The Doctor is In

Kevin Turnquist, a psychiatrist for more than twenty years, currently cares for some of the most seriously ill patients in the Hennepin County public mental health system. The good doctor, who specializes in schizophrenia, has pretty much seen it all—such as the woman who believes that during sleep she grows extra limbs that are clandestinely harvested for Wendy’s. If that sounds outlandish, consider a recent study suggesting that one in two Americans will suffer a mental illness at some point in their lives. Nowhere does that feel truer than here in the North, where winter is widely regarded as the season of mental apocalypse. We caught up with Turnquist to discuss the reasons we crash and burn.

Why do people get depressed, or is that a ridiculously simplistic question?
That’s a great question because it goes along with the idea that there is a single cause of depression, which my profession and especially the drug companies would like to perpetuate. There are all kinds of depression. Some people react to loss. Some people react to day length. But one commonality that seems to go across all the types is hippocampal atrophy.

The hippocampus seems to thrive on new memories and experiences. Should people take more vacations?
I think everybody should take more vacations! The Australians and people like that who get six weeks to two months every year, they seem to be happier people than us.

Which produces more endorphins, good sex or good food?
If you’re starving you might get an endorphin release from food. But there is this hierarchy of needs and I think most people would vote for the good sex.

How well do psychiatrists understand the human brain?
We don’t. We’ve learned a lot in the last ten to fifteen years, but look at how that’s translated into action. If you see five different psychiatrists, and you have a mental problem, you are likely to get five different diagnoses. Fortunately it doesn’t make much difference because whatever diagnosis you get, you are likely to get the same hodgepodge of medications regardless: an antipsychotic, a mood stabilizer, an antidepressant, a minor tranquilizer. It’s fair to say that we don’t know what causes any mental disorders and we don’t know how any of our medications actually work.

Yet sometimes they do work.
Well, the bath of surprise worked, too! Where people would be led down this walkway and fall through a trapdoor blindfolded into icy water. Almost anything will work if you induce the expectation of change.

What’s so bad about antidepressants?
The new ones seem to decrease the intensity of the connection between what you think about and what you feel. It’s been likened to turning the brightness knob on your TV all the way up. So everything kind of looks the same. And you don’t really feel that bad or worried about anything, but on the other hand, nothing touches you in the way that it normally would.

Should the emphasis be on therapy instead?
I think that in the next ten or twenty years, the research will show that good psychotherapy produces genuine brain changes. I don’t want to put you in the position of having to explain amygdala versus hippocampus.

I appreciate that.
But as you start to use brain structures, the pathways become reinforced. If you are exposed to any stimulus for ninety minutes, your brain starts to build new synapses to accommodate this. We start to form new symbols, because we construct our reality with symbols, for self and other. I’ve always thought one of the key elements of good therapy is being in the presence of someone who can tolerate you for who you are, and then starting to identify with that attitude.

Why don’t we understand the brain better?
It’s so complex. We’ve taken a very reductionistic approach, which works for other organs, like the liver. But the brain doesn’t yield to that sort of thing because there is brain and then there is mind.

How would you define brain versus mind?
Oh, I wouldn’t.

In what ways are we mentally similar to our primate cousins, chimpanzees?
Sex and aggression are the two basic drives. You watch humans on the freeway and interacting with each other and we’re no different than apes fighting over who is going to sit on the sunny rock.

And the main difference between us and them?
They’re shorter.

How do we fare mentally in Minnesota?
When you look at statistics, we kind of fall in the middle in terms of mental health. I do think there is something to this latitude and seasonal affective disorder. I think for some of us it tends to make us much more unstable than we would be otherwise. I use a light box every morning, during the winter anyway.

Are northern people more neurotic than those from other parts of the world?
I’ve never seen any studies on it, but intuitively I think there is something to it. If you are living close to the equator and the weather is always pretty much the same, you don’t have this winter to prepare for every year. You might not develop the same brain structures that you do if you are living somewhere where you are looking at six months of cold and dark. And the parts of the brain that are involved, frontal lobe structures, allow us to say, “What might happen?” “How can I prepare for what might happen?” As soon as you start to really grow those structures, you can think of all sorts of terrible things that might happen. I’m really good at it. I can think of a million terrible things that may happen in the next minute.

I guess we have “spring mania” to look forward to, the rejoinder to seasonal affective disorder.
Right. The classic example is Vincent van Gogh. His wild stuff was done in the spring with brilliantly intense colors, and in the fall he tended to cut off body parts.