglements of spirituality and psychopathology, and looks at ‘spiritually significant voices’ (identified by those who hear them as having spiritual/religious significance). Some have proposed making a differential diagnosis between ‘genuine’ spiritual experiences and mental illness, but the criteria for making such distinctions can be controversial and misleading, based on a false presupposition that the two are mutually exclusive. Research shows that patients identify some experiences as both part of an illness and spiritually significant. Patients with a psychiatric diagnosis are often subjected to epistemic injustice, wherein their claim to know things (e.g. spiritually) is discredited owing to prejudice associated with their diagnosis. A case study explores entanglement of spirituality with AVHs and considers implications for assessment/treatment. Voices of this kind may be meaningful for those who hear them, whether or not associated with a diagnosis, and affirmation of this and patients’ positive spiritual coping, where possible, can be a positive factor in promoting recovery.