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Liturgy in the Shadow of Trauma

Department of Theology, University of Portland, Portland, OR 97203, USA
Author to whom correspondence should be addressed.
Religions 2022, 13(7), 583;
Submission received: 24 May 2022 / Revised: 17 June 2022 / Accepted: 19 June 2022 / Published: 23 June 2022
(This article belongs to the Special Issue Sacramental and Liturgical Theology of Healing and Crisis Rites)


Much of the work surrounding the crisis of sexual abuse in the Catholic Church has focused on how the abuse remained simultaneously widespread while being kept private, but not how the effects of the abuse impact the liturgy itself. Paying particular attention to PTSD, moral injury, and moral distress, this article examines how systemic clergy perpetuated sexual abuse (CPSA) has damaged liturgical efficacy for both abuse survivors and Roman Catholic laity. Focusing on PSTD, moral injury, and moral distress frames the issue in a way that illuminates the church’s ongoing role in preventing the healing of survivors and limiting the potential for grace in the sacraments. In light of the exploration, we suggest that in order for widespread healing we must move towards a relational ontology that realigns with the survivors and reject language and practices that blame survivors for their discomfort in the church, instead affirming the dignity in the options to seek grace and relationship with God outside of the Roman Catholic tradition.

1. Introduction

In the 2015 film, Spotlight, audiences witness a dramatized portrayal of the Boston Globe’s investigation into the sex abuse scandal in the Boston Catholic Diocese. In an effort to confirm sources, a mere 67 min into the movie, investigative reporter Walter Robinson played by Michael Keaton confronts a prominent Boston lawyer who they suspect is involved in the Church’s attempt to silence the survivors of such abuse, “We’ve got two stories here: a story about degenerate clergy, and a story about a bunch of lawyers turning child abuse into a cottage industry. Which story do you want us to write? Because we’re writing one of them”. The Boston Globe would run their investigative article into the sexual abuse crisis in the Boston Catholic Diocese in 2002 within the “Spotlight” section of their newspaper, for which the 2015 film was named. What came after would be a scrambled attempt by the Roman Catholic Church to reconcile with their actions and explain how such silence could have persisted within the church in the face of such a horrific crisis. In the early 2000s rigorous media investigations, a throng of lawsuits, significant public outcry, and an ever-growing number of reports from survivors of clergy sexual abuse forced a negligent church hierarchy to reconcile with the survivors legally, answer for their actions publicly, and attempt to spiritually reconcile for the crimes they had so willfully ignored. Following years of cover-ups and quiet settlements organized by the upper rungs of the hierarchy and their legal representation, the details of the crisis would continue to proliferate as the immense scope and scale of the crisis became painfully apparent. In media and academic writing, the focus has often been on the horrific acts by the abusive clergy and, the perhaps even more horrifying, legal and clerical bureaucracy that enabled it. The question has long focused on how this could happen. The scope of this paper, instead, intends to investigate how this crisis has affected the lay population and survivors of clergy sexual abuse. The continued focus on how this happened makes sense, especially considering the scale of the crisis within a religious institution; however, focusing purely on the actions of the clergy elides a larger conversation about the traumatic forces at work in the lives of those in the congregation, especially those who have been direct or indirect victims of the systemic sexual abuse.
This article will focus on how the systemic violence of clergy perpetuated sexual abuse has impacted the liturgical life of the Roman Catholic Church. Central to our investigation into the effects of clergy sexual abuse on liturgical efficacy is an understanding of trauma theory and the effect of traumatic experiences, such as sexual abuse, on an individual’s experience of liturgical rituals. Jennifer Beste’s research into the ability of childhood incest survivors to receive God’s grace serves as a central text that guides our discussion of trauma and the lasting psychological effects that sexual abuse wreaks on an individual’s experience of God. Beste argues that “…in situations of overwhelming violence, a person’s capacity for responsive agency can be severely disabled… [She argues] that a critical re-examination of the human capacity to receive God’s grace must include greater appreciation for how God’s love is mediated, at least in part, through loving interpersonal relations” (Beste 2003). While Beste examines the relationship between a direct survivor of incest and God, our research into clergy perpetuated sexual abuse (hereafter, CPSA) delves beyond direct survivors and into the trauma the wider lay population has experienced as a result of systemic CPSA.
Following the exposure and investigation into the crisis in the early 21st century, the church hierarchy has attempted to retain their lay population. Many clergy continue to affirm that God’s love and salvation are found only in the Catholic church. However, despite the emphasis on love and mercy, the Catholic church has failed to properly recognize and acknowledge the profound moral, spiritual, and psychological implications that systemic CPSA has had on both the survivors of such abuse and the general lay population. Exploring the sexual abuse crisis beyond a purely theological lens enhances one’s ability to fully comprehend how these psychological effects may act as barriers to fruitful participation in the church’s liturgical life. Due to the sex abuse crisis and subsequent failure by the Roman Catholic Church to reckon with the deep wounds left on the Catholic community, the liturgical space for worship in the Catholic church has been transformed from a place of solace and instead become a space of violence for survivors of CPSA.

2. Liturgical Causality and Efficacy: Offering Grace through Provocative Signs

To begin our examination of how trauma influences the experience of worship, we will first turn our attention to a description of how the rituals of liturgical worship functions. What are the desired effects of these rituals and how do the rituals cause their intended effects? To answer these questions, it is beneficial to begin with an often-quoted definition from The Catechism of the Catholic Church. In defining the liturgical rituals known as ‘sacraments’, Paragraph 1131 of the Catechism says:
The sacraments are efficacious signs of grace, instituted by Christ and entrusted to the Church, by which divine life is dispensed [praebetur] to us. The visible rites by which the sacraments are celebrated signify and make present the graces proper to each sacrament. They bear fruit in those who receive them with the required dispositions.
In short, the sacraments are liturgical rituals that exist to offer divine life to the world. The desired effect of the rituals, then, is a way of living called “divine life”. This divine life is also called “grace”, and each of the seven sacraments has a different form of grace that it offers. For example, the grace of Penance is the forgiveness of sins and trust in God’s mercy, and the grace of the Eucharist is the life of charity that adds depth to the unity of the church community. Grace, therefore, should be thought of primarily as an activity to be embodied. To illustrate this with an analogy, a parent can actively show their child love using words, gestures, and gifts. One of the primary purposes of such active love, although by no means the only purpose, is to encourage their child to imitate that active love until it becomes a part of that child’s character. In return, that child’s acquired ability to actively love also encourages others (including the parent) to love more deeply. In other words, love is a gift-economy that perpetuates itself. So it is with the grace caused by liturgical worship. Liturgical rituals communicate the grace (i.e., the divine life) of God through signs in a way that offers a real experience of God’s love to those who participate in the rituals. This is how liturgical causality works. Liturgical rituals cause grace by making God’s love truly present. However, causality is not enough to assure efficacy. Put differently, the real presence of God’s love caused through liturgical rituals is a means to an end.
To better clarify the importance of distinguishing between liturgical causality and liturgical efficacy, we would like to turn briefly to the concept of ‘validity’. Of particular concern in Roman Catholic liturgical theology, the concept of validity is used to evaluate the quality of a particular liturgical celebration. Simply put, a liturgical celebration is said to be valid when its essential components are present. These essential components are those determined and promulgated by magisterial authority.1 For example, within Roman Catholicism, most liturgical rituals have prescribed materials (e.g., water, chrism, wine), prescribed words (e.g., ‘This is my body …’, ‘I baptize you …’), prescribed personnel (e.g., ordained ministers), and prescribed recipients (e.g., only unmarried, consenting men and women may be married). At its best, concern for validity is a form of caring about how the love of God is communicated to the community so as to best assure its efficacy. Like teachers who care about spelling and grammar, liturgists who care about validity want to see effective communication. However, as any good teacher knows, too much zeal for grammar can hinder the successful formation of a good writer. Similarly, too much zeal for validity can hinder the successful formation of Christians. When we become preoccupied with the means to an end, we can easily lose sight of the end. A valid liturgical celebration assures liturgical causality, but validity is not sufficient for liturgical efficacy. In fact, it is possible for preoccupation with validity to hinder liturgical efficacy.
When addressing the concept of validity, the Roman Catholic sacramental theologian Peter Fink notes that, “It is probably the case that the sharp line drawn between valid and invalid is no longer the most helpful way to assess the truth or untruth of the sacraments. Both are minimalist judgements: either the essentials are there or not … even where the essentials are judged not to be present [i.e., the sacrament is invalid], it is difficult to dismiss the act as empty and without sacramental value; defective, perhaps, but not without value” and insufficient for achieving full efficacy (Fink 1990, p. 1299). Yes, a valid liturgical celebration successfully expresses the love of God in the way that is unique to that celebration. The secondary effect of the sacrament is caused when it is validly celebrated: the presence of Christ’s love is offered and truly present. However, that does not assure that the active life of the recipients is transformed. Perfectly offering a gift does not assure that it will be accepted and used. An English speaker might validly express their love to a crowd of people, but if no one in that crowd speaks English, the message’s primary effect (i.e., spreading love into the life of the recipients) is decidedly unrealized. Similarly, invalidity does not preclude full efficacy. Fink points out that rituals that fall short of the magisterial definition of validity do not necessarily lack the ability to communicate grace in an effective manner; these invalid rituals are not lacking in value. Serving in his role as the prefect of the Congregation for the Doctrine of Faith, Joseph Cardinal Ratzinger forcefully made a similar point in a letter written in 1993 to the Bavarian, Lutheran bishop Johannes Hanselmann. In his letter, the future pontiff emphatically affirmed the efficacy of “invalid” sacraments:
I count among the most important results of the ecumenical dialogues the insight that the issue of the eucharist cannot be narrowed to the problem of “validity”. Even a theology oriented to the concept of [apostolic] succession, such as that which holds in the Catholic and Orthodox church, should in no way deny the saving presence of the Lord in a Lutheran Lord’s Supper.
Invalidity of a ritual does not preclude its gracious effects; a misspelled word can still lead to understanding.2 In fact, what appears as a misspelled word to one culture can be the correct spelling to another culture. While they cannot be separated, any good rhetorician knows that you should not allow the medium to obfuscate the message. When we acknowledge and grasp the profoundly dynamic history of the evolution of liturgical rites, we can better understand Fink’s exhortation to focus less on questions of validity (i.e., an overly narrow focus on causality) and focus more on questions of efficacy.
Liturgical celebrations are not mechanisms that achieve their goals automatically. Again, the Catechism asserts this clearly: “From the moment that a sacrament is celebrated in accordance with the intention of the Church [i.e., validly], the power of Christ and his Spirit acts in and through it, independently of the personal holiness of the minister. Nevertheless, the fruits of the sacraments also depend on the disposition of the one who receives them” (Catechism of the Catholic Church 2000, p. 1128). St. Thomas Aquinas also emphasizes the role of the recipient’s disposition when addressing liturgical efficacy. In an appeal to the theology of St. Augustine, Aquinas writes:
As Augustine says (Tract. lxxx super Joan.), the word operates in the sacraments “not because it is spoken”, i.e., not by the outward sound of the voice, “but because it is believed” in accordance with the sense of the words which is held by faith. And this sense is indeed the same for all, though the same words as to their sound be not used by all.
Hence, according to Aquinas, liturgical rituals do not achieve their primary effects (i.e., their fruitfulness) without the faith, hope, and love of the recipient; the liturgical signs need to be understood and their message needs to be accepted.
Here, we want to suggest that translators of the Catechism’s original Latin text made a decision that perpetuates an incomplete (and ultimately harmful) understanding of liturgical causality. By translating ‘praebetur’ as ‘dispensed’, the text can seem to define sacramental causality as an objective process of production whereby something called ‘grace’ is produced and dispensed to those who participate in the ritual. In this case, grace is seen as a commodity that can be accrued and lost. The more grace one accrues, the holier one becomes. Rather, as we saw in the definition quoted above, grace is an activity, a way of life. Grace is not an invisible material that is dispensed. The Latin word ‘praebetur’ would more accurately be translated as ‘offered’. Liturgical rituals offer the grace of divine life to those who celebrate them. These rituals are provocative invitations into a life of faith, hope, and charity. Each liturgical ritual is celebrated through signs that are intended to provoke this graceful, divine way of living. Worshiping God is not an activity aimed at changing God. Rather, worshiping God is an activity that is aimed at making the life of the community more conformed to the love of God.
Bearing this distinction between liturgical causality and liturgical efficacy in mind, we can now consider the ways that trauma might influence these liturgical processes. In order to do this, we must begin by defining trauma. We turn now to a brief exposition of a seminal work by Jennifer Beste. In her 2003 article, “Receiving and Responding to God’s Grace: A Re-Examination in Light of Trauma Theory”, she argues that grace is mediated through personal relationships. (Beste 2003) Rather than seeing grace as a divine action that always “works” regardless of the state of the recipient, Beste argues that trauma has dramatic effects on how grace is mediated. Beste rightfully insists that we must take seriously the role of the human body, its psychology, and its social context if we are to pastorally recognize and facilitate the life of grace in the Church.

3. Trauma and Its Consequences

Before offering a working definition of trauma, it is important to note that the definitions of trauma are myriad. Professor of clinical psychology, George Bonanno, has pointed out that “for most of the 20th century, trauma theory remained mired in controversy over definitional and etiological issues, especially in the context of war-related dysfunction …” (Bonanno and Mancini 2012). Because the prevalent understanding of trauma was primarily rooted in the experience of war veterans, many of the original definitions of trauma originated from the situations and experiences of veterans themselves. Some of these narrow understandings of trauma remain prevalent in our society today. However, by defining trauma so narrowly we risk ignoring significant psychological issues that occur outside of war like acts of violence.
In its most basic form, ‘trauma’ is a term that comes from the Greek word for ‘wound’. According to Beste,
Trauma is generally defined as a state of being overwhelmed both physically and psychologically: it is the experience of terror, loss of control, and utter helplessness during a stressful event that threatens one’s physical or psychological integrity or both. Trauma shatters persons’ key assumptions regarding self and one’s relations to others in the world, including a sense of self-protection, personal invulnerability, and safety and predictability in the world.
This definition of trauma, a threatening and stressful event that induces a terrifying state of being overwhelmed both physically and psychologically, is broad enough to include many events beyond war-like experiences of violence. A car accident, a cancer diagnosis, the sudden death of a family member, experiencing an earthquake, and, central to this article, the experience or witnessing of CPSA are all potentially traumatic events. Here, we follow Bonanno in using the term “potentially traumatic events” because not all people experience events in the same way. (Bonanno and Mancini 2012, p. 76) While an assault might cause someone pain, it will not necessarily be experienced as traumatic. Everyone experiences potentially traumatic events differently, and their reactions to these events dynamically unfold in the days, weeks, months, and even years following the event. The effects of a potentially traumatizing event on a person or a community cannot be reduced to a homogenous pathology (Bonanno and Mancini 2012, p. 76).
Trauma can influence all aspects of the human person—mind, spirit, and body—in diverse ways. To illustrate this point, Bessel van der Kolk writes that, “trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to function”. (Van der Kolk 2015, p. 34) This has been shown to be true of systemic CPSA. Within the context of the Roman Catholic sexual abuse crisis, millions of people have been exposed to potentially traumatic events. The documentation of this crisis has been and continues to be thorough, uncovering more examples of sexual abuse perpetuated by clergy and systemic attempts at cover-ups perpetuated by bishops.3 When attempting to understand the breadth and depth of this crisis and its effects, it is crucial to acknowledge that the trauma of CPSA has not only been inflicted on those who have been directly assaulted by a clergy member. Direct acts of assault are only one aspect of the larger sexual abuse crisis; there is also the systemic nature of the abuse to consider. As Roman Catholic bishop Robert Barron has written: “As is now well established, this pattern of abuse, reassignment, and cover-up was repeated again and again across the Catholic world, fueling massive frustration of the offended parties” (Barron 2019, pp. 8–9). Obviously, Barron’s use of the term “massive frustration” here is inadequate. Beyond the trauma caused to the survivors of direct assault, there is also the trauma inflicted upon those who witness such systemic violence.
Before turning our attention to three heterogeneous forms of dysfunction that can result from trauma, it must be noted that one of the signatures of trauma that has so efficiently fueled the Catholic sexual abuse crisis is shame. In an article entitled, “Transforming Trauma: The Power of Touch and the Practice of Anointing”, theologian Mindy Makant draws attention to the role played by shame in the shadow of trauma: “… even in the midst of such traumas, even in situations where the reality of the trauma is known by others, churches—like the communities of which they are a part—often have a tacit ‘don’t ask, don’t tell’ policy as if by pretending the ugly reality of trauma is not real it will go away” (Makant 2014, p. 160). Because of this, many traumatic events within the Church, especially in relation to CPSA, are silenced and disregarded completely. The following is an attempt to work against this tendency toward silence. By examining ways that post-traumatic stress disorder, moral injury, and moral distress influence the experience of liturgical worship, we are trying to provide a framework for acknowledging the current reality of Roman Catholic liturgical worship.

4. Liturgical Efficacy in the Shadow of Trauma

Trauma can have many consequences on a person’s psychological disposition and, as we argued above, a person’s predisposition plays an integral role in the process of liturgical efficacy. In this section, we want to briefly enumerate three interrelated consequences of exposure to trauma and the ways those consequences influence a person’s experience of liturgical rituals.

4.1. PTSD Subverting Liturgical Efficacy

One of the most studied consequences of trauma is a condition known as post-traumatic stress disorder. PTSD is a term that is primarily used to describe a series of symptoms that can arise in people who have experienced traumatic events. PTSD can manifest in many ways, such as uncontrollable flashbacks of the traumatic event, avoidance of thoughts and situations that recall the traumatic event, experiencing irritability or hypervigilance, loss of hope for the future, negative self-perception, and feelings of detachment that make it difficult to maintain relationships with friends and family (Mayo Clinic 2018). Van der Kolk points out that these symptoms are beyond the control of the person experiencing PTSD.
These reactions are irrational and largely outside people’s control. Intense and barely controllable urges and emotions make people feel crazy—and makes them feel like they don’t belong to the human race. Feeling numb during birthday parties for your kids or in response to the death of a loved one makes people feel like monsters. As a result, shame becomes the dominant emotion and hiding the truth the central preoccupation.
The same can be said of the experience of liturgical rituals. PTSD can confound the goals of rituals such as baptisms, weddings, and funerals. Far from making them feel loved and divinized, participating in these liturgical rituals can leave people with PTSD feeling retraumatized and dehumanized. While there are certainly many ways in which the PTSD that results from CPSA can have negative effects on the life of the survivor, here we will focus our attention on how flashbacks can transform the experience of liturgical rituals. For survivors of CPSA, flashbacks can occur at any time, but can also be triggered by any sensory experience that provokes a memory of the traumatic event. For example, the touch of a clergy member, simply seeing a priest, or entering a church might all induce a flashback. But these flashbacks are no mere recollection of a harmful past event. For people experiencing PTSD, flashbacks are moments of reliving the violence as though it were truly happening to them again. As Van der Kolk points out, “Flashbacks and reliving are in some ways worse than the trauma itself. A traumatic event has a beginning and an end—at some point it is over” (Van der Kolk 2015, p. 67). Flashbacks, on the other hand, are a constant, uncontrollable threat that corrupts one’s everyday realities, turning life-giving events like liturgical rituals into moments of violence. This is particularly horrendous because, instead of being a source of joy and meaning, the liturgical rituals are transformed into the source of one’s ongoing trauma. When avoiding these flashbacks, one is simultaneously forced to avoid a source of grace. The resulting feelings of guilt, shame, and hopelessness are understandable. In essence, PTSD subverts liturgical efficacy because it transforms the liturgical signs meant to provocatively offer God’s love into liturgical signs that inflict the systemic violence perpetrated by the clergy.
To provide an example of how PTSD goes beyond merely inhibiting liturgical efficacy, but can also transform the liturgy into an act of violence, Christine Courtois has noted that many clerical abusers go out of their way to equate the sexual violence they inflict with liturgical rituals: “[The abusers] have been known to rationalize their abuse by telling child victims that they are purifying them in the eyes of God … that the abuse is a special way that God communicates His love or sanctifies the child” (Courtois 2012, p. 98). These rapists and their episcopal advocates are ensuring that liturgical rituals become the real presence of sexual violation and dehumanization. In a letter addressing the clergy sexual abuse scandal, Pope Benedict XVI recounted a horrifying example of how CPSA can permanently corrupt the necessary disposition for effectively reading liturgical symbols:
A young woman who was a [former] altar server told me that the chaplain, her superior as an altar server, always introduced the sexual abuse he was committing against her with the words: ‘This is my body which will be given up for you’. It is obvious that this woman can no longer hear the very words of consecration without experiencing again all the horrific distress of her abuse.
In this way, PTSD can lead to a complete loss of liturgical efficacy. Not only can the eucharistic symbols not bring about the salvific effects they intend, they now accomplish the exact opposite. In the wake of this trauma, the dominical words of consecration (i.e., “This is my body …”) that are meant to manifest and offer the love of God are transformed into diabolical words of desecration that dehumanize and destroy the love at the heart of communion. The point here is not that the individual immorality of the presiding minister renders the liturgy ineffective; that would be the heresy of Donatism. Rather, we are saying that the systemic violence of CPSA, a violence primarily perpetrated and facilitated by the Roman Catholic clergy, easily subverts liturgical efficacy for the traumatized members of the faithful, transforming the liturgy into violence.

4.2. Moral Injury Hindering Efficacy by Destroying Trust

Beyond the acute, physiological effects of flashbacks experienced with PTSD, there are other consequences of systemic CPSA that can corrupt the processes of liturgical efficacy because of the effect it has on the psychological disposition of the liturgical recipient. One such consequence is known as moral injury. Initially developed in a clinical setting where veterans were dealing with the psychological consequences of perpetuating or witnessing traumatic acts of violence, moral injury is term that names the experience of betrayal by a moral authority. Clinical psychologist Brett Litz defines “moral injury [as] the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, bearing witness to, or learning about the facts that transgress deeply held moral beliefs and expectations”. (Hodgson and Carey 2017, p. 1214) With regard to systemic CPSA, we will focus on the experience of perceived betrayal of what one believes to be morally right or just. This betrayal tends to occur in two ways: individually or organizationally.
First, moral injury can result from the perceived betrayal of one’s own personal moral standards. An awareness of perpetrating immoral acts, or failing to stop immoral acts, can provoke feelings of shame and guilt, as well as self-harm and difficulty forgiving. In short, the result is an inner conflict that destabilizes one’s sense of integrity and ability to find meaning within their own life (Hodgson and Carey 2017, p. 1214). In the context of systemic CPSA, moral injury can result when a person followed the church hierarchy’s directives to place trust in ordained ministers, only to have that trust horribly betrayed. When one becomes aware of a particular act of sexual assault or of the general, systemic cover-up of CPSA, one’s sense of moral integrity can deteriorate. One might question why they were so willing to trust the clergy or wonder why they didn’t do more to protect the survivors of the abuse. This results in a reticence to trust oneself, hindering one’s ability to accept love and to love others.
Second, moral injury can occur when witnessing a moral failure perpetrated by those with legitimate authority, such as politicians, bishops, parents, priests, teachers, etc. This form of betrayal rooted in trust can provoke feelings of anger, depression, and despair, as well as a loss of a sense of meaning and purpose. Kent Drescher, a researcher with the VA’s National Center for PTSD, describes this experience of being betrayed by moral authority as resulting in, “a disruption in an individual’s confidence and expectations about… others’ motivations or capacity to behave in a just and ethical manner” (Hodgson and Carey 2017, p. 1215). Along with the confusion and feelings of betrayal, moral injury leaves behind shame, guilt, distrust, and despair that infiltrates every aspect of a person’s life.
Both Pope Benedict XVI and Bishop Robert Barron have attested to the pervasive presence of moral injury within the laity (although they do not use the term). In a pastoral letter to the Catholic Church in Ireland, Benedict XVI writes, “I know some of you find it difficult even to enter the doors of a church after all that has occurred” (Benedict XVI 2010). In a similar pastoral letter to the Catholic Church in the United States, Barron attests to the anger and sadness he witnessed in speaking with parishioners throughout his diocese: “In their bitter words and their even more bitter tears, I would sense both a deep love for the Church and a practically bottomless disillusionment with it” (Barron 2019, p. 13). In the end, the trauma of systemic CPSA has done pervasive damage to the ability of Roman Catholics to place trust in the clergy. “A Pew Research Center report dated 11 June 2019 stated, ‘about eight-in-ten U.S. adults say the recent reports of sexual abuse and misconduct by Catholic priests and bishops reflect ‘ongoing problems that are still happening’ in the Church’” (O’Brien 2020, p. 463). The fact that this lack of trust hinders the ability of liturgical rituals to be effective should be obvious. Liturgical rituals are intended to provocatively offer the love of God through actions that are primarily accomplished by the authority of clergy. If a person cannot trust the clergy, the liturgy simply cannot be uninfluenced by that pain and doubt. While the flashbacks of PTSD can transform liturgical rituals into the real presence of violence, moral injury indicates a deterioration of trust that can stop a liturgical recipient from experiencing the liturgy as the offering of divine love it is intended to be. In other words, moral injury can preclude the predisposition necessary to receive the liturgy fruitfully.

4.3. Moral Distress Hindering Efficacy through Guilt and Powerlessness

The third consequence of systemic CPSA that we will address is known as moral distress. Moral distress has many similarities to moral injury but differs primarily in its emphasis on a person’s sense of guilt accompanied by a feeling of powerlessness and resignation. As a concept, moral distress “originated from within the discipline of nursing, and as such, the definition and early exploration of the concept have been influenced by the disciplinary culture of nursing” (Musto and Rodney 2018, p. 12). When a nurse is repeatedly placed in contexts where they become aware of participating in medical care that results in the harm of patients, moral distress can arise. Although the harm done to a patient may not be the direct result of the nurse’s decision, the nurse can develop a sense of emotional pain, fear, and guilt that hinders their ability to carry out their work effectively. Moral distress is exacerbated by a feeling of powerlessness within a hierarchical system that greatly limits the nurse’s ability to influence the trajectory of patient care.
In an article that develops a theoretical model of moral distress, professors of nursing, Edison Luis Devos Barlem and Flavia Regina Souza Ramos offer the following definition of moral distress as …
… the feeling of powerlessness experienced during power games in the micro-spaces of action, which lead the subject to a chain of events that impels him or her to accept imposed individualities, have his or her resistances reduced and few possibilities of moral action; this obstructs the process of moral deliberation, compromises advocacy and moral sensitivity, which results in ethical, political and advocational inexpressivity and a series of physical, physical [sic] and behavioural manifestations.
The feeling of powerlessness in the face of repeated, harmful behaviors results in a state of docility, resignation, and numbness. Similar to people experiencing PTSD, moral distress guilt and shame can lead a person to shut down and ignore the harm being done. Rather than exercising one’s moral agency to resist the systemic evil, someone experiencing moral distress tends to “allow themselves to accept certain contexts as unchangeable or natural, renouncing the possibility to ethically resist situations that bring about moral distress” (Barlem and Ramos 2015, p. 613).
Clergy and laity who become aware of the breadth and depth of systemic CPSA may experience a similar sense of powerlessness that results in profound sense of guilt and resignation. To put it mildly, the Roman Catholic church is a deeply clerical and hierarchical institution that is not easily changed. So, a sense of powerlessness is understandable. However, when a Roman Catholic person comes to recognize that the liturgical rituals of the church are the primary arena in which this clerical hierarchy is maintained, one begins to move beyond powerlessness to a sense of guilt for participating in a violent structure that perpetuates CPSA. By merely participating in liturgical rituals that repeatedly recognize and perform docility to clerical authority, the laity is participating in the very system that enables CPSA. From this perspective of powerlessness and guilt, these liturgical rituals cease to primarily be provocative signs of God’s love and are rather experienced as participation in systemic sexual assault. As with moral injury, moral distress hinders liturgical efficacy because it undoes the predisposition necessary to experience the liturgy as the offering of grace. If, as we said above, the liturgy is intended to provoke a grace-filled way of living, then moral distress confounds that intention and instills a sense of helplessness and resignation.

4.4. A Crucial Caveat

To conclude this section, we must acknowledge and address a danger in the preceding arguments. Namely, by insisting the trauma corrupts the predisposition necessary for liturgical efficacy, we have ostensibly located the “problem” within the survivors of systemic CPSA. In her article, “Victimization via Ritualization: Christian Communion and Sexual Abuse”, Hillary Jerome Scarsella emphatically warns against this subtle form of victim blaming. Here it will be beneficial to quote Scarsella at length:
Some theologians may prefer theories that maintain a concept of the liturgy in itself or of a liturgical essence that stands apart from its cultural construction and appropriation by ritual participants. This kind of theory, together with a conviction that the essence of the liturgy is good, would likely reason that when ritual participation results in harm, that harm ought to be traced to misinterpretation on the part of the participant and not to the liturgy itself. Such an approach succeeds in protecting the sanctity of religious ritual and posits an explanation for how the harm of sexual abuse is exacerbated through communion participation, but the conclusion that participants who are harmfully impacted by participation in religious ritual suffer merely due to their own misinterpretation is a sophisticated form of victim blaming. It turns survivors’ testimony into a weapon wielded to dismiss and invalidate survivors’ warnings that something is amiss in the broader practice of communion. In particular, since the harm in question is that of sexualized violence, we must be highly skeptical of any analytical paradigm that locates the source of harm in the one who is being harmed. We need a theoretical framework that traces the harm survivors have incurred to systems and practices that exist outside of survivors themselves.
If, as we have argued, trauma inflicts consequences (i.e., PTSD, moral injury, and moral distress) that confound liturgical efficacy, then it could be assumed that the solution would be to treat the condition and heal the survivor. Ostensibly, if the necessary predisposition can be reinstated, then the liturgical rituals themselves would not need to change. After all, according to Catholic doctrine, liturgical rituals are sacred acts of God, instituted by Jesus.
To respond to this harmful misinterpretation, we want to emphatically state that we are not locating the problem “in” the survivor. The problem is an abusive culture of systemic CPSA fueled by clericalism. The lack of liturgical efficacy is unequivocally the fault of (1) the clergy who perpetuate sexual assault, and (2) the hierarchical system (especially the episcopacy) that protects and perpetuates clerical assailants. The tragic reality is that traumatized people are not misinterpreting the liturgical rituals. Quite the opposite is true. People experiencing PTSD, moral injury, and moral distress are acutely aware of the all-too-often denied state of the Roman Catholic Church and its broken liturgical life. So, if the solution cannot simply be to heal the consequences of trauma, what should be done?

5. Conclusions: Pastoral Suggestions

If we are willing to accept the pervasive presence of trauma in the liturgical life of the Roman Catholic Church, then we must be willing to adjust our understanding of the liturgy and the way we minister to word and sacrament. Rubricism, dogmatism, and legalism, by definition, eschew pastoral concern for the traumatized and, therefore, eschew pastoral concern for the fruitfulness of liturgical rituals.4 The following suggestions focus on how Roman Catholic clergy and liturgists should reform the way they understand and speak about the place of the liturgy in the life of the church. As is often the problem with Roman Catholic sacramental theology, there is a tendency to over spiritualize the way we speak about liturgical rituals. The embodied reality of the rituals is, often intentionally, ignored in an effort to universalize and objectify the role liturgical rituals play in the life of the church. If, however, ministers and theologians acknowledge the reality of trauma and its effects, such spiritualization must cease.

5.1. Recapturing a Relational Ontology of Ordained Ministry

Our first pastoral suggestion is to work against theologies of ordained ministry that create ministers who are interchangeable liturgical symbols. The sacrament of Holy Orders is a liturgical ritual that, according to Roman Catholic doctrine, imparts an indelible character that constitutes an irreversible ontological change in the ordained minister. In other words, when a man is ordained, he is substantially changed in a manner that makes him part of a class of people who can preside at liturgies such as the eucharist, anointing of the sick, and penance. His very being, the substance of who he is, is now different from that of lay people. This ontological change that takes place at ordination is what makes a man capable of validly celebrating these liturgies. As such, whenever a Roman Catholic lay person walks into a church, a valid liturgy will occur regardless of which particular man is serving as the liturgical presider. What matters is whether he is an ordained minister. Hence, the Roman Catholic church has a practice of moving presbyters and bishops from one community to another based on the structural needs of the greater church. There are, of course, many good reasons that changes in pastoral personnel occur. However, this interchangeability can exacerbate the perpetuation of trauma’s consequences throughout the church. As we outlined above, the trauma of systemic CPSA is not simply inflicted by individual acts of sexual abuse perpetrated by clergy. It is also inflicted by the bishops and the hierarchical culture of clericalism that advocates for the power of clerics above all else. Because the presbyters and bishops are all so readily interchangeable, their sins (whether personal or structural) are also readily interchangeable. The result of this substance ontology is an ordained ministry that is fundamentally corrupted by systemic CPSA; as liturgical symbols, these men cannot function as they are intended to function. Each cleric becomes the real and painful presence of systemic violence.
Within the context of Roman Catholic liturgical rituals, an ordained minister is supposed to be the pastoral presence of Jesus for the assembly. Being a good pastor should be a matter of using one’s unique gifts to cultivate virtuous relationships within one’s flock (Belcher and Hadley 2021). Unlike substance ontologies that prioritize a minister’s ordination status, this focus on a pastor’s ability to build and support the relationships within the church is called a relational ontology. Who we are as human individuals is constantly being formed by our relationships to others. In this theology of ordained ministry, an ordination ritual doesn’t simply leave an indelible character that results in a new substance and new liturgical abilities. Rather, the ordination establishes new relationships and new roles that require ongoing care and formation. From the perspective of relational ontology, the particularity of the person who is serving as the pastor matters. They cannot simply be interchanged without significant impact on the liturgical life of the community. To be clear, a relational ontology does not preclude the possibility on a substance ontology. A theology of ordained ministry rooted in a relational ontology simply shifts from a focus on liturgical causality and validity to a focus on liturgical efficacy. A theology of ordained ministry rooted in relational ontology would prioritize how the minister is affecting the offer of grace within the context of trauma and its consequences.
The particularity of the minister and the particularity of their community matter. When the relational nature of ordained ministry is obfuscated by minimalistic concerns for validity, a virtuous and gifted minister can become the symbolic presence of systemic CPSA in a manner that triggers flashbacks, moral injury, and moral distress. A theology of ordained ministry that results in interchangeable liturgical ministers perpetuates the spread of trauma throughout the church. A relational ontology of ministry, on the other hand, mitigates the current reality wherein “one bad apple spoils the bunch”. So, we suggest that the Roman Catholic hierarchy take concrete steps to minimize the interchangeability of bishops and presbyters. For example, bishops and presbyters could be chosen from the populations they serve and remain in those communities throughout their career. Further, parishioners could have a meaningful and systemic role in choosing their pastors (e.g., parish councils conducting hiring interviews), rather than simply being asked to symbolically show their “consent” during an ordination liturgy that will proceed regardless of their response.

5.2. Avoiding the Language of Survivor Blaming

Our second pastoral suggestion is to encourage Roman Catholics (especially the clergy) to stop using rhetoric that either directly or indirectly blames the survivors of systemic CPSA for their own pain. For example, in March of 2010, Pope Benedict XVI wrote a pastoral letter to the Roman Catholics of Ireland, a country that was in the process of uncovering the depths of the scandal. In the letter, the Pope wrote:
At the same time, I ask you not to lose hope. It is in the communion of the Church that we encounter the person of Jesus Christ …. I know some of you find it difficult even to enter the doors of a church after all that has occurred. Yet Christ’s own wounds, transformed by his redemptive sufferings, are the very means by which the power of evil is broken and we are reborn to life and hope.
In this passage, we see a failure to appreciate the reality of trauma and its consequences. First, Pope Benedict fails to comprehend the nature of “losing hope”. The very fact that he believes that “not losing hope” is a decision you can request from someone is an egregious failure to properly understand the nature of trauma and its psychological consequences. Even if one wanted to argue that a nuanced theology of hope is at play in this passage, it should be noted that this is a passage from a pastoral letter, not a theological treatise. A good pastor would prioritize how their language is going to be heard by the traumatized audience they are attempting to reach. Asking the survivors of one’s own violence “not to lose hope” places the blame for their loss of hope on the victims. The loss of hope is the result of the ongoing violence being done by and through the church’s clergy. Instead of asking the faithful not to lose hope, the pope and his fellow clergy should start being worthy of it.
Another form of survivor blaming that should disappear is the language of liturgical obligations. Once the clergy acknowledge the depth of the trauma they are inflicting and the consequences it is having of liturgical efficacy, it becomes unconscionable to tell the faithful that they have an obligation to attend liturgical rituals, no matter how much nuance and contextualization is used to deliver the message. This is especially true for messages delivered during liturgies to a large and diverse assembly. Every member of the clergy should always and everywhere assume that they are in the presence of at least one person who has been traumatized by systemic CPSA. Such is the enormity of this structural sin. Given that assumption, a pastor’s job is not to emphasize that the laity have a responsibility to the liturgy. Using such language provokes guilt in someone who should be encouraged to care for themselves. If a traumatized Roman Catholic avoids mass on Sunday due to their PTSD, moral injury, or moral distress, they are in no way failing to keep the sabbath holy. That sin continues to be far more egregiously committed by those perpetuating systemic CPSA.5
The last form of victim blaming rhetoric that we will mention that should be avoided is the tendency of some Roman Catholics to congratulate fellow Catholics who refuse to leave the church. It is harmful when Roman Catholics congratulate other “committed” Catholics who have stayed and “refuse to give up on the Church”. When we encourage and congratulate those who have stayed, we risk characterizing the survivors who have left as people who have “given up” or “cut and run”.6 In so doing, we run the risk of implying that it is virtuous to stay with your abuser. This rhetoric easily induces the shame and isolation that stops survivors from escaping their pain.

5.3. Affirm the Presence of Salvation outside the Church

Avoiding language that blames the survivors and inflicts further pain, leads us to our third and final pastoral suggestion: Roman Catholics should vehemently affirm the presence of salvation outside the Roman Catholic Church. Many Roman Catholic clergy believe and preach that remaining in or coming back to the church, especially a return to the liturgical rituals of the church, will provide healing to those experiencing the consequences of personal or systemic CPSA. To return to the excerpt from Benedict XVI’s pastoral letter, he claims that “the communion of the Church” is where we “encounter the person of Jesus Christ”, and it is through this encounter that we are “reborn to life and hope”. While the pope is undoubtedly speaking in good faith and out of a desire to see people healed, he is essentially asking people to return to the site of their trauma without acknowledging the true influence of trauma on liturgical efficacy. A pastor who understands PTSD, moral injury, and moral distress cannot in good conscience assert that the liturgy continues to effectively offer grace to the traumatized. To be clear, we are not saying that Roman Catholics should deny the salvific presence of Christ in the liturgy for everyone. It is obvious that many people still find and respond to the salvific offering of God’s love in and through the liturgical rituals of the Roman Catholic Church. However, through absolutely no fault of their own, that is simply no longer true for many Roman Catholics.
So, rather than following the exhortations of Benedict XVI in 2010, we should return to the pastoral insights of Joseph Cardinal Ratzinger in 1993 from his letter to Lutheran bishop Johannes Hanselmann. As we mentioned above, Ratzinger rejected the notion that Roman Catholics need to deny the salvific presence of Jesus Christ in the eucharistic liturgies of Lutherans. Many Roman Catholics may seek and find God and healing in the liturgical rituals of other Christian churches or other religious traditions. Over the last 100 years, Roman Catholic doctrine and theology has gone to great lengths to affirm the goodness of non-Catholic traditions and the salvation they offer.7 Therefore, instead of trying to keep survivors inside the Roman Catholic Church, pastors should be working to help survivors escape violence and find a place of healing. Roman Catholics have a responsibility to help survivors into the relationships and liturgies that don’t trigger and exacerbate their trauma. In the words of Jennifer Beste, “As we realize our responsibilities as God’s collaborators, we see that another major ethical implication is the imperative to discern appropriate forms of neighbor love to counteract the conditions that harm persons’ capacity to respond to God’s grace” (Beste 2003, p. 16).
If we know that a liturgical ritual is not only ineffective but harmful, then pastoral ministers and theologians need to do what they can to protect survivors of systemic CPSA by helping them find sources of healing. Pastors should help people avoid Roman Catholic liturgical rituals by assuring them that, not only is there no sin in such avoidance, but there is also courageous and holy self-care in seeking out the ritual encounters that will help heal the physical, emotional, and spiritual trauma that has been inflicted upon them. If the survivors insist that they want to continue participating in Roman Catholic liturgies, ministers should help them determine the root of their desire. If the reasons are rooted in a fear of hell, or a fear of judgement from the community, the survivors need to be reassured that seeking God and healing elsewhere is a courageous and holy endeavor.
To be clear, we are not denying the real differences between religious traditions. The eucharistic celebrations of the Russian Orthodox Church, for example, are not completely the same as Roman Catholic eucharistic celebrations, and the Jewish faith is not the same as the Christian faith. The visions of salvation and the paths to healing that these differing traditions offer must be acknowledged and pastorally considered. However, to be pastorally considered in a manner that avoids perpetuating trauma, the health and wellness of each particular person must take precedence.

5.4. Learning from Sin

The courage of survivors to stand against systemic CPSA, especially through leaving the Roman Catholic Church, is itself a salvific message to the church. In voicing their pain and walking away from the source of violence, they are helping the Roman Catholic Church better know its own sins. In seeking their own health, survivors are simultaneously showing the church the way towards its own penance and healing. For many Roman Catholics who rightfully love their faith, this is a difficult reality to accept, because it appears that, not only are we encouraging people to walk away from the liturgical presence of Jesus, we are also admitting that the liturgical presence of Jesus can be the source of harm. However, such perceptions can be assuaged by a better understanding of ecumenism.
All too often, Roman Catholics are incorrectly taught to affirm their identity by denigrating other religious identities. Fallacies such as, “Protestants don’t believe in the real presence Jesus in the eucharist”, or “There is no salvation outside the church”, are used to assert the superiority of a Roman Catholic identity and maintain the number of members in the church. Instead, the real and salvific presence of Christ in the liturgical rituals of other churches should be affirmed. Similarly, the goodness and beauty of other religious and philosophical traditions should be affirmed. To put it bluntly (but honestly), it should be acknowledged that for many survivors of systemic CPSA, there is a real experience of having no salvation inside the church. Therefore, pastors and theologians should begin to help survivors find salvation elsewhere.
The liturgical rituals of the Roman Catholic Church have an immense amount of healing potential. Yet, when cultivating a liturgy that heals, a liturgist must always acknowledge the liturgy’s limits. In order to heal, the Roman Catholic Church must first acknowledge not just the pervasiveness of CPSA, but the multitude of ways (not just through PTSD but through moral distress and injury) CPSA has potentially affected anyone looking to participate in the liturgy. Such acknowledgement is only the beginning but is necessary for healing in the Roman Catholic Church. We hope this article can help clergy, liturgists, and theologians in this process of healing.

Author Contributions

Conceptualization, D.F.T., N.L., M.B. and K.S.; writing—original draft preparation, D.F.T., M.B. and K.S.; writing—review and editing, D.F.T., N.L., M.B. and K.S. All authors have read and agreed to the published version of the manuscript.


This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.


Jesus’ institution of the seven sacraments did not permanently establish the criteria for validity. The criteria for validity are not permanent; they change over time based on historical context.
This argument makes an assumption that should be challenged. The assumption in this analogy is that some non-Catholic liturgies are invalid (i.e., misspelled). This claim only holds true from the Catholic perspective.
In his short book, A Letter to a Suffering Church, one Roman Catholic bishop, Robert Barron, has attested to the horrifying and systemic nature of this abuse: “A group of priests in the Pittsburgh diocese acted as a predatory ring, identifying potential candidates for abuse and passing information about them back and forth. They would take Polaroid photos of the children, in one case requesting a young man to take off his clothes and stand on the bed in the attitude of the crucified Jesus. To children that they found particularly attractive they would give gold crosses to wear around their necks, so as to signal their availability to other pedophile priests. One priest raped a young girl in the hospital, just after she had her tonsils removed. Another raped a girl, got her pregnant, and then arranged for the young woman to have an abortion. A Pittsburgh priest would give homeless boys drugs, money, and alcohol in exchange for sex. And while these crimes were being committed, the priests in question were typically removed from the parish or institution where the complaint originated but then reassigned somewhere else in the diocese, free to abuse again. As is now well established, this pattern of abuse, reassignment, and cover-up was repeated again and again across the Catholic world, fueling the massive frustration of the offended parties.” pp. 8–9.
At their best, rubrics are intended to protect the faithful from liturgical abuses that might hinder liturgical efficacy. However, as we mentioned with regard to validity, an over-emphasis on rubrics mistakes the means for the end. Rubricism, dogmatism, and legalism are all examples of tendencies toward such mistakes.
As a lay Roman Catholic, I (Turnbloom) would argue that when I choose to keep my Sunday obligation, I am doing more to violate the sanctity of the sabbath than those who protect themselves by avoiding mass. Such is my own experience of moral distress as a result of systemic CPSA.
For an example of this rhetoric see: Barron (2018).
For further information on how Roman Catholic doctrine has treated the issue of salvation outside of the Roman Catholic communion, see: Ellis (2021), Pope et al. (2002), Aihiokhai (2016).


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Turnbloom, D.F.; Breen, M.; Lamberger, N.; Seddon, K. Liturgy in the Shadow of Trauma. Religions 2022, 13, 583.

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Turnbloom, David Farina, Megan Breen, Noah Lamberger, and Kate Seddon. 2022. "Liturgy in the Shadow of Trauma" Religions 13, no. 7: 583.

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