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The central question addressed in this paper is how we as clinicians decide whether a particular belief system, usually a religion to which our patients adhere, is pathological or not. The author differentiates this issue from that of a religion being pathologically used to express a particular neurosis or character disorder. The discussion begins with Freud's view of religion as a delusion of the masses. Meissner makes an important distinction between the pathological quality of a belief system and its truth value. The determination of the pathological standing of a religious belief says nothing about its truth value. Freud seems to have made truth value the test of pathogenicity. Meissner uses what he calls the realm of transitional conceptualization, which is neither exclusively subjective nor exclusively objective, to determine whether a religious belief is delusional or not. A belief system may be pathological without being delusional, but, if delusional, it is also pathological. Other criteria used to determine whether a system is pathological or not are: a) openness verses closedness, b) broadness versus narrowness of perspective, and c) degrees of rigidity versus flexibility. As an example of the use of these criteria, the Manichean belief system is compared with Schreber's “theocosmological” system. Finally, the author discusses belief systems from the perspective of the human needs that these systems meet, as opposed to Freud's sole emphasis on their wish-fulfilling aspect. Meissner thereby recognizes that religions provide illusions that satisfy fundamental areas of human need, which affords these systems a degree of legitimacy and acceptability.