E. Morton Jellinek

Elvin Morton Jellinek (1890-1963), or more commonly 'E. Morton Jellinek, was a biostatistician, physiologist, and a researcher into alcoholism. He was born in New York on 15 August 1890. He 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.

Academic career
Jellinek studied biostatistics and physiology at the University of Berlin (from 1908 to 1911) and at the Joseph Fourier University in Grenoble (1911). He received a Master of Education degree at the University of Leipzig in 1914. In 1935, the University of Leipzig bestowed an honorary Doctor of Science degree upon him. In 1965, 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.

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

Perhaps the first to speak of such things was Socrates; who, in Plato's dialogue Protagoras, questions Protagoras about how one might possibly explain, especially in relation to the "pleasures of food, and drink and sex", 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" (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.

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.
 * 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.

Rush argued that "habitual drunkenness should be regarded not as a bad habit but as a disease", describing it as "a palsy of the will".
 * 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.

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

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

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

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

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 tinder 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".


 * 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".
 * 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" employed by Alcoholics Anonymous is derived from this classification of Jellinek, and it was named out of respect for Jellinek’s work.


 * 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.

The question of whether or not alcoholism is a disease is still a matter of considerable dispute and heated argument.

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 "reactors to placebo".

This seems to be the first time that anyone had spoken of either "placebo reactions" or "placebo responses".

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.