by Craig Rennebohm with David Paul. Boston, Beacon Press, 2008, 224 pp., $23.95.
With a sensitive and poetic touch, Craig Rennebohm and David Paul produced this wonderful series of narratives about homeless men and women. The preface of Souls in the Hands of a Tender God informs the reader that the stories presented have been collected over 30 years of Rennebohm’s ministry with homeless individuals who have suffered while contending with the onslaught of severe and chronic mental illness. I read every story in the book, and I even reread some of them, recognizing the significant objective the authors set. These narratives were intended to be “stories of struggle and recovery, suffering and hope” (p. ix). In these stories, readers are encouraged to “discover the movement of the Spirit, the touch of the Holy, the infinite tenderness of God” (p. ix). The narratives were also meant to be an antithesis to Sinners in the Hands of an Angry God, a famous sermon delivered in 1741 by Jonathan Edwards in Connecticut. Edwards utilized frightening tableaux to bring sinners to the penitential table, reminding them of being held by a slender spider’s thread over the pit of hell by a God lacking in mercy for the unrepentant sinner.
To their credit, Rennebohm and Paul consistently find a way to weave a story of their God, who is full of compassion and mercy and who can be counted on to offer a way to solace and eventual recovery. They also answer the obvious question about why mental illness should afflict anybody by making clear how the biological basis of mental disorders accounts for the existence of mental illness. The authors are ahead of Jonathan Edwards, of course, as the 18th-century preacher would not have had access to present-day developments in the neurosciences. This would have left him with no alternative but to wonder about mental illness as a result of some problem in the relationship between God and the patient.
The third chapter discusses Rennebohm’s own experience with mental illness, which started while he was a junior-year student at Carleton College. It is a spellbinding account of the horror that melancholia can wreak on its victims. In this narrative, Rennebohm takes a drive in the midst of his profound depression. He believes that it was only by the grace of God that he did not steer the vehicle into the cement supports of a bridge. He eventually guided the car off the road and ended up in a yard that housed the work remnants of someone who had been engaged in making pottery. This encounter with a potter’s field—the Biblical burial ground for homeless people—is recalled some years later as Rennebohm makes the association with the Book of Jeremiah, Chapter 18, and thinks of God as a gentle potter who “shapes and reshapes our journey with us in the direction of well-being” (p. 36). The authors employ this metaphor of the potter to cement the “image of an ever-creative, loving God” (p. 36). But the reader never learns how the authors reach this conclusion, since the 18th chapter contains Jeremiah’s entreaty to God to wreak havoc on those who object to his preaching.
The authors do not adequately explain what measures can be taken by those suffering with mental illness to dispel the terrible thoughts they have when their sickness worsens—thoughts of a nihilistic, cynical nature that lead them inexorably back to the idea that some personal inadequacy must explain their bout of sickness. So many of my patients have asked me the basic question: “Why me?” The authors of this book do not deal with this essential simplicity in an effective way—at least, not for me.
As I was finishing this text, I came across James Wood’s recent essay in The New Yorker (“God and the Problem of Suffering” [June 9 and 16, 2008, pp. 116–122]), and I recognized that Rennebohm and Paul had set themselves an impossible task. They had plunged into the business of explicating the relationship between God and suffering patients, but they avoided some obvious questions. For example, why is Terri (a homeless woman suffering from depression, seizures, and tuberous sclerosis) afflicted so profoundly as she hangs around the steps of Seattle’s St. James Cathedral with the hope that she can one day be a helper at the altar? Wood asks us the question, Is the woman’s suffering a punishment for sinful behavior, a redemptive test (Rennebohm and Paul suggest that Terri viewed her homelessness as a test of her faith that God would provide [pp. 10–11]), or just a prelude to her ultimately entering the kingdom of heaven? And when Rennebohm and Paul indicate that the Holy Spirit is with her, how does this alleviate the woman’s suffering? In fact, why does she have to suffer so very long and so very painfully? Why won’t God just step in and short-circuit it all? The consolation that they offer, in their description of another case history, is that “the Spirit is with us always” (p. 108).
Rennebohm and Paul have no answers—satisfying ones, that is—for these paralyzing questions. Neither does anybody else for that matter. But they do point out that in the midst of this helplessness, caregivers can be companions to the sufferers and can remind both the sufferers and other bystanders that the sufferers have not lost their humanity. It is this part of the text that I found wonderful. The authors redefine the conceptual basis of our caring for these unfortunate individuals who lead lives darkened by chronic, serious mental illness. In the midst of their intense suffering, we must remember that they are human beings. The very act of just offering them a glass of water or sitting quietly with them until they are able to hold a conversation—these gestures are majestically full of kindness and gracious compassion. Simple companionship is a potentially transformative act of spirituality.
Caregivers in every psychiatric or other medical service in which the diseases treated are severe and chronic should read this book. It is worth the struggle of confronting the questions about God and suffering. But it is equally important to grasp the potential significance of every act of kindness we perform in the business of caring for those who have lost their minds, for even a brief moment. This text adds dignity to the practices of all the professionals and paraprofessionals who are charged with facilitating the recovery of psychiatric patients, especially those patients who struggle with the additional jeopardy of homelessness.
Book review accepted for publication August 2008 (doi: 10.1176/appi.ajp.2008.08060948).