E. Morton Jellinek

Elvin Morton Jellinek (1890-1963), E. Morton Jellinek, or most often, E. M. Jellinek, was a biostatistician, physiologist, and an alcoholism researcher. He was born in New York City and died at the desk of his study at Stanford University on 22 October 1963. He was fluent in nine languages and could communicate in four others. Addiction researcher Griffith Edwards holds that, in spite of Jellinek's apparently invented doctorate, Jellinek's The Disease Concept of Alcoholism was a work of outstanding scholarship based on a careful consideration of the available evidence.^[1]

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Academic career

Jellinek studied biostatistics ^[2] There is no evidence of that he ever received any undergraduate degree from Berlin, Grenoble, or Leipzig. Jellinek's claim to have earned a Master of Education degree at the University of Leipzig in 1914 has never been substantiated and his claim to have earned a Doctor of Science degree from the University of Tegucigalpa in Honduras in 1935 has, also, never been substantiated.^[3] Whilst initially, his publications were signed "E.M. Jellinek, Sc. D. (Hon.)", it was not long before he dropped the "(Hon.)," leading others to mistakenly believe that the degree was earned. In 1956, he received an honorary Doctor of Surgery from the University of Chile.

During the 1920s, he conducted research in Sierra Leone and at Tela, Honduras. In the 1930s he returned to the U.S.A. and worked at the Worcester State Hospital, Worcester, Massachusetts, from whence he was commissioned to conduct a study for the Research Council on Problems of Alcohol. The eventual outcome of his study was the 1942 book, Alcohol Addiction and Chronic Alcoholism.

From 1941 to 1952, he was Associate Professor of Applied Physiology at Yale University. In 1952 he was engaged by the World Health Organization in Geneva as a consultant on alcoholism, and made significant contributions to the work of the alcoholism sub-committee of the W.H.O.'s Expert Committee on Mental Health.

Upon his retirement from the W.H.O. in the late 1950s, he returned to the USA. In 1958 he joined the Psychiatry Schools of both the University of Toronto and the University of Alberta, and in 1962, he moved to Stanford University in California, where he remained until his death.^[4]

Alcoholism and the will

Several events are significant in the gradual evolution of the notion that "alcoholism" is both (a) the cause of the drinking problems of an individual,^[5] and (b) a treatable "disease".

Perhaps the first to speak of such things was Socrates; who, in Plato's dialogue Protagoras,^[6] questions Protagoras about how one might possibly explain, especially in relation to the "pleasures of food, and drink and sex",^[7] why it is, when they are driven by desire (hedone, ηεδονε), "that many people who know what is best and are not willing to do it, though it is in their power, but do something else"^[8] (Taylor, 1976, pp.46-47).

The early Christian, Paul of Tarsus described a similar state of affairs:

For that which I do I allow not: for what I would, that do I not; but what I hate, that do I. (Romans, 7:15)

The Scottish physician Thomas Trotter (1760-1832), was the first to characterize excessive drinking as a disease, or medical condition.^[9]

The American physician Benjamin Rush (1745-1813), a signer of the United States Declaration of Independence -- who understood drunkenness to be what we would now call a "loss of control" -- was, perhaps, the first to use the term "addiction" in this sort of meaning.^[10]

My observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly and entirely. 'Taste not, handle not, touch not' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance.^[11]

Rush argued that "habitual drunkenness should be regarded not as a bad habit but as a disease" -- essentially a disturbed, distressed, and uncomfortably destabilized condition (i.e., dys-ease) rather than an actual illness -- describing it as "a palsy of the will".^[12]

Rush’s contribution to a new model of habitual drunkenness was fourfold: First, he identified the causal agent—spiritous liquors; second, he clearly described the drunkard’s condition as a loss of control over drinking behavior—as compulsive activity; third, he declared the condition to be a disease; and fourth, he prescribed total abstinence as the only way to cure the drunkard.^[13]

The French Psychologist, Théodule Ribot (1839-1916), spoke of Les Maladies de la volonté ("diseases of the will").^[14]

Jellinek and alcoholism as a disease

In 1849, the Swedish Physician Magnus Huss (1807-1890)^[15] was the first to systematically classify the damage that was attributable to alcohol ingestion. Huss coined the term alcoholism and used it to label what he considered to be a chronic, relapsing disease.^[16]

Jellinek coined the expression "the disease concept of alcoholism",^[17] and significantly accelerated the movement towards the medicalization of drunkenness and alcohol habituation.

Jellinek’s initial 1946 study was funded by Marty Mann^[18] and R. Brinkley Smithers^[19] (Falcone, 2003). It was based on a narrow, selective study of a hand-picked group of members of Alcoholics Anonymous (AA) who had returned a self-reporting questionnaire.^[20] It is certain that a biostatistician of Jellinek’s eminence would have been only too well aware of the "unscientific status" of the "dubiously scientific data that had been collected by AA members".^[21]

In his 1960 book he identified five different types of alcoholism,^[22] and defined them in terms of their abnormal physiological processes:^[23]

In order to differentiate alcoholism not just diachronically, along a time line but also synchronically across groups of people, thus distinguishing types of alcoholics in a way that ran quite counter to the AA emphasis on the unity of all alcoholics, Jellinek came up with the idea of grouping different drinking patterns and naming them by giving each a Greek letter. One might think that the purpose of such a classification is to expand the range of alcoholism and include as many people as possible under the "disease concept"; but, contrary to what the title suggests, Jellinek's 1960 magnum opus in fact tries to limit the scope of the "disease concept", stating that most of the types described might be alcoholics, but they are not diseased — because they do not stiffer from "loss of control".^[24]

• Alpha alcoholism: the earliest stage of the disease, manifesting the purely psychological continual dependence on the effects of alcohol to relieve bodily or emotional pain. This is the "problem drinker", whose drinking creates social and personal problems. Whilst there are significant social and personal problems, these people can stop if they really want to; thus, argued Jellinek, they have not lost control, and as a consequence, do not have a "disease".
• Beta alcoholism: polyneuropathy, or cirrhosis of the liver from alcohol without physical or psychological dependence. These are the heavy drinkers that drink a lot, almost very day. They do not have physical addiction and do not suffer withdrawal symptoms. This group do not have a "disease".
• Gamma alcoholism: involving acquired tissue tolerance, physical dependence, and loss of control. This is the AA alcoholic, who is very much out of control, and does, by Jellinek's classification, have a "disease".^[25]
• Delta alcoholism: as in Gamma alcoholism, but with inability to abstain, instead of loss of control.
• Epsilon alcoholism: the most advanced stage of the disease, manifesting as dipsomania, or periodic alcoholism.

While Jellinek's classification draws a clear (if arbitrary) line between the garden-variety alcoholic and the truly diseased alcoholic, it does not draw such a clear boundary between alcoholism in general and normal drinking. This is Jellinek's Achilles' heel . . .

By relying on cultural norms to define several of his types, he implicitly gives up the project of providing a single, objective, universally valid clinical definition of alcoholism, and opens the door to anthropological nominalistic definitions along the lines of "whatever is normal drinking in that particular culture is normal drinking". (Valverde, 1998, p.112)

The so-called "Jellinek curve" ^[26] is derived from this classification of Jellinek, and it was named out of respect for Jellinek’s work.^[27] Jellinek later completely dissociated himself from this chart's representations; however it is still known as the "Jellinek curve".

• 1945: The American Medical Association recommends borderline limits to determine alcohol influence in the suspected drunken driver.
• 1951: The World Health Organization recognized alcoholism as a medical problem.
• 1956: The American Medical Association declared alcoholism to be a treatable illness.
• 1960: The American Medical Association states that a blood alcohol level of 0.1% should be accepted as prima-facie evidence of alcohol intoxication.
• 1965: The American Psychiatric Association declared that alcoholism was a disease.
• 1966: The American Medical Association declared that alcoholism was a disease.^[28]

Other contributions

In post-war 1946, pharmaceutical chemicals were in short supply. A headache remedy manufacturer found that supplies of one of its remedy’s three constituent chemicals was running out.

They asked Jellinek, then at Yale, to test whether the absence of that particular chemical would affect the drug’s efficacy in any way. Jellinek set up a complex trial -- with 199 subjects, divided randomly into four test groups -- involving various permutations of the three drug constituents, with a placebo as a scientific control. Each group took a test remedy for two weeks. The trial lasted eight weeks, and by the end of the trial all groups had taken each test drug for two weeks (although each group took them in a different sequence).

The trial eventually demonstrated that the chemical in question did make a significant contribution to the remedy’s efficacy.

Over the entire population of 199 subjects, 120 of the subjects responded to the placebo, and 79 did not.

In the process of examining the data produced by his trial, Jellinek discovered that there was a significant difference in responses to the active chemicals between the 120 who had responded to the placebo and the 79 who did not.

Jellinek (1946, p.90) described the 120 as being "reactors to placebo", and this seems to be the first time that anyone had spoken of either "placebo reactions" or "placebo responses".^[29]

See also

• Addiction
• Akrasia
• Alcoholics Anonymous
• Alcoholism: A Disease? Pro and Con
• Disease model of addiction
• Drug tolerance
• Placebo (origins of technical term)
• Stanton Peele

Notes

1. ^ Griffith Edwards. Alcohol: The World's Favourite Drug. 1st US ed. Thomas Dunne Books: 2002. ISBN 0-312-28387-3. P 98.
2. ^ and physiology at the University of Berlin from 1908 to 1910. He then studied philosophy, philology, anthropology, and theology for two years at the Joseph Fourier University in Grenoble. He was also enrolled,, apparently concurrently, at the University of Leipzig from 25 November 1911 to 29 July 1913, and from 22 November 1913 to 2 December 1914 for classes in languages, linguistics and cultural history.
3. ^ In 1935, the University of Leipzig bestowed an honorary Doctor of Science degree upon him,(1997, p.1620)
4. ^ For more information, see 1964 obituary in The American Journal Of Psychiatry [1]
5. ^ That is, rather than identifying individuals as "alcoholics" simply because they ingest alcohol, this view strongly asserts that these individuals ingest alcohol because they are "alcoholics".
6. ^ At 352a1-357e8
7. ^ 353c
8. ^ 352d
9. ^ Trotter (1804/1988)
10. ^ Levine (1978/1985)
11. ^ Rush; taken from Levine (1985), p.47.
12. ^ Valverde (1998, p.2). Rush expounded his views in Rush (1808). They are briefly described in both Levine (1978/1985) and Valverde (1998).
13. ^ (Levine, 1985, p.47)
14. ^ Ribot (1894).
15. ^ He was physician to the Swedish kings Charles XIV and Oscar I.
16. ^ The term first appeared (in 1849) in the Swedish edition of Alcoholismus Chronicus, or Chronic Alcohol Illness. A Contribution to the Study of Dyscrasias Based on my Personal Experience and the Experience of Others, which was soon translated to German (1852) and later into English.
17. ^ It also appears as the title of his 1960 book, The Disease Concept of Alcoholism.
18. ^ Marty Mann (1905-1980), the first female member of Alcoholics Anonymous
19. ^ In his lifetime, R. Brinkley Smithers (1907-1994) -- an American philanthropist, and founder of the Christopher D. Smithers Foundation, which had been named after his father, an IBM founder (via the Computing Tabulating Recording Corporation), and a Director of IBM (1913-1952) -- a self-styled "recovering alcoholic", donated more than $US40 million to alcoholism programs; $US13.5 million through the Smithers Foundation, and $US28 million from his own his personal funds.(Peele[2])
20. ^ Of the 158 questionnaires returned, Marty Mann selected 98; and it was upon this hand-picked population that Jellinek’s reported in his 1946 study.
21. ^ Valverde (1998), pp.110-111; Valverde also observes that the AA questionnaire that was the source for Jellinek's classification only had relevance to "the experience of white, male, middle-class alcoholics in the 1940s" (p.110).
22. ^ It is significant that he produced no data to back up his arbitrary divisions.
23. ^ Jellinek's systematic categorization system soon became accepted as a scientific and comprehensive theory of alcoholism amongst those who subscribe to the "disease concept of alcoholism"
24. ^ Valverde, 1998, p.111.
25. ^ "It is characterized by binge drinking and a slow downward slide into helplessness"(Valverde, 1998, p.112).
26. ^ [3]
27. ^ [4]
28. ^ Over the years, the AMA has issued a number of policy statements that express its official position on the matter:

    (a) The AMA believes it is important for professionals and laymen alike to recognize that alcoholism is in and of itself a disabling and handicapping condition. (H-30.995: Alcoholism as a Disability)

    (b) The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice, and encourages physicians, other health professionals, medical and other health related organizations, and government and other policymakers to become more well informed about drug dependencies, and to base their policies and activities on the recognition that drug dependencies are, in fact, diseases. (H-95.983 Drug Dependencies as Diseases)

    (c) The AMA reaffirms its policy endorsing the dual classification of alcoholism under both the psychiatric and medical sections of the International Classification of Diseases. (H-30.997 Dual Disease Classification of Alcoholism)

29. ^ This is 10 years prior to Beecher's 1955 paper, "The Powerful Placebo", which is commonly and incorrectly named as the source of the term; see Placebo (origins of technical term).

References

• Archibald, H.D., "Dr. Elwin [sic] Morton Jellinek: (1891-1964)", American Journal of Psychiatry, Vol.120, (June 1964), pp.1217-1218. (Jellinek's obituary)
• Beecher, H.K., "The Powerful Placebo", Journal of the American Medical Association, Vol.159, No.17, (24 December 1955), pp.1602-1606.
• Falcone, T.J., "Alcoholism: A Disease of Speculation", Baldwin Research Institute, 2003. [5]
• Jellinek, E. M., The Disease Concept of Alcoholism, Hillhouse, (New Haven), 1960.
• Levine, H.G., "The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America", Journal of Studies on Alcohol, Vol.39, No.1, (January 1978), pp.143-174. (Reprint: Journal of Substance Abuse Treatment, Vol.2, No.1, (1985), pp.43-57.) Available at [6]
• Page, P.B., "E. M. Jellinek and the Evolution of Alcohol Studies: A Critical Essay", Addiction, Vol.92, No.12, (December 1997), pp.1619-1637.
• Peele, S., "R. Brinkley Smithers: The Financier of the Modern Alcoholism Movement", The Stanton Peele Addiction Website, (not dated), retrieved from [7] on 18 June 2006.
• Ribot, T. (Snell, M. trans.), The Diseases of the Will: Authorised Translation from the Eighth French Edition, The Open Court Publishing Company, (Chicago), 1894.
• Rush, B., An Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind: With an Account of the Means of Preventing, and of the Remedies for Curing Them, Thomas Dobson, (Philadelphia), 1808.
• Taylor, C.C.W., Plato: Protagoras, Clarendon Press, (Oxford), 1976. [ISBN 0-19-872045-9]
• Trotter, T. (Porter, R., ed.), An Essay, Medical, Philosophical, and Chemical, on Drunkenness and Its Effects on the Human Body, Routledge, (London), 1988. (This a facsimile of the first (1804) London edition. The book itself was based on the thesis "De ebrietate, ejusque effectibus in corpus humanum" that Trotter had presented to Edinburgh University in 1788.)
• Valverde, M., Diseases of the Will: Alcohol and the Dilemmas of Freedom, Cambridge University Press, (Cambridge), 1998.

List of significant works by Jellinek

• Haggard, H. W. & Jellinek, E. M., Alcohol Explored, Doubleday, Doran & Company, Inc., (Garden City), 1942.
• Jellinek, E. M. (ed), Alcohol Addiction and Chronic Alcoholism, Yale University Press, (New Haven), 1942.
• Jellinek, E. M. "Clinical Tests on Comparative Effectiveness of Analgesic Drugs", Biometrics Bulletin, Vol.2, No.5, (October 1946), pp.87-91.
• Jellinek, E. M., "Phases in the Drinking History of Alcoholics: Analysis of a Survey Conducted by the Official Organ of Alcoholics Anonymous", Quarterly Journal of Studies on Alcohol, Vol.7, (1946), pp.1-88.
• Jellinek, E. M., The Disease Concept of Alcoholism, Hillhouse, (New Haven), 1960.

• [8] Controversy over Jellinek’s true academic status.

• [9] Roizen's Lecture to 2000 Annual Meeting of the Alcoholic Beverage Medical Research Foundation.

• [10] Origins of the Alcoholics Anonymous "Jellinek Curve".

• [11] "Jellinek Curve".

• [12] Alcoholism: A disease of speculation (criticism of Jellinek's work, and the veracity of the concept of alcoholism as a disease).