In the middle of the twentieth century, Reinhold Niebuhr became one of the most influential Protestant theologians in America. Writing in works such as Moral Man and Immoral Society and especially The Nature and Destiny of Man, Niebuhr sought to explain a stubborn feature of human existence. Why do individuals and societies capable of justice, creativity, and self-sacrifice repeatedly produce exploitation, violence, and oppression?
His answer centered on the Christian doctrine of sin. Human beings occupy a peculiar position in creation. We are finite creatures bound by limitation, vulnerability, and mortality. Yet we are also capable of self-transcendence. We can step back from ourselves, imagine alternate futures, judge our own actions, and contemplate eternity. According to Niebuhr, this tension generates anxiety. Faced with the insecurity of being finite, human beings seek to secure themselves through power, knowledge, righteousness, or control. Pride becomes the characteristic form of sin because it represents an attempt to escape creatureliness by making the self larger than it is.
Few theologians described this dynamic more powerfully. Yet the very success of Niebuhr’s account raised a question. What if not all forms of spiritual distortion look like self-exaltation? What if some people go wrong not by making themselves too large but by making themselves too small?
In 1960, Valerie Saiving Goldstein posed precisely this challenge in her landmark essay, The Human Situation: A Feminine View. Her concern was not that Niebuhr was wrong about pride. Her concern was that he had mistaken one manifestation of the human predicament for the whole of it.
Saiving observed that much twentieth-century theology described sin as self-assertion and love as selflessness. Human beings were portrayed as creatures anxious about their own survival and significance. Sin emerged when they attempted to overcome that anxiety through domination, prestige, power, or self-aggrandizement. Love, by contrast, required self-giving and self-sacrifice. The problem, Saiving argued, was that this description fit some people far better than others.
For many women, she suggested, the central temptation was not excessive self-assertion but its opposite. Instead of magnifying the self, they often struggled with what she described as “triviality, distractibility, and diffuseness,” “dependence on others for one’s own self-definition,” and the “underdevelopment or negation of the self.”
Saiving’s challenge was theological. If the human predicament has been described incorrectly, then the proposed cure may also be inadequate. A person whose problem is domination may indeed need self-sacrifice. A person whose problem is self-erasure may not.
The irony is difficult to miss. A theology built around combating pride can become remarkably effective at teaching people to surrender themselves. Yet for some people, surrender is not the problem. They have spent their entire lives surrendering. They do not need to become less visible. They need to become visible at all.
Two decades later, Susan Nelson Dunfee sharpened the argument. She observed that Christian theology had developed sophisticated accounts of pride while neglecting what she called “the sin of hiding.” Women, she argued, were often taught to confess the wrong sins. They were called to repent of self-assertion while their actual distortions remained unnamed. The result was not liberation but bondage. By failing to identify the real problem, the church inadvertently reinforced it. As Dunfee put it, Christianity had often “added to woman’s guilt and failed to call her into her full humanity.”
Dunfee’s observation remains unsettling because it exposes a possibility few theologians enjoy considering. What if some forms of spiritual distortion have been hiding in plain sight?
Most Christians know how to recognize arrogance. We recognize the executive who dominates every meeting. We recognize the pastor who cannot tolerate criticism. We recognize the politician convinced of his own righteousness. But what about the person who disappears? What about the individual who cannot articulate a personal desire apart from the expectations of others? What about the person whose identity exists entirely through service, caregiving, or accommodation? What about the person who has become so diffuse that no clear self remains to be offered to God?
These patterns rarely attract the same moral scrutiny as pride. They often appear virtuous. They can masquerade as humility, sacrifice, devotion, or service. Yet beneath the surface they may represent profound distortions of human flourishing.
At this point the discussion is often reduced to a debate about gender. Saiving’s original argument emerged from reflection on women’s experience, but the deeper question extends beyond women and men. The larger issue is whether Christian theology has sometimes universalized one manifestation of spiritual distortion while overlooking others.
One of the difficulties in evaluating Saiving’s critique is determining whether she identified a genuine blind spot in Christian anthropology or merely described patterns associated with a particular social location. Even if one grants her observations, an obvious question remains. How would we know whether these neglected manifestations of spiritual distortion actually occur with any regularity? More importantly, how might they be recognized apart from the theoretical frameworks that first identified them?
However, critique alone cannot carry the argument very far. If pride is not the only recognizable expression of fallen humanity, what other patterns should theology attend to? How might they be described? How might they be distinguished?
A similar question was being explored from an entirely different direction within the field of professional chaplaincy. While theologians debated the nature of sin, hospital chaplains were wrestling with a different problem altogether: How does spiritual distress actually present itself in human lives? Physicians diagnose disease. Psychologists assess cognition, emotion, and behavior. What exactly does a chaplain assess?
The question proved surprisingly difficult. Spiritual distress is notoriously resistant to measurement. Unlike blood pressure, it cannot be observed directly. Unlike depression, it rarely presents through a standardized cluster of symptoms. Two patients facing identical diagnoses may exhibit radically different forms of suffering. One becomes consumed with questions of meaning and purpose. Another focuses almost exclusively on fractured relationships. A third struggles primarily with worth, identity, belonging, or abandonment. The external crisis may be the same. The internal experience is not.
Out of decades of clinical observation emerged the Spiritual Assessment and Intervention Model, commonly known as Spiritual AIM. Developed through more than twenty years of chaplaincy practice and supervision, the model arose from a simple but profound observation: human beings do not experience spiritual distress in identical ways. Its architects repeatedly noticed that patients confronting illness, mortality, loss, and uncertainty tended to cluster around recurring concerns. Some wrestled primarily with questions of meaning and direction. Others with self-worth and belonging within community. Still others with reconciliation, forgiveness, love, and broken relationships. Rather than reducing these patterns to personality types or psychological traits, Spiritual AIM proposed that they reflected differing primary spiritual needs that become especially visible under conditions of crisis.
At first glance, this framework appears far removed from the concerns of Saiving and Dunfee. Spiritual AIM was not developed as a theory of sin. It was not designed to critique Niebuhr. Its architects were not attempting to revise theological anthropology. They were trying to understand why people suffer differently.
Yet this distance is precisely what makes the convergence so intriguing. Saiving and Dunfee argued that theology had become adept at recognizing certain manifestations of spiritual distortion while overlooking others. Spiritual AIM arrives at a similar conclusion from an entirely different discipline, identifying recurring and distinguishable patterns of spiritual struggle that emerge under crisis.
The convergence becomes particularly interesting when one considers Spiritual AIM’s category of Self-Worth and Belonging to Community. The category begins with the assumption that human beings have a fundamental need to know that they are valued, that they belong, and that they have a meaningful place within a community. When this need comes under threat, distress often emerges through concerns of identity, worth, acceptance, and belonging. Yet what makes these struggles difficult to recognize is that they frequently appear under the guise of virtue. Patients may minimize their own needs, resist receiving care, avoid burdening others, or define their value almost entirely through service, caregiving, and responsibility toward others.
Their distress does not manifest through domination or self-assertion but through self-effacement. In this respect, Spiritual AIM begins to illuminate the same territory that concerned both Saiving and Dunfee. The problem is not merely wounded self-esteem. It is the tendency to disappear into relationships, roles, and responsibilities to the point that one’s own personhood becomes difficult to recognize.
Spiritual AIM is not a theory of sin. Its categories are not descriptions of vice. Meaning and Direction, Self-Worth and Belonging to Community, and Reconciliation are not pathologies to be overcome. They are fundamental human needs. Every person requires meaning. Every person requires belonging. Every person requires love. To lack these things is not holiness. It is deprivation.
This distinction matters because spiritual distress and spiritual distortion are not identical. A patient wrestling with the loss of identity brought on by cancer is not necessarily exhibiting a moral failure. A father fearful of becoming a burden to his family is not automatically trapped in sin. A woman grieving the loss of the caregiving role that once gave structure and purpose to her life is experiencing a real spiritual wound. Distress itself is not the problem.
Yet crisis has a way of exposing the places where distortion takes root. When meaning becomes threatened, faith itself becomes vulnerable. Some respond by grasping for certainty and control. Uncertainty becomes intolerable. Every unanswered question demands an answer. Every ambiguity must be resolved. The need for meaning hardens into the need for mastery. Others move toward despair. Hope gives way to cynicism, resignation, or nihilism. The search for meaning collapses into the conviction that no meaning exists to be found.
When belonging becomes threatened, the temptation is often self-erasure. The desire to be loved collapses into the need to be needed. Worth becomes inseparable from usefulness. One’s identity becomes dependent upon the approval, affirmation, or expectations of others. What began as a legitimate desire for community becomes the gradual disappearance of the self.
When reconciliation becomes threatened, the temptation is often blame, resentment, or domination. The desire to love and be loved becomes consumed by conflict. Relationships become battlegrounds rather than gifts. Energy is devoted to controlling, accusing, or correcting others rather than restoring communion.
The distortion, in each case, is not the need itself. The distortion emerges in the way the need is pursued. This distinction helps explain why certain manifestations of spiritual struggle are so difficult to recognize. Pride announces itself. Domination attracts attention. Control is visible. Self-erasure is quieter. It often disguises itself as virtue. The person who never asks for help appears generous. The person who consistently places others first appears selfless. The person who suppresses every personal desire appears sacrificial. Yet self-sacrifice and self-negation are not the same thing. Christianity calls people to love their neighbor as themselves, not instead of themselves. One cannot offer oneself in love if no self remains to offer.
This, perhaps, is where the significance of Saiving’s critique and Spiritual AIM’s observations finally converge. Both draw attention to dimensions of human experience that can be overlooked when spiritual distortion is described too narrowly. One arrives there through theological reflection. The other through clinical observation. Together, they suggest that Christian anthropology requires a richer descriptive vocabulary than pride alone.
The language available to a tradition shapes what it can recognize, what it can challenge, and what it can heal. When entire patterns of spiritual distress remain unnamed, they are easily mistaken for personality, temperament, maturity, or even virtue. The person struggling with control is often visible. The person disappearing into caregiving, usefulness, responsibility, or the needs of others may be far less so.
This is where the contribution of Spiritual AIM may be especially valuable. Its primary achievement is not the creation of new categories but the cultivation of attention. By listening for recurring spiritual needs rather than beginning with predetermined assumptions about how distress should appear, chaplains are trained to notice dimensions of human experience that might otherwise remain hidden.
For pastors, spiritual directors, and chaplains, this kind of assessment offers more than a diagnostic tool. It offers a way of seeing. Spiritual care depends upon the ability to discern what is actually occurring beneath the surface of a person’s words, behaviors, relationships, and questions. The same underlying crisis may emerge through very different concerns.
Spiritual assessment, therefore, becomes an essential pastoral task. Before spiritual care can guide, encourage, challenge, or heal, it must first learn to recognize what is present. The work of spiritual care begins by learning to see more clearly.
Oh someone's been reading my mail.... Thank you for these great thoughts to mull over. Will definitely need to reread this!