A. Moral Injury and the Spiritual Care of Disaster Responders: A Pastoral Theology of Presence After Catastrophe

Rev GC Smith, PhD

Introduction: The Questions Responders Carry

The responder had not slept in nearly thirty hours when he quietly admitted, “I don’t know how to pray here anymore.”

We were standing outside a temporary disaster shelter after a tornado outbreak that had destroyed large sections of a Midwestern town. Generators hummed behind us in the darkness. Children slept on cots inside the shelter gymnasium while exhausted volunteers sorted donations beneath fluorescent lights that never fully dimmed. Earlier that afternoon, the responder had assisted with debris searches in a neighborhood where multiple fatalities had occurred. Before that, he had spent hours helping survivors locate medications, comfort frightened children, and move personal belongings out of unstable structures before incoming rain arrived again.

Now he stood in the parking lot staring toward the ruined neighborhoods beyond the school grounds and spoke with the flat emotional exhaustion common among experienced responders.

“I used to know what to say to people,” he continued. “Now it just feels like words.”

His statement reflects an experience increasingly recognizable among long-term disaster responders, chaplains, clergy, healthcare workers, and humanitarian personnel who repeatedly enter environments of catastrophe and prolonged human suffering. Existing literature often interprets responder distress through frameworks such as burnout, compassion fatigue, secondary traumatic stress, or post-traumatic stress disorder. These frameworks remain important and clinically valuable. Disaster responders frequently do experience exhaustion, emotional depletion, hypervigilance, intrusive imagery, sleep disruption, and cumulative trauma exposure. Yet many responders describe another dimension of suffering that exceeds the explanatory capacity of psychological stress language alone.

Increasingly, responders describe moral anguish.

They speak not merely of fatigue, but of spiritual disorientation. Not simply emotional exhaustion, but erosion of meaning. Not only traumatic exposure, but the gradual collapse of theological and moral frameworks that once sustained vocation, identity, and hope.

The language of moral injury offers an important interpretive framework for understanding this deeper wound.

Jonathan Shay’s early work with combat veterans defined moral injury in relation to betrayal, leadership failure, and violations of what is “right” in high-stakes situations.^1 Brett Litz later expanded the concept to include perpetrating, witnessing, or failing to prevent actions that violate deeply held moral beliefs and expectations.^2 While much moral injury literature emerges from military contexts, the framework has increasingly expanded into healthcare, law enforcement, ministry, and caregiving professions where individuals confront repeated moral distress, institutional limitation, and impossible ethical realities.^3

Disaster response environments generate precisely these conditions.

Responders routinely encounter suffering they cannot meaningfully resolve. They witness preventable vulnerability, unequal recovery systems, institutional inadequacy, bureaucratic failure, mass grief, and prolonged helplessness. They make decisions under impossible conditions while carrying the emotional burden of lives they could not save, homes they could not restore, and suffering they could not explain. Over time, these realities often wound not only the psyche, but also the moral and spiritual imagination.

For many responders, disaster work eventually destabilizes theological certainty itself.

The responder who no longer knows how to pray after body recovery operations. The chaplain who can no longer speak honestly about suffering using inherited theological language. The disaster spiritual care volunteer who finds explanations increasingly unbearable in the presence of catastrophic grief. The experienced responder who feels emotionally intact enough to continue functioning operationally while simultaneously experiencing profound moral exhaustion internally.

These experiences suggest the need for a broader pastoral theology of disaster response, one attentive not only to trauma, but also to moral and theological injury.

This article argues that disaster responders are often morally and spiritually wounded not simply by trauma exposure, but by repeated encounters with helplessness, preventable suffering, institutional limitation, and the gradual collapse of explanatory frameworks that once sustained meaning. Consequently, spiritual care for disaster responders must move beyond resilience rhetoric and toward practices of accompaniment, lament, theological humility, grief acknowledgment, and sustained human presence after catastrophe.

The article proceeds in five movements. First, it explores the development of moral injury theory and its relevance for disaster response contexts. Second, it examines the particular moral burdens generated by prolonged exposure to catastrophe work. Third, it argues that disaster response frequently produces forms of theological moral injury in which inherited religious explanations become destabilized through repeated encounters with suffering. Fourth, it proposes pastoral and spiritual care responses grounded less in certainty than in accompaniment, lament, and relational steadiness. Finally, the article suggests that mature spiritual care after catastrophe often shifts from explanation toward presence as its primary theological and pastoral mode.

This movement from explanation toward accompaniment represents not a collapse of faith, but a transformation in the shape of faith itself.

As Shelly Rambo suggests, trauma frequently resists narratives of resolution and demands theological attention to survival, lingering suffering, and unfinishedness.^4 Serene Jones similarly argues that trauma destabilizes coherent meaning-making structures and disrupts the narratives through which persons ordinarily interpret suffering and identity.^5 Disaster responders often inhabit precisely this destabilized terrain for prolonged periods of time. They repeatedly enter spaces where inherited theological certainties no longer function cleanly, where prayer becomes strained, and where suffering exceeds available interpretive systems.

At the same time, pastoral theologians such as Carrie Doehring, Bonnie Miller-McLemore, Emmanuel Lartey, and Andrew Root have emphasized the importance of relational presence, contextual attentiveness, emotional honesty, and embodied care within pastoral practice.^6 Their work helps illuminate why responders often require something deeper than motivational resilience language or theological reassurance. They require spaces where moral ambiguity, grief, exhaustion, helplessness, and theological disruption can be acknowledged honestly without shame.

Likewise, the tradition of pastoral presence represented by Henri Nouwen, Seward Hiltner, and Thomas C. Oden remains deeply relevant within disaster spiritual care contexts.^7 These traditions remind caregivers that ministry does not primarily consist in explanation or emotional control, but in accompaniment, witness-bearing, and remaining faithfully present within human vulnerability.

Such presence becomes especially critical after repeated exposure to catastrophe.

Many responders can continue functioning operationally long after they begin fragmenting spiritually. They continue deploying. Continue helping survivors. Continue organizing shelters, distributing supplies, managing volunteers, and offering emotional support. Yet internally they often carry unresolved grief, accumulated helplessness, emotional numbing, theological exhaustion, and moral confusion that remains largely invisible within responder culture.

In this sense, disaster responders frequently become hidden casualties of catastrophe themselves.

Not because they lack resilience.

But because repeated exposure to overwhelming suffering changes people morally and spiritually over time.

The task of pastoral theology, therefore, is not merely to help responders remain operationally effective. It is to help them remain human.

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Notes

1. Jonathan Shay, Achilles in Vietnam: Combat Trauma and the Undoing of Character (New York: Scribner, 1994).

2. Brett Litz et al., “Moral Injury and Moral Repair in War Veterans,” Clinical Psychology Review 29, no. 8 (2009): 695–706.

3. See Rita Nakashima Brock and Gabriella Lettini, Soul Repair: Recovering from Moral Injury after War (Boston: Beacon Press, 2012).

4. Shelly Rambo, Spirit and Trauma: A Theology of Remaining (Louisville: Westminster John Knox Press, 2010).

5. Serene Jones, Trauma and Grace: Theology in a Ruptured World (Louisville: Westminster John Knox Press, 2009).

6. See Carrie Doehring, The Practice of Pastoral Care; Bonnie Miller-McLemore, Christian Theology in Practice; Emmanuel Lartey, In Living Color; and Andrew Root, The Pastor in a Secular Age.

7. See Henri Nouwen, The Wounded Healer; Seward Hiltner, Preface to Pastoral Theology; and Thomas C. Oden, Pastoral Theology: Essentials of Ministry.

I. Moral Injury Beyond Military Contexts

The concept of moral injury emerged initially within military and combat-related contexts, particularly through the work of Jonathan Shay, whose clinical engagement with Vietnam veterans revealed forms of suffering inadequately explained by fear-based trauma models alone.^8 Shay argued that many veterans were wounded not simply by exposure to violence, but by betrayal, moral violation, and the collapse of trust within situations carrying profound ethical stakes. Moral injury, in this understanding, involved damage to character, meaning, trust, and moral orientation itself.

Later formulations by Brett Litz and colleagues broadened the framework by describing moral injury as the lasting psychological, biological, spiritual, behavioral, and social impact of “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”^9 This expansion proved especially significant because it moved moral injury beyond direct perpetration and into the realm of helpless witnessing, perceived inadequacy, impossible choices, and moral distress arising from circumstances where no genuinely “good” outcome remained possible.

These insights have increasing relevance for disaster response contexts.

Although disaster responders do not typically operate within combat environments, they frequently inhabit morally destabilizing situations characterized by overwhelming suffering, institutional insufficiency, prolonged helplessness, and repeated exposure to traumatic human loss. Responders often witness children displaced from homes, families searching debris for loved ones, elderly survivors abandoned by support systems, and communities fractured by unequal recovery resources. They routinely confront realities in which human need dramatically exceeds available intervention.

Importantly, the moral burden in disaster response does not usually emerge from intentional harm.

Rather, it emerges from sustained proximity to suffering that cannot be adequately repaired.

This distinction matters pastorally and theologically.

Disaster responders often describe a persistent sense of insufficiency. They cannot save everyone. They cannot prevent further suffering. They cannot restore what has been lost. They cannot explain why one family survives while another does not. They cannot stop children from being frightened, eliminate inequitable systems, or reverse catastrophic destruction. Over time, the cumulative experience of limitation itself becomes morally exhausting.

In this sense, disaster moral injury frequently develops through repetition rather than singularity.

Not one catastrophic moment, but hundreds.

Not one impossible decision, but prolonged exposure to impossible realities.

A responder helping recover bodies after flooding may continue functioning operationally while privately carrying unresolved guilt about the people who could not be reached in time. A shelter volunteer may begin emotionally fragmenting after repeated encounters with frightened children asking questions no adult can answer honestly. A disaster chaplain may discover increasing difficulty praying beside catastrophic loss after years of witnessing suffering resistant to explanation. Recovery workers may become morally exhausted by systems that routinely fail vulnerable populations long after public attention disappears.

These wounds are not reducible to burnout.

Burnout implies depletion.

Moral injury implies rupture.

The distinction is significant.

Burnout suggests exhaustion caused by overwork. Moral injury suggests damage produced when one’s moral, spiritual, or theological assumptions can no longer adequately contain lived experience. As Rita Nakashima Brock and Gabriella Lettini argue, moral injury frequently involves a loss of trust, meaning, coherence, and relational connection that destabilizes both identity and moral orientation.^10

Disaster responders often describe precisely this destabilization.

They speak of emotional numbing that frightens them. Of becoming unable to tolerate simplistic religious explanations they once offered comfortably. Of carrying accumulated grief that never fully resolves between deployments. Of increasingly questioning systems they once trusted. Of struggling to maintain emotional tenderness after prolonged exposure to suffering. Of exhaustion not merely physical, but existential.

Many also describe shame.

Not because they acted immorally, but because they could not do enough.

This dynamic appears repeatedly in disaster contexts. Responders frequently internalize unrealistic responsibility for outcomes fundamentally beyond their control. They replay rescue decisions mentally. They remember names and faces years later. They carry memories of survivors they could not adequately help. Even highly experienced responders often describe lingering guilt associated with perceived inadequacy despite overwhelming structural limitations.

Such guilt becomes especially acute when institutional systems fail visibly.

Responders frequently serve as intermediaries between suffering populations and bureaucratic structures incapable of meeting urgent human need. They distribute limited resources among overwhelming demand. They communicate delays they did not create. They witness inequities they cannot repair. Over time, many begin carrying moral distress not only toward catastrophe itself, but toward the institutional insufficiencies surrounding disaster recovery.

This reality significantly expands traditional trauma frameworks.

Trauma theory often emphasizes threat, fear, and psychological overwhelm. Moral injury additionally attends to betrayal, meaning collapse, helplessness, shame, ethical conflict, and spiritual destabilization. Disaster responders frequently experience both simultaneously.

Moreover, disaster response environments possess characteristics that intensify cumulative moral burden.

Unlike singular traumatic incidents, disasters often unfold in prolonged waves. Initial rescue transitions into shelter management, resource coordination, long-term recovery, and ongoing grief accompaniment. Responders repeatedly witness survivors at vulnerable transitional moments: immediately after loss, during displacement, amid bureaucratic frustration, and throughout exhausting recovery processes. These repeated exposures accumulate emotionally and spiritually over time.

The repetitive nature of catastrophe also erodes protective narratives.

Early in disaster work, responders often sustain themselves through strong vocational frameworks. They believe deeply in helping, service, faithfulness, and compassionate presence. Many continue believing these things throughout their careers. Yet repeated exposure to overwhelming suffering gradually complicates simplistic narratives about resilience, justice, divine providence, or redemptive suffering.

Responders begin noticing patterns.

Communities with fewer resources recover more slowly.

Vulnerable populations suffer disproportionately.

Institutional attention fades long before emotional recovery occurs.

Children continue carrying trauma years later.

Some losses never meaningfully resolve.

Certain prayers remain unanswered.

The result is not necessarily loss of faith.

More often, it is destabilization of previously inherited forms of certainty.

This distinction becomes essential for pastoral theology.

Many responders do not experience moral injury as atheism or rejection of spirituality. Rather, they experience it as exhaustion with inadequate explanatory frameworks. They become unable to speak honestly about suffering using theological language that no longer feels emotionally truthful in catastrophe settings. They continue believing in God while simultaneously struggling to reconcile repeated exposure to devastation with inherited assumptions about providence, justice, meaning, or divine intervention.

In this sense, disaster response often wounds theology before it wounds belief.

Such theological destabilization deserves serious pastoral attention.

For too long, responder care models have focused primarily on operational sustainability, emotional resilience, and trauma symptom management without adequately addressing the moral and spiritual consequences of repeated catastrophe exposure. Yet responders themselves frequently describe moral confusion, existential exhaustion, prayer disruption, theological disorientation, and accumulated grief as central dimensions of their suffering.

Pastoral theology is uniquely positioned to engage these realities.

Not because it offers easy resolution.

But because it possesses traditions capable of holding ambiguity, lament, relational presence, moral struggle, and spiritual unfinishedness without requiring premature coherence.

Disaster responders often do not need certainty restored as much as they need honest accompaniment within uncertainty itself.

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Notes

8. Jonathan Shay, Achilles in Vietnam: Combat Trauma and the Undoing of Character (New York: Scribner, 1994), 20–22.

9. Brett Litz et al., “Moral Injury and Moral Repair in War Veterans,” Clinical Psychology Review 29, no. 8 (2009): 695–706.

10. Rita Nakashima Brock and Gabriella Lettini, Soul Repair: Recovering from Moral Injury after War (Boston: Beacon Press, 2012), 13–29.

II. Catastrophe and the Moral Burden of Response

Disaster work places responders inside sustained environments of human vulnerability where suffering becomes both immediate and repetitive. Unlike acute emergencies that resolve relatively quickly, disasters often unfold across prolonged periods of instability, grief, displacement, and recovery. Responders do not simply witness isolated traumatic incidents. They repeatedly enter fractured human worlds.

Shelters fill with exhausted families carrying plastic bags containing the few belongings they managed to save. Children ask when they can go home while parents privately realize there may no longer be a home to return to. Elderly survivors wander unfamiliar hallways disoriented by medication loss, interrupted routines, and sudden dependency upon strangers. Volunteers distribute meals while simultaneously listening to stories of missing relatives, destroyed businesses, dead pets, collapsed churches, and interrupted lives.

Responders absorb these realities cumulatively.

The emotional burden rarely arrives through one dramatic moment alone. More often, it develops through repetition. One grieving family after another. One exhausted conversation after another. One devastated neighborhood after another. Over time, responders begin carrying accumulated human sorrow that remains psychologically and spiritually unresolved.

This accumulation matters.

As Carrie Doehring argues, traumatic exposure frequently reshapes emotional and spiritual meaning systems through repeated relational encounters with suffering.^11 Disaster responders inhabit precisely such repeated encounters. Unlike short-term observers, they often remain embedded within catastrophe long enough to witness both acute devastation and prolonged aftermath. They encounter survivors not only during rescue, but also during displacement, bureaucratic frustration, emotional collapse, and the exhausting uncertainty of recovery itself.

One shelter volunteer described to me the experience of helping a mother locate medication for her diabetic child after flooding displaced the family from their home. The volunteer spent nearly twelve hours navigating emergency systems, pharmacies, transportation barriers, insurance complications, and overwhelmed relief agencies before obtaining the medication late that evening. Operationally, the situation ended successfully.

Yet afterward the volunteer admitted privately, “I can’t stop thinking about how close that child came to dying simply because the system couldn’t move fast enough.”

The distress did not emerge solely from trauma exposure.

It emerged from moral confrontation with systemic inadequacy.

Disaster responders repeatedly encounter such moments. They witness how catastrophe magnifies preexisting inequalities. Communities with financial resources recover differently than impoverished communities. Elderly populations suffer differently than younger populations. Rural survivors often remain underserved long after national attention disappears. Responders witness institutional systems functioning unevenly across race, class, geography, disability, and social vulnerability.

These realities generate moral strain precisely because responders enter disaster work hoping to help.

Instead, they often discover the painful limits of intervention.

This helplessness becomes spiritually corrosive over time.

Responders routinely describe the frustration of distributing inadequate resources while standing in the presence of overwhelming need. They speak of impossible decisions regarding prioritization, delayed assistance, bureaucratic restrictions, or safety limitations preventing access to survivors. Some carry memories of body recovery operations where rescue became impossible before teams could arrive. Others remember children asking questions no honest person could answer.

Such experiences accumulate morally as well as emotionally.

The language of compassion fatigue alone often fails to capture this deeper dimension. Compassion fatigue implies emotional depletion from caring too much. Yet many responders continue caring deeply even while becoming morally and spiritually destabilized. Their suffering emerges not from diminished compassion, but from repeated confrontation with realities compassion cannot adequately repair.

In this sense, disaster response frequently produces a crisis of efficacy.

Responders begin realizing that presence cannot undo devastation. Supplies cannot restore interrupted histories. Emotional support cannot erase catastrophic loss. Spiritual care cannot explain why suffering distributes itself unevenly across vulnerable populations.

One experienced responder described standing in a tornado-damaged neighborhood where one child survived while another child in the adjacent home died. “People kept asking why,” he explained. “And after enough disasters, you realize there usually isn’t an answer that doesn’t sound cruel or dishonest.”

This recognition often marks an important turning point in responder experience.

Early in disaster work, many responders sustain themselves through narratives of usefulness, competence, faithfulness, or meaningful intervention. Over time, however, repeated exposure to catastrophic suffering destabilizes these narratives. Responders increasingly confront realities beyond repair, explanation, or emotional resolution.

The result is often moral exhaustion.

Not simply fatigue.

Exhaustion arising from repeated encounters with the limits of one’s ability to protect human life, preserve dignity, or maintain coherent meaning structures in the face of overwhelming suffering.

Importantly, responders frequently carry these burdens privately.

Responder culture often rewards competence, steadiness, emotional containment, and operational reliability. Many responders therefore continue functioning effectively while simultaneously experiencing increasing internal fragmentation. They organize shelters, coordinate volunteers, manage logistics, and support survivors while privately carrying unresolved grief, intrusive memories, emotional numbing, and theological disorientation.

This emotional concealment intensifies moral injury.

As Bonnie Miller-McLemore suggests, pastoral and caregiving identities often become entangled with expectations of emotional steadiness and sacrificial availability.^12 Responders may therefore experience shame when they begin struggling internally. They interpret emotional exhaustion as personal weakness rather than cumulative exposure to morally overwhelming realities.

Some begin withdrawing emotionally from survivors as self-protection. Others become increasingly irritable, cynical, or detached. Still others continue functioning externally while experiencing profound spiritual depletion internally.

One disaster chaplain described returning home after deployments and realizing he no longer wanted to pray publicly. “I could still perform the prayers,” he admitted. “But something inside me no longer trusted the explanations underneath them.”

This statement reflects a critical dimension of disaster moral injury: the erosion of explanatory confidence.

Repeated catastrophe exposure destabilizes not only emotional resilience, but also moral and theological coherence. Responders increasingly encounter suffering resistant to traditional interpretive frameworks. Children die despite prayer. Entire communities disappear within minutes. Vulnerable populations suffer disproportionately. Good people lose everything. Recovery unfolds unevenly and often unjustly.

Over time, responders may begin questioning not only systems, but also inherited assumptions about justice, providence, meaning, and divine action.

Importantly, this questioning does not necessarily represent loss of faith.

More often, it represents collapse of simplistic theological certainty.

As Serene Jones argues, trauma disrupts coherent narrative systems and fractures previously stable assumptions about reality and identity.^13 Disaster responders frequently inhabit this fracture repeatedly. They continue operating within faith traditions while increasingly unable to reconcile catastrophic suffering with inherited theological language that once felt sufficient.

This destabilization often produces profound loneliness.

Responders may fear speaking honestly about theological uncertainty within religious environments that reward confidence and reassurance. Clergy responders, in particular, frequently experience pressure to remain interpretively stable for survivors while privately carrying unresolved moral and spiritual questions themselves.

Yet unresolved questions continue accumulating.

The responder who remembers every child fatality years later.

The volunteer haunted by body recovery operations.

The chaplain unable to offer explanations honestly anymore.

The shelter worker emotionally unraveling after prolonged exposure to frightened families.

The recovery coordinator exhausted by institutional inadequacy.

These responders are not simply tired.

They are carrying moral weight.

And increasingly, pastoral theology must learn to recognize this burden not as peripheral to disaster response, but as central to it.

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Notes

11. Carrie Doehring, The Practice of Pastoral Care: A Postmodern Approach, rev. ed. (Louisville: Westminster John Knox Press, 2015), 39–58.

12. Bonnie Miller-McLemore, Christian Theology in Practice: Discovering a Discipline (Grand Rapids: Eerdmans, 2012), 103–121.

13. Serene Jones, Trauma and Grace: Theology in a Ruptured World (Louisville: Westminster John Knox Press, 2009), 21–44.

III. Theological Moral Injury

Among the most underexamined dimensions of disaster response is the way catastrophe gradually destabilizes inherited theological frameworks. Responders often enter disaster work sustained by deeply rooted beliefs about compassion, vocation, divine presence, justice, prayer, providence, and meaningful service. Many possess strong spiritual identities shaped through congregational life, ministry formation, caregiving traditions, or personal faith commitments. These beliefs frequently provide initial motivation for entering disaster work in the first place.

Yet repeated exposure to catastrophic suffering often transforms the theological imagination in ways responders neither anticipate nor fully understand.

Importantly, this transformation rarely occurs dramatically.

More often, it unfolds slowly.

One deployment after another.

One funeral after another.

One shelter conversation after another.

The responder who once spoke confidently about God’s purposes gradually becomes quieter. The chaplain who once offered explanations instinctively begins hesitating before speaking. The volunteer who once prayed easily finds prayer increasingly strained after repeated encounters with mass suffering. Over time, inherited theological language may begin feeling emotionally dishonest within catastrophe settings.

This experience may be described as theological moral injury.

By this I mean the moral and spiritual destabilization that occurs when repeated exposure to suffering renders previously sustaining theological explanations inadequate, morally unbearable, or psychologically unsustainable. Responders do not merely question doctrine intellectually. They experience a deeper rupture between lived catastrophe and inherited theological meaning structures.

Disaster work frequently wounds theology before it wounds belief.

This distinction is essential.

Many responders do not lose faith entirely. Rather, they lose confidence in particular explanatory frameworks that once enabled them to interpret suffering coherently. They continue believing in God while simultaneously becoming unable to speak about catastrophe using previous religious assumptions.

For example, responders often describe increasing discomfort with theological explanations that frame suffering as divinely intended, spiritually necessary, or morally instructive. Statements once offered reflexively—“Everything happens for a reason,” “God has a plan,” “The Lord needed another angel,” or “This tragedy will somehow bring good”—may begin sounding emotionally violent after prolonged exposure to catastrophic grief.

One experienced disaster chaplain admitted after years of deployment work:

“I realized I could no longer stand beside parents identifying a child’s body and tell them God had a special purpose in this.”

His struggle was not atheism.

It was moral refusal.

A refusal to force catastrophic suffering into explanatory frameworks that no longer felt ethically or spiritually truthful.

Such experiences reveal an important pastoral theological reality: disaster responders are often wounded not only by what they witness, but by the inadequacy of inherited language surrounding what they witness.

As Shelly Rambo argues, trauma frequently resists redemptive resolution narratives that too quickly move toward closure, meaning, or transcendence.^14 Trauma leaves residues. It lingers. It disrupts coherent narrative movement. Rambo’s theology of “remaining” becomes especially relevant in disaster contexts where responders continue carrying unresolved grief, unanswered questions, and emotional fragments long after deployments formally conclude.

Disaster responders often inhabit precisely this terrain of theological unfinishedness.

They continue praying while no longer certain what prayer accomplishes.

They continue offering presence while increasingly unable to explain suffering.

They continue believing in God while struggling profoundly with inherited assumptions about providence, justice, intervention, or meaning.

This internal disruption may produce shame within religious caregiving cultures that implicitly reward certainty and reassurance.

Clergy responders often feel especially vulnerable here. Congregational ministry traditionally positions clergy as interpreters of suffering. Pastors are expected to offer theological coherence during crisis. Yet repeated disaster exposure may gradually erode the emotional credibility of explanatory certainty itself. Clergy responders may continue speaking inherited theological language publicly while privately experiencing profound dissonance regarding its adequacy.

One retired minister involved in long-term disaster spiritual care described this experience poignantly:

“The longer I stayed in disaster work, the less interested I became in defending God.”

Again, this was not loss of faith.

Rather, it reflected transformation in the shape of faith.

Theological moral injury frequently moves responders away from certainty and toward humility, lament, silence, and accompaniment. The problem is that many faith communities possess limited language for this transition. Doubt is often interpreted as weakness. Ambiguity becomes threatening. Silence feels pastorally insufficient. Consequently, responders may suppress theological disruption internally while continuing caregiving externally.

Over time, however, unresolved theological strain becomes spiritually exhausting.

Prayer changes.

Many responders describe increasing difficulty praying interventionist prayers after repeated exposure to catastrophe. Others describe emotional numbness during worship or inability to tolerate triumphalist religious language disconnected from human suffering. Some continue participating faithfully in religious practice while privately feeling alienated from the certainty surrounding them.

The issue is not lack of devotion.

It is accumulated moral dissonance.

Repeated catastrophe exposure destabilizes assumptions about fairness, protection, reward, suffering, and divine action. Responders witness vulnerable populations devastated while others escape unharmed. They encounter children traumatized for reasons no coherent theology can comfortably justify. They observe recovery systems functioning unevenly despite prayers, goodwill, and compassionate effort.

Theological certainty becomes harder to sustain untouched by these realities.

As Serene Jones notes, trauma fractures the interpretive narratives through which people organize meaning and identity.^15 Disaster responders repeatedly inhabit fractured narrative environments. Their theological imaginations are shaped not primarily through abstraction, but through sustained proximity to devastation.

Consequently, responders often become suspicious of premature meaning-making.

They resist explanations that move too quickly toward redemption while suffering remains immediate and unresolved. They become wary of theological language functioning defensively rather than compassionately. Some discover increasing emotional resonance with biblical lament traditions precisely because lament permits unresolved grief without requiring explanatory closure.

This movement toward lament may represent not theological collapse, but theological maturation.

The Hebrew Scriptures themselves contain extensive traditions of protest, lament, accusation, silence, and unresolved suffering. The Psalms repeatedly refuse simplistic reconciliation. The book of Job dismantles explanatory certainty more than it resolves it. Even Christ’s cry from the cross—“My God, my God, why have you forsaken me?”—places abandonment and unanswered suffering within the center of Christian memory.

Yet many responders report that faith communities often provide limited practical space for sustained lament.

Instead, responders encounter pressure toward positivity, resilience, gratitude, or emotional recovery. While these impulses may emerge from compassion, they can unintentionally deepen moral injury by discouraging honest acknowledgment of grief, ambiguity, helplessness, and theological disruption.

This is where pastoral theology becomes critically important.

Pastoral theology possesses resources capable of accompanying people through unresolved spiritual suffering without demanding premature certainty. As Emmanuel Lartey emphasizes, pastoral care requires deep contextual attentiveness to lived human experience rather than rigid imposition of predetermined interpretive systems.^16 Responders need spaces where theological struggle can be voiced honestly without fear of spiritual judgment or institutional discomfort.

Likewise, Andrew Root argues that contemporary ministry frequently fails when it prioritizes technique, management, or successful outcomes over genuine relational presence within suffering.^17 Disaster response environments expose this limitation repeatedly. Catastrophe resists management. Human grief resists efficiency. Some suffering cannot be resolved.

Responders eventually learn this emotionally.

The question then becomes whether spiritual care systems are capable of helping responders live honestly within this knowledge.

Theological moral injury therefore invites a crucial pastoral shift.

The goal is no longer restoring untouched certainty.

The goal becomes sustaining truthful faithfulness after certainty has been disrupted.

Such faithfulness often appears quieter than earlier forms of belief.

More humble.

Less defensive.

More willing to remain beside suffering without explanation.

More attentive to presence than resolution.

Paradoxically, many responders discover that this quieter faith eventually carries greater emotional honesty than the theological certainty catastrophe gradually dismantled.

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Notes

14. Shelly Rambo, Spirit and Trauma: A Theology of Remaining (Louisville: Westminster John Knox Press, 2010), 1–24.

15. Serene Jones, Trauma and Grace: Theology in a Ruptured World (Louisville: Westminster John Knox Press, 2009), 13–29.

16. Emmanuel Lartey, In Living Color: An Intercultural Approach to Pastoral Care and Counseling, 2nd ed. (London: Jessica Kingsley Publishers, 2003), 61–79.

17. Andrew Root, The Pastor in a Secular Age: Ministry to People Who No Longer Need a God (Grand Rapids: Baker Academic, 2019), 87–112.

IV. Spiritual Care After Certainty

If disaster response frequently produces moral and theological injury, then responder care must move beyond models focused exclusively on operational resilience, emotional stabilization, or psychological symptom reduction. While these interventions remain valuable, they are insufficient for addressing the deeper moral and spiritual wounds responders often carry after prolonged catastrophe exposure.

Responders do not merely need stress management.

Many need help surviving the erosion of meaning itself.

This distinction significantly alters the shape of spiritual care.

Too often, responder support systems rely upon language emphasizing toughness, perseverance, positivity, or resilience without adequately acknowledging grief, helplessness, ambiguity, and moral exhaustion. Within some religious contexts, responders additionally encounter spiritual clichés that unintentionally deepen alienation: assurances that God remains in control, reminders to “keep the faith,” encouragement toward gratitude, or exhortations to focus on positive outcomes despite ongoing suffering.

Such responses may emerge from sincere compassion.

Yet responders frequently experience them as emotionally distancing.

One long-term volunteer described attending a post-deployment debriefing where participants were repeatedly encouraged to “focus on the victories.” She later admitted privately:

“I remember thinking, what about the people we couldn’t help? What happens to them inside us?”

Her question reveals a central failure in many responder care systems.

The unresolved dead remain psychologically and spiritually present.

So do the displaced families, the frightened children, the exhausted parents, the failed rescues, the unanswered prayers, and the moments of helplessness responders carry long after deployments conclude. Resilience rhetoric often struggles to address these lingering moral realities because it emphasizes recovery of function more than acknowledgment of burden.

Pastoral theology offers a different possibility.

Rather than demanding restoration of certainty or emotional invulnerability, pastoral care can create spaces where responders process grief, ambiguity, helplessness, anger, shame, and theological disruption honestly within relationally safe communities. This approach aligns closely with the work of Carrie Doehring, who emphasizes trauma-informed pastoral care grounded in emotional awareness, relational attentiveness, and meaning-making practices capable of engaging suffering without denial or premature closure.^18

Responders often need permission before they need solutions.

Permission to admit exhaustion.

Permission to acknowledge anger.

Permission to describe helplessness.

Permission to confess theological uncertainty.

Permission to grieve losses they could not prevent.

Permission to stop performing emotional steadiness constantly.

One experienced disaster chaplain described the relief of finally hearing another responder say aloud:

“Sometimes this work changes your faith in ways nobody prepares you for.”

The statement did not solve his struggle.

But it reduced his isolation.

This reduction of isolation becomes one of the primary tasks of spiritual care after catastrophe.

Moral injury frequently intensifies in secrecy. Responders often believe they are failing spiritually because they can no longer sustain inherited emotional or theological certainty. They interpret numbness, prayer fatigue, anger, or ambiguity as evidence of weakness rather than cumulative exposure to morally overwhelming realities. Consequently, they hide these experiences behind continued operational competence.

Pastoral caregivers must therefore cultivate environments where honesty becomes safer than performance.

This requires theological humility.

Responders frequently do not need caregivers who explain suffering. They need caregivers capable of remaining emotionally present without defensively resolving moral ambiguity. As Henri Nouwen argued in The Wounded Healer, authentic caregiving emerges not from distance above suffering, but from the willingness to enter human vulnerability honestly and relationally.^19

This insight becomes especially important in disaster spiritual care.

Responders often trust people who speak truthfully about limitation more than those who offer certainty untouched by catastrophe. Spiritual caregivers who acknowledge grief, uncertainty, and unfinishedness without panic frequently create deeper safety than those attempting to restore coherence too quickly.

Lament therefore becomes a crucial spiritual practice.

Modern Western religious culture often undervalues lament because lament resists efficiency, positivity, and emotional closure. Yet biblical traditions repeatedly preserve lament as faithful speech precisely within conditions of unresolved suffering. The Psalms contain protest, accusation, confusion, grief, silence, and unanswered questions. Job refuses simplistic explanations. The prophets cry out against injustice and abandonment. Even Christ prays from within forsakenness.

Lament allows responders to remain spiritually honest without requiring immediate resolution.

This matters profoundly.

Responders carrying moral injury often fear that acknowledging anger, confusion, or theological disruption represents spiritual failure. Lament traditions counter this fear by demonstrating that unresolved suffering belongs inside faithful speech rather than outside it.

One responder involved in multiple hurricane deployments described discovering unexpected comfort in the Psalms after years of spiritual exhaustion:

“I realized Scripture sounded more emotionally honest than most church language.”

That observation deserves careful attention.

Many responders experience greater theological connection through texts of grief, protest, and longing than through triumphalist narratives disconnected from catastrophe. Spiritual care after moral injury must therefore recover traditions capable of sustaining people through unresolved suffering rather than bypassing it prematurely.

Narrative processing also becomes essential.

As trauma theorists and pastoral theologians alike recognize, human beings require relational space to integrate overwhelming experience into meaningful narrative forms.^20 Disaster responders often carry fragmented memories, unresolved emotional residue, moral confusion, and spiritually disorienting experiences that remain psychologically unintegrated precisely because responder culture prioritizes action over reflection.

Consequently, responders frequently continue deploying without adequately processing prior deployments.

The result is cumulative burden.

One shelter worker described suddenly breaking down emotionally during what appeared externally to be a relatively minor incident involving a frightened child during severe weather. Only later did she realize the event had activated years of accumulated unresolved grief from previous deployments involving children displaced by disasters.

The psyche remembers what operations move past too quickly.

So does the spirit.

Spiritual care must therefore create rhythms of reflection capable of interrupting endless responder motion. Debriefings alone are insufficient if they focus exclusively on operational review or symptom monitoring. Responders require opportunities for theological reflection, moral processing, grief acknowledgment, storytelling, silence, ritual, and communal witness-bearing.

This work cannot be rushed.

Nor can it be reduced to technique.

As Seward Hiltner argued, pastoral care involves sustaining, guiding, healing, and reconciling dimensions that unfold relationally over time rather than through immediate problem-solving interventions.^21 Responders frequently need sustained accompaniment more than rapid emotional correction.

Importantly, accompaniment differs from rescue.

Spiritual caregivers cannot remove catastrophe from responders’ histories. They cannot restore untouched innocence or uncomplicated certainty. Nor should they attempt to erase all grief, ambiguity, or moral struggle. Some suffering properly leaves marks.

The task instead becomes helping responders remain emotionally and spiritually human within those marks.

This often requires helping responders rediscover practices of embodiment and relational connection after prolonged exposure to suffering. Many responders become emotionally detached as survival adaptation. They suppress grief to continue functioning. Over time, however, such detachment may extend beyond deployments into family relationships, congregational life, friendships, and prayer itself.

Spiritual care must gently interrupt this emotional constriction.

Not through forced emotional disclosure.

But through relational steadiness, attentive listening, contemplative practice, communal support, ritual acknowledgment, and spaces where responders no longer need to perform invulnerability.

Such care becomes especially important because disaster responders are often extraordinarily compassionate people who gradually lose access to their own tenderness under cumulative moral strain.

Helping responders recover tenderness may therefore become one of the most sacred dimensions of spiritual care after catastrophe.

⸻

Notes

18. Carrie Doehring, The Practice of Pastoral Care: A Postmodern Approach, rev. ed. (Louisville: Westminster John Knox Press, 2015), 95–127.

19. Henri Nouwen, The Wounded Healer: Ministry in Contemporary Society (New York: Image Books, 1979), 72–88.

20. See Shelly Rambo, Spirit and Trauma; Serene Jones, Trauma and Grace; and Carrie Doehring, The Practice of Pastoral Care.

21. Seward Hiltner, Preface to Pastoral Theology (Nashville: Abingdon Press, 1958), 31–54.

V. Presence Beyond Explanation

Repeated catastrophe exposure often transforms responders’ understanding of what spiritual care actually is.

Early in caregiving vocations, many responders imagine spiritual care primarily in terms of meaningful words, theological insight, emotional reassurance, or interpretive guidance. Clergy, chaplains, and faith-based volunteers frequently enter disaster settings carrying assumptions that suffering requires explanation, that faithfulness involves helping people “make sense” of tragedy, or that ministry consists largely in providing emotionally stabilizing answers.

Over time, however, catastrophe destabilizes these assumptions.

Responders discover that many forms of suffering resist explanation without diminishing human dignity. They learn that grief rarely unfolds according to theological logic. They encounter survivors whose losses cannot be morally justified without causing additional harm. They stand beside parents identifying children, families searching debris for photographs, exhausted shelter residents staring silently at cots beneath fluorescent lights, and communities whose histories disappear within minutes.

In such moments, explanation often becomes inadequate.

Sometimes it becomes intrusive.

Many responders eventually describe a subtle but profound vocational shift: they stop trying primarily to explain suffering and begin learning how to remain present within it.

This movement from explanation toward accompaniment represents one of the most significant pastoral transformations produced by disaster work.

It also reflects a deeply important pastoral theological insight.

As Thomas C. Oden argued, pastoral care is fundamentally grounded not in abstraction, but in attentive presence within concrete human struggle.^22 Likewise, Henri Nouwen emphasized that ministry often emerges less through competence or certainty than through the willingness to remain vulnerably present with wounded people without attempting to control or resolve their suffering.^23

Disaster responders frequently discover this experientially long before they can articulate it theoretically.

One responder recalled sitting beside a woman in a shelter cafeteria several days after catastrophic flooding. The woman had barely spoken all afternoon. Volunteers had offered food, information, blankets, and logistical support, yet she remained emotionally distant and visibly overwhelmed. Eventually the responder sat beside her silently for nearly twenty minutes without asking questions or offering reassurance.

Finally the woman whispered, “Thank you for not trying to fix this.”

The responder later described the interaction as transformative.

“I realized she didn’t need answers from me,” he explained. “She needed someone willing to stay.”

This realization marks an important theological turning point.

Disaster spiritual care often becomes most authentic precisely when responders relinquish the need to rescue suffering people from ambiguity, grief, or unanswered questions. Mature spiritual care shifts from controlling meaning toward bearing witness.

Bearing witness requires presence more than explanation.

It requires emotional steadiness capable of remaining near suffering without defensively minimizing it. It requires listening without immediately translating grief into lessons or redemption narratives. It requires resisting the impulse to protect theological systems at the expense of honest human pain.

This does not mean meaning disappears.

Nor does it imply that theology becomes irrelevant.

Rather, theology itself becomes reoriented through catastrophe.

Responders often discover that divine presence matters more than divine explanation. Accompaniment becomes more spiritually credible than certainty. Compassion becomes more trustworthy than interpretation. Silence sometimes becomes holier than speech.

As Shelly Rambo suggests, trauma theology must attend carefully to what remains unresolved and unfinished rather than forcing premature movement toward resolution.^24 Disaster spiritual care frequently inhabits precisely this unfinished terrain. Responders stand beside suffering that cannot yet be redeemed narratively, emotionally, or materially. Entire communities remain displaced. Survivors continue grieving years later. Some wounds do not heal cleanly.

Presence therefore becomes a theological act.

Not passive presence.

Not detached observation.

But relational willingness to remain emotionally available within suffering that cannot be controlled or fully repaired.

This form of presence carries significant moral implications for responders themselves.

One of the central dangers of moral injury is emotional hardening. Repeated catastrophe exposure can gradually narrow emotional responsiveness as a form of psychological self-protection. Responders may become increasingly detached, cynical, emotionally numb, or spiritually exhausted. Some continue functioning operationally while quietly losing access to tenderness, wonder, grief, or relational openness.

Presence interrupts this hardening.

Relational accompaniment helps responders remain human by preserving emotional connection in environments where suffering easily becomes depersonalized through repetition. When responders sit beside survivors without rushing, listen without fixing, grieve without minimizing, and remain emotionally available without demanding resolution, they resist the moral fragmentation catastrophe often produces.

In this sense, presence serves not only survivors.

It also protects responders themselves from becoming emotionally mechanized by repeated exposure to suffering.

This insight aligns closely with the pastoral theological work of Emmanuel Lartey, who emphasizes relational mutuality and contextual attentiveness within caregiving encounters.^25 Disaster spiritual care is not merely something responders do to survivors. It is a profoundly human encounter in which both parties remain vulnerable to grief, limitation, uncertainty, and moral struggle.

Such mutual vulnerability can feel frightening within responder cultures organized around competence and control.

Yet it may also represent one of the few genuine protections against moral dehumanization.

Responders frequently discover that small acts of relational presence carry disproportionate spiritual significance within disaster settings:

• sitting beside frightened children during storms,

• listening to survivors repeat stories multiple times,

• helping families search for photographs,

• sharing coffee with exhausted volunteers at three in the morning,

• praying quietly without explanation,

• or simply remaining physically present while someone grieves.

These acts often appear insignificant operationally.

Yet survivors consistently remember them.

More importantly, responders remember them too.

Because such moments restore human particularity within catastrophe’s tendency toward abstraction. Disasters easily reduce people to numbers, cases, fatalities, clients, or logistical problems. Presence resists this reduction by insisting relationally that suffering persons remain fully human and morally visible.

This insistence matters spiritually.

As Andrew Root argues, contemporary ministry frequently becomes distorted when it prioritizes outcomes, solutions, or managerial effectiveness over relational encounter itself.^26 Disaster work exposes the limits of outcome-oriented caregiving repeatedly. Some suffering cannot be fixed. Some losses cannot be repaired. Some questions remain unanswered.

Yet people may still be accompanied faithfully.

Indeed, responders often discover that accompaniment itself becomes a form of hope.

Not hope grounded in certainty.

Hope grounded in refusal to abandon one another within suffering.

This distinction profoundly reshapes spiritual care after catastrophe.

The goal is no longer restoring responders to untouched certainty or emotional invulnerability. Nor is the task helping responders avoid grief entirely. Instead, spiritual care seeks to sustain the responder’s capacity for tenderness, honesty, compassion, and relational presence despite repeated encounters with devastation.

This work is deeply theological.

Not because it resolves suffering.

But because it reflects a vision of human care rooted less in mastery than in faithful accompaniment.

In this sense, disaster responders often become witnesses to a quieter form of ministry than many initially expected.

Less triumphant.

Less certain.

More human.

And perhaps, precisely for that reason, more truthful.

⸻

Notes

22. Thomas C. Oden, Pastoral Theology: Essentials of Ministry (San Francisco: Harper & Row, 1983), 89–117.

23. Henri Nouwen, The Wounded Healer: Ministry in Contemporary Society (New York: Image Books, 1979), 39–62.

24. Shelly Rambo, Spirit and Trauma: A Theology of Remaining (Louisville: Westminster John Knox Press, 2010), 85–112.

25. Emmanuel Lartey, In Living Color: An Intercultural Approach to Pastoral Care and Counseling, 2nd ed. (London: Jessica Kingsley Publishers, 2003), 123–146.

26. Andrew Root, The Pastor in a Secular Age: Ministry to People Who No Longer Need a God (Grand Rapids: Baker Academic, 2019), 201–224.

Conclusion: Helping Responders Remain Human

Late one evening after a tornado deployment, I watched an exhausted responder walk slowly through a crowded shelter carrying coffee to volunteers beginning another overnight shift. Nothing about the moment appeared dramatic. No formal prayer was offered. No theological insight emerged. Around him children slept beneath donated blankets while displaced families stared quietly at television weather reports no one trusted anymore. The responder moved from cot to cot placing paper cups into tired hands.

At one point a volunteer looked up and whispered, “Thank you for staying.”

The sentence has remained with me because it captures something essential about disaster spiritual care that many responder systems still struggle to recognize fully.

Catastrophe changes people.

Not only survivors.

Responders too.

Repeated exposure to overwhelming suffering leaves emotional, moral, relational, and theological marks that do not disappear simply because deployments end. Responders carry accumulated grief, unresolved helplessness, moral exhaustion, prayer fatigue, and destabilized assumptions about justice, meaning, and divine action. Many continue functioning operationally long after they begin fragmenting internally.

Yet responder cultures often remain far more comfortable discussing stress than moral anguish, more comfortable naming burnout than theological disruption, and more comfortable restoring functionality than accompanying grief.

This article has argued that the language of moral injury offers an important framework for understanding the deeper wounds disaster responders frequently carry. Responders are often morally and spiritually injured not only by trauma exposure, but by repeated encounters with helplessness, preventable suffering, institutional limitation, and the gradual erosion of explanatory frameworks that once sustained meaning. Disaster work frequently wounds theology before it wounds belief. It destabilizes inherited assumptions about providence, suffering, justice, prayer, and human vulnerability.

Consequently, spiritual care after catastrophe cannot focus exclusively on resilience, emotional regulation, or operational readiness.

Responders require something deeper.

They require spaces where grief can be acknowledged honestly. Where ambiguity does not represent spiritual failure. Where lament remains permissible. Where silence is not treated as weakness. Where theological certainty is not demanded defensively. Where accumulated suffering can be witnessed rather than minimized.

Most importantly, responders require accompaniment.

As pastoral theology repeatedly reminds us, the deepest forms of care often emerge not through explanation, but through presence. Responders frequently discover this themselves through catastrophe work. Over time, many stop trying to explain suffering and begin learning how to remain faithfully near it instead. They discover that human beings rarely survive devastation because someone solved suffering intellectually. More often, they survive because someone stayed.

This insight carries profound implications for pastoral theology.

The task of spiritual care is not restoring responders to untouched innocence or uncomplicated certainty. Nor is it helping responders avoid grief entirely. Some suffering properly alters those who witness it repeatedly. The goal instead is helping responders remain emotionally, morally, relationally, and spiritually human within the realities they continue carrying.

Such care requires theological humility.

It requires recovering traditions of lament, witness-bearing, silence, and accompaniment capable of sustaining people through unresolved suffering. It requires emotionally honest communities where responders no longer need to perform invulnerability. It requires pastoral caregivers willing to remain present without rushing prematurely toward resolution.

Perhaps most importantly, it requires recognizing that moral injury is not evidence of responder weakness.

Often it is evidence that responders have continued feeling deeply in environments that reward emotional hardening.

Disaster responders regularly enter places where human vulnerability becomes painfully visible. They stand beside lives interrupted without warning. They witness grief no explanation can fully contain. They carry memories that remain emotionally unfinished for years. Yet many continue returning because they refuse to abandon suffering people entirely.

That refusal matters.

Indeed, it may represent one of the clearest theological witnesses disaster response offers.

Not certainty untouched by catastrophe.

Not triumph over suffering.

But the stubborn human willingness to remain present with one another despite suffering.

In the end, the spiritual care of disaster responders begins not by repairing certainty, but by helping responders carry catastrophe without losing their capacity for tenderness, honesty, compassion, and presence.

The task is not restoring invulnerability.

The task is helping people remain human.

Bibliography

Rita Nakashima Brock, and Gabriella Lettini. Soul Repair: Recovering from Moral Injury after War. Boston: Beacon Press, 2012.

Carrie Doehring. The Practice of Pastoral Care: A Postmodern Approach. Rev. ed. Louisville: Westminster John Knox Press, 2015.

Seward Hiltner. Preface to Pastoral Theology. Nashville: Abingdon Press, 1958.

Serene Jones. Trauma and Grace: Theology in a Ruptured World. Louisville: Westminster John Knox Press, 2009.

Emmanuel Lartey. In Living Color: An Intercultural Approach to Pastoral Care and Counseling. 2nd ed. London: Jessica Kingsley Publishers, 2003.

Brett Litz, et al. “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy.” Clinical Psychology Review 29, no. 8 (2009): 695–706.

Bonnie Miller-McLemore. Christian Theology in Practice: Discovering a Discipline. Grand Rapids: Eerdmans, 2012.

Henri Nouwen. The Wounded Healer: Ministry in Contemporary Society. New York: Image Books, 1979.

Thomas C. Oden. Pastoral Theology: Essentials of Ministry. San Francisco: Harper & Row, 1983.

Shelly Rambo. Spirit and Trauma: A Theology of Remaining. Louisville: Westminster John Knox Press, 2010.

Andrew Root. The Pastor in a Secular Age: Ministry to People Who No Longer Need a God. Grand Rapids: Baker Academic, 2019.

Jonathan Shay. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner, 1994.

Rev. Gregory C. Smith, PhD, is a retired Presbyterian Church (USA) Minister of Word and Sacrament and disaster spiritual care provider with the American Red Cross and Presbyterian Disaster Assistance. His writing and research focus on moral injury, pastoral theology, trauma, disaster response, and the spiritual consequences of long-term caregiving in catastrophic environments.