Frasier Crane and his brother, Niles, both practiced psychiatry on their popular NBC sitcom “Frasier.” Mob boss Tony Soprano had his therapist on HBO’s hit show “The Sopranos.” And HBO has even made therapy the focus of two recent shows — “Tell Me You Love Me” and “In Treatment.”

But all of these TV portrayals may actually make viewers less likely to seek psychological services themselves. That’s according to a new study by three Iowa State University psychologists.

ISU psychology professors David Vogel and Douglas Gentile collaborated with graduate student Scott Kaplan on the study of 369 Iowa State students. It explored how exposure to television shows may contribute to negative perceptions about psychological services that can lead to lower intentions to seek such services. They produced a paper titled “The Influence of Television on Willingness to Seek Therapy,” which was published in the March issue of the Journal of Clinical Psychology, a professional journal.

Unflattering portrayals of mental health professionals

Kaplan has conducted a related content analysis on television portrayals of mental health professionals. It found that they’re not favorable.

“Generally, it seems like therapists are portrayed unethically — like sleeping with the client, or implanting false memories, or talking about their clients outside the session,” Vogel said. “These are things that almost never happen with real therapists, but on a show — because they’re probably more exciting — they happen more frequently.”

“Therapists also often are portrayed as buffoons,” Gentile said. “That’s either by being the jokester, like Frasier, or by being the butt of jokes. In either case, these are not positive portrayals. They do not show the skill, expertise and ethics of professional therapists.”

But it’s not just the portrayal of the therapists that may be keeping people out of therapy. It’s also the portrayal of those who seek counseling on TV.

“If you examine the portrayal of the clients, it’s probably as bad or worse,” Vogel said. “So why would you seek therapy if you believe you’re going to be perceived negatively and you’re going to see someone who’s incompetent and not able to help you?”

Because dramas and comedies are the two types of shows that often portray psychologists and psychotherapy, the ISU psychologists asked respondents how often they watched TV comedy and drama shows. They also asked them to assess perceptions of the stigma associated with seeking professional help, attitudes toward therapy, their intentions to seek therapy for psychological and interpersonal concerns, and their feelings of depression.

TV ties to therapy stigma

The study found a positive correlation between viewers’ exposure to comedy and drama shows and their perceptions of stigma associated with seeking professional help. This stigma was then related to lower willingness to seek professional mental health services.

“One of the things that’s important to note about this particular study is that we showed that TV exposure was related to your perceptions of the stigma associated with seeking help, which has been found to be one of the main factors found from inhibiting people from seeking that help,” Vogel said. “So you perceive that yourself, and other people, would be crazy to go (to therapy).”

That’s a problem for those people who could really benefit from professional mental health services. According to Vogel, the most recent studies in the mental health field have found that about half of population experiences a situation in their lives where psychological therapy could be helpful — about 20 percent in a single year. But in a given year, only about 10 percent of the people who could benefit from therapy will seek help from a psychologist or other mental health professional.

“Mental health services are already vastly underutilized, and this cultural stigma is part of the reason,” Gentile said. “And this study suggests that this cultural stigma exists partly because of the way that psychologists and their patients are portrayed on television.”

[Mike Ferlazzo @ Iowa State University]

Though antiretroviral “cocktails” can target an active infection, they cannot get at the virus when it retreats inside the host’s T cells, where it may lie dormant for decades, waiting for an opportunity to burst forth in a fresh round of infection. What HIV hunters need is a good bird dog.

Now, Stanford chemist Paul Wender and his coworkers have found a way to synthesize better bird dogs, agents that can be tailored to flush HIV out into the open where the immune system and antiretroviral therapies can destroy it. Wender is senior author of a paper about the research in the May 2 issue of Science.

“We’re not sure how far this will go, but certainly, from a theoretical point of view, it has promise of taking therapy to the next level???that is, addressing issues related to eradication of the disease, of the virus, at least,” said Wender, the Francis W. Bergstrom Professor.

Wender and his co-workers Jung-Min Kee and Jeff Warrington have developed a way to synthesize prostratin and DPP, two compounds that occur naturally in plants, in the laboratory. Prostratin, found in the Mamala plant (Homalanthus nutans) that grows in the Samoan rainforest, has shown promise in previous studies as an activator of dormant HIV. DPP, a molecular relative of prostratin found in resin spurge (Euphorbia resinifera), which grows in arid regions, also has shown potential.

Research has been hampered, though, because the compounds are difficult to obtain, particularly in the quantities needed for practical lab work on their mode of action and therapeutic potential. The yield from both plants is low and highly variable; the availability of the plants is limited; and isolating the compound is difficult. Heavy harvesting of the wild plants, especially in Samoa, also could cause ecological damage.

But synthetic prostratin and DPP, which now can be readily made in the lab, changes that equation.

“We have now minimized, if not eliminated, the issue of availability of prostratin and DPP,” Wender said. “But equally, if not more importantly, we have opened access to other compounds that might be similar in structure but superior in function.”

Previous work done in mice by researchers at the University of California-Los Angeles indicates that prostratin, used in combination with interleukin-7, an immune system stimulator made in bone marrow, managed to flush out and eliminate approximately 80 percent of the dormant virus. But with HIV, 80-percent efficiency is not enough. Anything less than 100 percent means the virus is still lurking in the T-cells and will spring back to action as soon as an opportunity presents itself.

“Nature has produced these compounds for various reasons in the plants from which they’re derived, but certainly not to treat human maladies,” Wender said. “They’re not optimized for human therapy.”

But with synthetic prostratin and DPP available, researchers can take the basic compounds and tinker with the structure and related function. “We could find out how to improve them by reverse engineering: figuring out what is important and what isn’t important,” Wender said. “We could begin to design and synthesize molecules that would never be found in nature but might actually be therapeutically more beneficial than what has been found thus far.”

In the Science paper, Wender and his team detail how both compounds can be synthesized, but also show the initial phase of designing and making new derivative compounds.

Although prostratin has long been used by traditional Samoan healers without their patients experiencing acute side effects, it is possible that undesirable effects could show up in an immune-impaired patient taking prostratin or DPP. But Wender noted that engineering the compounds in a lab would permit scientists to circumvent these problems. “Usually these kinds of side effects are a result of a drug hitting multiple targets. So it hits one target, which is beneficial, but then it hits some other target, too,” he said. “But by modifying the structures, you could select for the beneficial activity over the non-beneficial activity.”

“It’s a little bit like draw poker,” Wender said. “The important point is that we’re not forced to use the hand we get. We’ll get a hand and we’ll return a few cards if we don’t like it, because we can keep on tuning this until we get it right, so that a royal flush, hopefully, can be realized.”

Wender’s team developed their method of synthesizing prostratin and DPP by using a renewable resource, croton oil, made from the seeds of a small tree (Croton tiglium) cultivated in Asia. They derived phorbol from the croton oil and then converted it into the structure of prostratin.

The conversion process required some engineering finesse; they had to overcome a hurdle when, by removing an oxygen atom, they triggered a series of anticipated but seemingly undesired changes.

“To the credit of my coworkers, Jung-Min Kee and Jeff Warrington, they employed a strategy that sometimes is missed,” Wender said. “Rather than fighting the flow, they went with it.” They found a way to redirect the chemical complications into a solution to the problem that proved even better than the route they had initially sought to follow.

“Eventually they produced a shorter, more economical way of connecting our starting material, phorbol, to our target, prostratin,” Wender said. The process Kee and Warrington came up with requires only five steps, which is of tremendous importance in making it economically feasible. As Wender pointed out, “steps cost money and human time.”

Wender emphasized that the work of his team is the most recent chapter in efforts of a truly global community, starting with the Samoan healers, who willingly shared their knowledge with Paul Cox, an ethnobotanist who saw them prescribing a tea made from Mamala bark for patients with hepatitis-like symptoms. Cox, in turn, sent samples to the National Institutes of Health, in hopes that the bark might have antiviral properties useful in fighting some cancers. Researchers at NIH then analyzed the bark and isolated prostratin.

Prostratin belongs to a class of compounds called tiglianes, many of which promote tumor growth, so it had no initially perceived use in fighting cancer. But NIH researchers found that prostratin was not a tumor promoter and checked to see if perhaps it could help combat HIV, which is when its remarkable ability to flush out the dormant virus was discovered. Significantly, prostratin has also been found to block uptake of the purged virus, offering yet another potentially therapeutic benefit.

“The whole effort is a testimonial to a global community working to deal with what I think is a global, and top priority, problem,” Wender said.

The research was funded by the National Institutes of Health. At the time of the study, Kee was a doctoral candidate in chemistry and Warrington was a postdoctoral scholar at Stanford. Kee is now a postdoctoral scholar at Rockefeller University, and Warrington is working in the biotech industry.

The Joint United Nations Programme on HIV/AIDS estimates that 33.2 million people were living with HIV and 2.1 million people lost their lives to AIDS in 2007. Current antiviral therapies require lifelong treatment, and patients must consistently take doses of medication on a precise schedule, which creates compliance challenges for many of them. The antiviral drugs often become ineffective as the virus develops resistance and are exceptionally costly, the last a major problem in less-developed regions of the globe.

[Louis Bergeron @ Stanford University]

The Socratic dialogue is a particular way of developing children’s, as well as adults’, thinking skills through cooperative dialogue where significant human ideas and values are discussed. By participating in Socratic seminars regularly every other week, preschool children and older students develop their thinking skills. The seminars address literature and art work, with questions such as these: is Pippi Longstocking a good friend, is Jack stupid or smart when he sells his mother’s cow for some beans, or are we born good or evil? In the beginning the students have difficulty expressing their thoughts, but with time their ability to express themselves and to examine ideas critically and logically develops.

The study included seven groups of children, five to sixteen years old. The groups were filmed during three years of philosophizing in the classroom and the films were analyzed. The interaction in the classroom was positively influenced, according to Ann S Pihlgren. The teacher dominated less, more students spoke and the students gradually took over the responsibilities of the teacher to promote exploration in the dialogue. The ability to use the Socratic seminar is learned by students and teachers through practice and by testing the rules of the seminar. The students construct a supportive group culture through their silent interaction, where gestures, glances, and body language are used to show not only support or sympathy for each other, but also cooperation with each other when someone attempts to disturb or to provoke the dialogue. The teacher role changes to one of support, ensuring that the analysis is fruitful and that the dialogue is respectful.

Socratic methods have developed independently in various countries. They all describe a set of methodological steps to attain similar objectives. An opening question is answered by all participants and followed by cooperative, critical analysis. Finally, the new ideas are connected to the everyday life experience of the participants.

It seems as if this ritualized structure and the nurturing culture of the seminar provide a safe circle, helping the participants to try new, bold ideas that they might otherwise not have tested, Ann S. Pihlgren says. By cooperating when examining the ideas they also seem to learn a way to address problems on their own without teacher intervention.

To work with methods connected to the ancient philosopher Socrates may seem out-of-date in a modern school, but that is absolutely not the case, Ann S. Pihlgren states.

The Socratic seminars have been seen as a complement to traditional classroom teaching for hundreds of years. But it is not easy to learn how to stage them to get positive effects. It is especially hard for teachers, who often fall back to their traditional, controlling “teacher” roles. The dissertation offers excellent tools for teachers who want to develop students’ thinking and to foster cooperative group dialogue.

The name of the dissertation: Socrates in the Classroom. Rationales and Effects of Philosophizing with Children. The dissertation can be downloaded as a pdf here.

[Jonas Ablad @ Swedish Research Council]