Stigma has a powerful way of preventing people from getting the treatment they need

The Q&A below is transcribed from a phone interview with Dr. Linda Carpenter, director of the Neuromodulation Clinic and chief of the Mood Disorders Research Program at Butler Hospital, for Honest Conversations.

What are mood disorders?

Mood disorders are a really broad spectrum of conditions where people have trouble with their mood, or the state that is often referred to as “spirit.” Depression is something that impacts a person’s general outlook on everything. There is a spectrum of good and bad moods, and all of us experience some bad moods sometimes. But, people with mood disorders have a medical condition, because there is persistently abnormal mood that comes with distress and dysfunction in a person’s life.

What causes mood disorders?

We know there’s no one single cause of mood disorders. We have some data that shows certain genes may be involved, and also some hormonal fluctuations, as well as certain injuries to the brain like strokes and inflammatory conditions such as multiple sclerosis. Exposure to stress seems to play a big part in depression. Research shows that sometimes depression appears to be linked to inflammatory processes in the body and functioning of the immune system. Certain medications, such as one to treat hepatitis, can cause depression in vulnerable individuals. There are lots of other contributing factors from a person’s environment, too. We know that certain diets and nutritional patterns can reduce or increase the risk of having depression symptoms.

What effect does family history have?

Events early in life, like exposure to stress and trauma, can change a person’s biology and make them more vulnerable for development of depression for the rest of their life. We are not sure why some individuals are more vulnerable and others are more resilient to the effects of stress or maltreatment in early life. Having a family history of depression suggests a person will be at greater risk for depression than other people without a history of depression among their blood relatives. But, in addition to genetics or DNA, family members share exposure to many other things in their environment. Environmental factors may be very important in shaping risk for any one person to develop a mood disorder. People who live or are raised in similar environments share things in common, like the tendency to eat certain foods and exposures to certain chemicals and organisms located in the places where they live. Often, they share similar stressors like poverty or pollution or poor diet, and it’s really hard to separate those things out when trying to size up the chance any one person will suffer from depression.

How do you differentiate between average feelings and major depression?

I think that sometimes it’s tricky for people to know if they’re just in a funk or if they’ve got to the point where they have a psychiatric disorder that needs medical attention. The way mental health professionals think about mood disorders hinges on whether the symptoms are causing the person a significant amount of distress or trouble functioning. If they’re not able to do the things they were able to do before they got into this emotional state, or if they’re having problems with work or relationships, then the persistent symptoms – which include abnormal mood and sleep and appetite and thought patterns – may represent major depression.

How is depression and bipolar disorder related?

Often people who have bipolar disorder start off just experiencing depression, same as people who are “unipolar.” Then at some point, there comes the other side of the illness: mania or hypomania. Those phases are characterized by hyperactive mental states where a person is really revved up. There’s a misconception about bipolar people, that they’re all feeling euphoric and “walking on water” with a mood that is abnormally good. The truth is that bipolar disorder is a roller coaster of a disease. People with bipolar disorder get severe lows and the highs and mixed states are not so great, they may be full or irritability or anxiety or agitation.

Why do people resist getting help?

Stigma, stigma, stigma. It’s amazingly powerful but not totally unjustified. If you have a broken foot, or a heart attack, or liver disease, you know you can take time out of work to heal your illness. Your employers, your neighbors, and everyone you encounter feel sympathy for you in your state of illness, and they talk about it with you and you get lots of support. If you start to have mental health symptoms, you can’t easily find that kind of support. If you tell others you have mental health symptoms, people around you may not know what to do, or they may withdraw. The other problem is that unlike a broken foot or a sore joint, when people are experiencing mental health symptoms, they feel like they are the symptoms and the diseases. It’s not so easy to step outside yourself and reflect on your mood and say, “Oh well, that’s not me, that’s my depression.” Unlike other types of health problems, symptoms of mental disorders may not feel so abnormal at first. People may try to understand them as a consequence of something that happened. Everyone assumes that mental illness happens to other people and not to themselves. I think most people don’t imagine, “this could happen to me just as much as a heart attack could happen to me.”

How do you help your patients?

I think taking the time to sit and talk with people, and learn about what they were like before their depression, is so important. Helping them separate themselves from their depression goes a long way. We have to understand their strengths and their pre-depression life in order to appreciate them as more than a collection of symptoms or history of treatments.

What gives you hope?

There’s so much we’ve come to understand about how the brain functions. I think psychiatry and the neuroscience involved in psychiatry is fascinating. One of the most exciting things to happen in our field since I’ve been a doctor is neuromodulation. With new non-invasive neuromodulation technology like Transcranial Magnetic Stimulation (TMS), physicians have a way to manipulate brain circuitry without anesthesia, surgery or sedation. Being able to use magnetic energy, which goes through your scalp and your tissues unimpeded, to manipulate brain function, is a huge breakthrough; it does things that medications just can’t do in the brain. TMS is a whole new area of treatment for depression that didn’t exist 10 years ago. During TMS, the patient is sitting awake and alert, listening to music through ear buds, while magnetic energy is pulsed through their scalp into their brain. A patient having TMS drives themselves into clinic each day for a 30-minute treatment, and then they can drive themselves back home afterwards.

What does the future hold?

I believe TMS could have such a broad impact on the treatment of all psychiatric disorders in the future, not only as a stand-alone treatment but also for making psychotherapies work better, for diagnosing brain disorders, and for treating a variety of other medical and neuropsychiatric brain conditions. To me, TMS is represents a powerful reason for hope for people with mood disorders.

Butler Hospital’s Programs and Services

Butler Hospital is Rhode Island’s psychiatric hospital focused on treatments, teaching and research for behavioral health. Learn about our inpatient, outpatient and partial hospital programs.

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7 comments

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  • I have been a patient at Butler Campus for 42 years at Butler with four Drs.i was diagnosed at 31 years old.i have gone for years just to keep my meds.on track.The care that I was given lead me to become a mother wife and had the best care ever.Thank you Butler and all the help I was given.I have a wonderful life.

    • Jeanne, if you need to speak with someone at any time, you can contact us 24/7 at the Behavioral Health Service Call Center, available at 1 (844) 401-0111. Butler Hospital Patient Assessment Services Department is also open 24/7, so you can come in immediately if you ever need to. And if you are experiencing an emergency or if you’re are at risk of harming yourself or others, call 911 immediately.

  • This is a doctor who really gets it. Frankly, not all do:
    “I think taking the time to sit and talk with people, and learn about what they were like before their depression, is so important. Helping them separate themselves from their depression goes a long way. We have to understand their strengths and their pre-depression life in order to appreciate them as more than a collection of symptoms or history of treatments.”

  • It is mostly because people think they can’t afford the care they so desperately need this is all nice explanations but I noticed no one mentioned what healthcare insurance you have to have in order to get help. It all sounds so easy but the elephant in the room is can people afford this period in when they find out the insurance is not covered for the care they become more depressed. So please don’t leave out the insurance part. Thank you

    • Valeria, thank you for your comment. It is equally as frustrating to us that many plans do not cover our services, however, we are committed to providing quality, medically necessary services to our patients without consideration to a person’s ability to pay. No one will ever be denied an evaluation and as part of our membership to EMTALA (https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/), we are required by law to treat and stabilize anyone that comes into our emergency department, regardless of their insurance status or ability to pay. We strive to do the right thing and we appreciate you having this Honest Conversation with us.

Butler Hospital

Dr. Linda Carpenter

Director of the Neuromodulation Clinic and Chief of the Mood Disorders Research Program at Butler Hospital


An internationally-acclaimed researcher and clinician, Dr. Linda Carpenter is one of the world’s leading experts on the novel treatment of depression with Transcranial Magnetic Stimulation (TMS). Passionately driven to help patients who are unable to find relief from depression symptoms with traditional medications, Dr. Carpenter has researched the efficacy of TMS, successfully lobbied insurance providers to cover the proven treatment, and cared for many hundreds of patients through the Neuromodulation Clinic at Butler Hospital. Also acting as chief of the Mood Disorders Research Program, Dr. Carpenter works with and supports researchers at Butler doing investigational research across the mood disorders field.

Do you need help now? The Care New England Behavioral Health Services Call Center is available 24/7 at 1 (844) 401-0111 or view our services online.