E. Morton Jellinek
Encyclopedia
Elvin Morton "Bunky" Jellinek (1890-1963), E. Morton Jellinek, or most often, E. M. Jellinek, was a biostatistician, physiologist, and an alcoholism
Alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...

 researcher
Researcher
A researcher is somebody who performs research, the search for knowledge or in general any systematic investigation to establish facts. Researchers can work in academic, industrial, government, or private institutions.-Examples of research institutions:...

. He was born in New York City
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...

 and died at the desk of his study at Stanford University
Stanford University
The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university on an campus located near Palo Alto, California. It is situated in the northwestern Santa Clara Valley on the San Francisco Peninsula, approximately northwest of San...

 on 22 October 1963. He was fluent in nine languages and could communicate in four others. Addiction researcher Griffith Edwards
Griffith Edwards
Griffith Edwards, CBE was born in India and received his M.D. from Oxford University, since which time he has focused on the study and treatment of alcohol and other drug dependence and related aspects of addictions...

 holds that, in his opinion, Jellinek's The Disease Concept of Alcoholism was a work of outstanding scholarship based on a careful consideration of the available evidence.

Academic career

Jellinek studied biostatistics and physiology at the University of Berlin from 1908 to 1910. He then studied philosophy
Philosophy
Philosophy is the study of general and fundamental problems, such as those connected with existence, knowledge, values, reason, mind, and language. Philosophy is distinguished from other ways of addressing such problems by its critical, generally systematic approach and its reliance on rational...

, philology
Philology
Philology is the study of language in written historical sources; it is a combination of literary studies, history and linguistics.Classical philology is the philology of Greek and Classical Latin...

, anthropology
Anthropology
Anthropology is the study of humanity. It has origins in the humanities, the natural sciences, and the social sciences. The term "anthropology" is from the Greek anthrōpos , "man", understood to mean mankind or humanity, and -logia , "discourse" or "study", and was first used in 1501 by German...

, and theology
Theology
Theology is the systematic and rational study of religion and its influences and of the nature of religious truths, or the learned profession acquired by completing specialized training in religious studies, usually at a university or school of divinity or seminary.-Definition:Augustine of Hippo...

 for two years at the Joseph Fourier University
Joseph Fourier University
Université Joseph Fourier , often known as UJF, is a French university situated in the city of Grenoble and focused on the fields of sciences, technologies and health...

 in Grenoble
Grenoble
Grenoble is a city in southeastern France, at the foot of the French Alps where the river Drac joins the Isère. Located in the Rhône-Alpes region, Grenoble is the capital of the department of Isère...

. He was also enrolled, apparently concurrently, at the University of Leipzig
University of Leipzig
The University of Leipzig , located in Leipzig in the Free State of Saxony, Germany, is one of the oldest universities in the world and the second-oldest university in Germany...

 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.

During the 1920s, he conducted research in Sierra Leone
Sierra Leone
Sierra Leone , officially the Republic of Sierra Leone, is a country in West Africa. It is bordered by Guinea to the north and east, Liberia to the southeast, and the Atlantic Ocean to the west and southwest. Sierra Leone covers a total area of and has an estimated population between 5.4 and 6.4...

 and at Tela
Tela
Tela is a town in Honduras on the northern Caribbean coast. It is located in the department of Atlantida.-History:Tela was founded by the Spanish conquistador Cristóbal de Olid on 3 May 1524 near an indigenous town named Tehuacán, ruled by a cacique named Cucumba which had a very good source of...

, Honduras
Honduras
Honduras is a republic in Central America. It was previously known as Spanish Honduras to differentiate it from British Honduras, which became the modern-day state of Belize...

. In the 1930s he returned to the U.S.A. and worked at the Worcester State Hospital, Worcester, Massachusetts
Worcester, Massachusetts
Worcester is a city and the county seat of Worcester County, Massachusetts, United States. Named after Worcester, England, as of the 2010 Census the city's population is 181,045, making it the second largest city in New England after Boston....

, 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
Yale University
Yale University is a private, Ivy League university located in New Haven, Connecticut, United States. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States...

. In 1941 he was managing editor of the newly established Quarterly Journal of Studies on Alcohol (now the Journal of Studies on Alcohol and Drugs
Journal of Studies on Alcohol and Drugs
The Journal of Studies on Alcohol and Drugs is a peer-reviewed scientific journal that publishes original research articles on various aspects of the use and misuse of alcohol and other drugs. Topics covered include the biological, medical, epidemiological, social, psychological, and legal aspects...

). In 1952 he was engaged by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 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
University of Toronto
The University of Toronto is a public research university in Toronto, Ontario, Canada, situated on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution of higher learning in Upper Canada...

 and the University of Alberta
University of Alberta
The University of Alberta is a public research university located in Edmonton, Alberta, Canada. Founded in 1908 by Alexander Cameron Rutherford, the first premier of Alberta and Henry Marshall Tory, its first president, it is widely recognized as one of the best universities in Canada...

, and in 1962, he moved to Stanford University in California, where he remained until his death.

Disease concept of alcoholism

In 1849, the Swedish Physician Magnus Huss (1807-1890) was the first to systematically classify the damage that was attributable to alcohol ingestion. Huss coined the term alcoholism
Alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...

 and used it to label what he considered to be a chronic, relapsing disease.

Jellinek coined the expression "the disease concept of alcoholism
Disease Theory of Alcoholism
The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function. The existence of alcoholism as a disease is accepted by some within the medical and scientific communities, although critics...

", and significantly accelerated the movement towards the medicalization
Medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat...

 of drunkenness
Drunkenness
Alcohol intoxication is a physiological state that occurs when a person has a high level of ethanol in his or her blood....

 and alcohol habituation
Habituation
Habituation can be defined as a process or as a procedure. As a process it is defined as a decrease in an elicited behavior resulting from the repeated presentation of an eliciting stimulus...

.

Jellinek’s initial 1946 study was funded by Marty Mann and R. Brinkley Smithers (Falcone, 2003). It was based on a narrow, selective study of a hand-picked group of members of Alcoholics Anonymous
Alcoholics Anonymous
Alcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...

 (AA) who had returned a self-reporting questionnaire. Valverde opines 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".

In his 1960 book he identified five different types of alcoholism, and defined them in terms of their abnormal physiological processes:
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 suffer from "loss of control".

  • 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
    Polyneuropathy
    Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously. It may be acute and appear without warning, or chronic and develop gradually over a longer period of time. Many polyneuropathies have both motor and sensory...

    , or cirrhosis of the liver from alcohol without physical or psychological dependence. These are the heavy drinkers that drink a lot, almost every day. They do not have physical addiction
    Substance dependence
    The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...

     and do not suffer withdrawal
    Withdrawal
    Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...

     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".
  • 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
    Dipsomania
    Dipsomania is a historical term describing a medical condition involving an uncontrollable craving for alcohol. It was used in the 19th century to describe a variety of alcohol-related problems, most of which are most commonly conceptualized today as alcoholism, but it is occasionally still used to...

    , 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
Achilles' heel
An Achilles’ heel is a deadly weakness in spite of overall strength, that can actually or potentially lead to downfall. While the mythological origin refers to a physical vulnerability, metaphorical references to other attributes or qualities that can lead to downfall are common.- Origin :In Greek...

 . . .
By relying on cultural norm
Norm (sociology)
Social norms are the accepted behaviors within a society or group. This sociological and social psychological term has been defined as "the rules that a group uses for appropriate and inappropriate values, beliefs, attitudes and behaviors. These rules may be explicit or implicit...

s 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 "Jellinek curve" is derived from this classification of Jellinek, and it was named out of respect for Jellinek’s work. Jellinek later completely dissociated himself from this chart's representations; however it is still known as the "Jellinek curve".

Recognition of placebo effect

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
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...

 in any way. Jellinek set up a complex trial -- with 199 subjects, divided randomly into four test groups -- involving various permutation
Permutation
In mathematics, the notion of permutation is used with several slightly different meanings, all related to the act of permuting objects or values. Informally, a permutation of a set of objects is an arrangement of those objects into a particular order...

s of the three drug constituents, with a placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

 as a scientific control
Scientific control
Scientific control allows for comparisons of concepts. It is a part of the scientific method. Scientific control is often used in discussion of natural experiments. For instance, during drug testing, scientists will try to control two groups to keep them as identical and normal as possible, then...

. Each group took a test remedy for two weeks. The trial lasted eight weeks, by the end of which each group had taken each test drugs, albeit in a different sequence. Over the entire population of 199 subjects, 120 of the subjects responded to the placebo, and 79 did not. The trial demonstrated that the chemical in question significantly contributed to the remedy's efficacy.

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. He (1946, p.90) described the former group as being "reactors to placebo", and this seems to be the first time that anyone had spoken of either "placebo reactions" or "placebo responses".

Selected publications

  • 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.

See also

  • Akrasia
    Akrasia
    Akrasia , occasionally transliterated as acrasia, is the state of acting against one's better judgment. The adjective form is "akratic".-Classical approaches:...

  • Alcoholics Anonymous
    Alcoholics Anonymous
    Alcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...

  • Disease model of addiction
    Disease model of addiction
    The disease model of addiction describes an addiction as a lifelong disease involving biologic and environmental sources of origin. The traditional medical model of disease requires only that an abnormal condition be present that causes discomfort, dysfunction, or distress to the individual...

  • Drug tolerance
  • Placebo (origins of technical term)
  • Stanton Peele
    Stanton Peele
    Stanton Peele, Ph. D., J.D., is a licensed psychologist, attorney, practicing psychotherapist and the author of books and articles on the subject of alcoholism, addiction and addiction treatment.His awards have included:1989...


External links

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