Review of Anxious Experts: Disaster Response and Spiritual Care from 9/11 to the Climate Crisis By Joshua Moses, Philadelphia: University of Pennsylvania Press, 2022, 224 pp.

Reviewed Book

Anxious Experts: Disaster Response and Spiritual Care from 9/11 to the Climate Crisis By Joshua Moses, Philadelphia: University of Pennsylvania Press, 2022, 224 pp.

Anxious Experts: Disaster Response and Spiritual Care from 9/11 to the Climate Crisis. Joshua Moses, Philadelphia: University of Pennsylvania Press, 2022, 224 pp.

Cover of Anxious Experts (2022)

Karla Vermeulen

SUNY New Paltz

Joshua Moses’s Anxious Experts: Disaster Response and Spiritual Care from 9/11 to the Climate Crisis is a fascinating account of a critical period in the evolution of Disaster Mental Health and the early tension between mental health experts and spiritual care providers for dominance in the field. Incorporating emotional and psychological reactions to disasters in the broader emergency response system is remarkably recent, paralleling the addition of Post-Traumatic Stress Disorder to the Diagnostic and Statistical Manual in 1980. Only then did the American Red Cross begin to incorporate mental health impacts in their disaster response, which then gradually trickled down into federal, state, and county disaster planning. Concern with those emotional needs continues to grow today, in part due to the recognition of the human suffering these events cause. From the perspective of emergency response organizations, it also acknowledges how these typical psychological effects can prevent survivors from participating in their own recovery, thereby placing demands on the response community that could be reduced by kick-starting people’s resilience and ability to help themselves. Within this context, Anxious Experts delineates how the much longer history of pastoral care for those in distress alternately informed and competed with the newer field of secular Disaster Mental Health, a dynamic that continues today.

Moses’s text is grounded in his own experiences volunteering in New York City after the attacks of 9/11, allowing him to directly observe how the scale and shock of the attacks led to an unprecedented level of both political attention and financial support for the mental health needs of survivors. As in any situation where human need is matched by ample but not unlimited resources, this led to some competition between the two main camps who felt they were best equipped to address emotional needs: mental health professionals and spiritual care providers. 

Unsurprisingly, the mental health professionals began with the advantage in this tension between collaboration and competition across fields, as Moses observes that emergency response organizations work from a secular perspective that needs to maintain a divide between church and state. Throughout the book, Moses deftly outlines how members of faith communities, including both individual clergy members and members of broader groups like the New York Disaster Interfaith Services (NYDIS) struggled to establish and maintain a role within the official response system. Part of this struggle included the need to provide empirical evidence for the efficacy of spirituality as a source of healing, which is far more difficult to demonstrate then the effectiveness of more routinized mental health interventions. As Moses notes, this conflict leads to a contradictory form of spirituality, “a meaning-focused expertise that has just enough spirituality to look different from secular mental health practices but not too much” (p. 44). In this context, spirituality must appear understandable and safe, but as Moses demonstrates, this façade does not hold: When it comes to supporting disaster survivors, the meaning-making that pastoral care emphasizes is “not without political and theological implications” (p. 45), leading to what he describes as “bureaucratic spirituality,” which tried (not always successfully) to address emergency managers’ concerns about how to ensure pastoral care provider were properly qualified and credentialed to be included in disaster response plans.

According to Moses, this tension between mental health and spiritual care raises broad questions about the role of spiritual care in disaster response, like whether faith-based helpers are more effective than secular mental health providers at helping survivors find meaning in tragedy (an outcome both camps would agree is essential for processing a significant disaster or loss). It also impacts practical questions, such as how to ensure spiritual care providers will not use their contact with survivors to proselytize, and how to certify whether they have adequate training in basic trauma reactions to know when a referral to a mental health professional is needed. Notably, there is little reciprocal focus on this last point in most trainings for secular helpers to be able to understand when a survivor is experiencing a spiritual crisis and could benefit from referral to a chaplain, demonstrating how dominant the secular approach remains in the disaster response field, despite how beneficial more spiritual interventions are for many people.

Moses intersperses his main chapters with “interludes” describing in-depth interviews or experiences with spiritual practitioners, including a body worker who uses massage to help release the physiological effects of trauma, a chaplain who claims to help people communicate with the dead using “induced after-death communication,” and a woman who calls herself “the Prophetess” who believes God speaks through her to predict disasters. Most of these interludes appear to reinforce mainstream concerns about the evidence-free interventions offered by those on the fringes of the spiritual world, which bolsters that mistrust of faith-based helpers. Unfortunately, Moses did not discuss any in-depth profiles of spiritual care practitioners who effectively navigated the faith vs. psychology divide in supporting disaster survivors, which would have added nuance to readers’ understanding of faith-based care.

Critically, Moses expresses appropriate concerns about a training he attended in Pastoral Crisis Intervention (PCI), the faith-based version of Critical Incident Stress Management (CISM). This response approach was developed in the 1980s to support first responder groups who had trained together, responded together to a particularly traumatic event, and now needed a way to process that experience together. These debriefings, in which responders came together within days after the event to discuss what happened and to process their reactions, were later used with the general public, where it became clear they not only didn’t reduce extreme reactions like PTSD, but risked causing it. Moses importantly calls attention to how this approach was overly mechanistic, describing how trainings offered little room “for a world where things simply don’t make sense,” unfortunately isolating people from the ways pastoral care usually helps people find meaning in unexplainable tragedy (p. 109). 

Moses concludes by tying 9/11 to broader concerns about the state of the world: “On the one hand, the attacks of 9/11 were a discrete event, with a beginning and an end. On the other hand, they marked the threshold into an era of an intensified sense of risk and instability, where disaster and disruptions caused by global threats, particularly the climate crisis and its reverberating day-to-day catastrophes, have become a way of life with no imaginable conclusion: an endless Age of Anxiety” (p. 151). In a text that would be most of interest to scholars of anthropology, but which also can educate secular disaster mental health providers about the significant role pastoral care can play in a coordinated response, Moses leaves the reader with existential questions about how religion, spirituality, and the mental health professions might all intersect to find meaning in disaster—thought-provoking questions with no simple answers in our increasingly precarious modern world.