Elvin Morton "Bunky" Jellinek (1890-1963), E. Morton Jellinek, or most often, E. M. Jellinek, was a biostatistician, physiologist, and an alcoholism Alcoholism, also known as alcohol dependence, is a disabling addictive disorder. It is characterized by compulsive and uncontrolled consumption of alcohol despite its negative effects on the drinker's health, relationships, and social standing. Like other drug addictions, alcoholism is medically defined as a treatable disease. The term " 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. He was born in New York City and died at the desk of his study at Stanford University The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university located in Stanford, California, United States. The university is located on an 8,180-acre campus in northwestern Santa Clara Valley approximately 37 miles (60 km) southeast of San Francisco and approximately 20 miles (32 on 22 October 1963. He was fluent in nine languages and could communicate in four others. Addiction researcher 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. He has been a major international figure influencing the development of the discipline of alcohol and drug studies, promoting 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.^[1]

Academic career

Jellinek studied biostatistics and physiology at the University of Berlin The Humboldt University of Berlin is Berlin's oldest university, founded in 1810 as the University of Berlin (Universität zu Berlin) by the liberal Prussian educational reformer and linguist Wilhelm von Humboldt, whose university model has strongly influenced other European and Western universities. From 1828 it was known as the Frederick William 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 The University of Leipzig , located in Leipzig in the Free State of Saxony, Germany, is one of the oldest universities in Europe and the second-oldest university (by consecutive years of existence) in Germany. It has a long tradition of globally oriented and culturally comparative historical research and tertiary-level teaching 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.^[2]

During the 1920s, he conducted research in Sierra Leone The country has a tropical climate, with a diverse environment ranging from savannah to rainforests. Freetown is the capital, largest city and economic center. The other major cities are Bo, Kenema, Koidu Town and Makeni and at Tela Tela is a town in Honduras on the northern Caribbean coast of the department of Atlantida, Honduras Honduras (pronounced /hɑnˈdʊrəs/ , Spanish: República de Honduras, pronounced [reˈpuβlika ðe onˈduɾas]) is a republic in Central America. It was formerly known as Spanish Honduras to differentiate it from British Honduras (now Belize). The country is bordered to the west by Guatemala, to the southwest by El Salvador, to the southeast by. In the 1930s he returned to the U.S.A. and worked at the Worcester State Hospital, Worcester, Massachusetts Worcester is a city in Worcester County, Massachusetts, United States. Named after Worcester, England, the city had a population of 182,596, making it the estimated second largest city in New England.a[›] It is the county seat of Worcester County. Worcester is located approximately 40 miles west of Boston, and marks the western periphery of the, 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 is a private research university in New Haven, Connecticut, and a member of the Ivy League. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States. Yale has produced many notable alumni, including five U.S. presidents, nineteen U.S. Supreme Court. In 1952 he was engaged by the World Health Organization The World Health Organization is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the 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 The University of Toronto is a public research university in Toronto, Ontario, Canada, situated north of the city's Financial District 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 the colony of Upper Canada. Originally controlled by the Church of and the 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 top universities in Canada. The main campus covers 50 city blocks with over 90 buildings, and in 1962, he moved to Stanford University in California, where he remained until his death.^[3]

Works

Disease concept of alcoholism

In 1849, the Swedish Physician Magnus Huss (1807-1890)^[4] was the first to systematically classify the damage that was attributable to alcohol ingestion. Huss coined the term alcoholism Alcoholism, also known as alcohol dependence, is a disabling addictive disorder. It is characterized by compulsive and uncontrolled consumption of alcohol despite its negative effects on the drinker's health, relationships, and social standing. Like other drug addictions, alcoholism is medically defined as a treatable disease. The term " and used it to label what he considered to be a chronic, relapsing disease.^[5]

Jellinek coined the expression "the disease concept 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 widely accepted within the medical and scientific communities, although critics exist",^[6] and significantly accelerated the movement towards the 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. The process of medicalization can be driven by new evidence or theories about conditions, or by of drunkenness Alcohol intoxication is a physiological state occurring when an organism has a high level of ethanol in its bloodstream, or when ethanol otherwise causes the physiological effect known as drunkenness. In humans, common symptoms may include slurred speech, euphoria, impaired balance, poor coordination, flushed face, reddened eyes, reduced and alcohol habituation Habituation, a form of non-associative learning, is the psychological process in humans and other organisms in which there is a decrease in psychological and behavioral response to a stimulus after repeated exposure to that stimulus over a duration of time.

Jellinek’s initial 1946 study was funded by Marty Mann^[7] and R. Brinkley Smithers^[8] (Falcone, 2003). It was based on a narrow, selective study of a hand-picked group of members of Alcoholics Anonymous Alcoholics Anonymous is an international mutual aid movement claiming more than 2 million members and declaring its "primary purpose is to stay sober and help other alcoholics achieve sobriety". AA was founded in 1935 by Bill Wilson and Dr. Bob Smith (Bill W. and Dr. Bob) in Akron, Ohio. Along with other early members, Wilson and Smith (AA) who had returned a self-reporting questionnaire.^[9] 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".^[10]

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".^[11]

• 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 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 involvement; some also involve dysfunction of the autonomic, or cirrhosis of the liver Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to progressive loss of liver function. Cirrhosis is most commonly caused by alcoholism, hepatitis B and C, 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 Historically, addiction has been defined with regard solely to psychoactive substances which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain and do not suffer 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/or alcohol. In order to experience the symptoms of withdrawal, one must have first developed a physical symptoms A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality. A symptom is subjective, observed by the patient, and not measured. 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".^[12]
• 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 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 describe a particular condition of periodic,, 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 An Achilles’ heel is a fatal 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 . . .

By relying on cultural norms Social norms are the behavioral expectations and cues within a society or group. This sociological 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. Failure to follow the rules can result in severe punishments, including 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 Nominalism is a metaphysical view in philosophy according to which general or abstract terms and predicates exist, while universals or abstract objects, which are sometimes thought to correspond to these terms, do not exist. Thus, there are at least two main versions of nominalism. One version denies the existence of universals—things that can definitions along the lines of "whatever is normal drinking in that particular culture is normal drinking". (Valverde, 1998, p.112)

The "Jellinek curve" ^[13] is derived from this classification of Jellinek, and it was named out of respect for Jellinek’s work.^[14] 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 In a healthcare context, efficacy indicates the capacity for beneficial change of a given intervention (e.g. a medicine, medical device, surgical procedure, or a public health intervention) in any way. Jellinek set up a complex trial -- with 199 subjects, divided randomly into four test groups -- involving various permutations 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 values is an arrangement of those values into a particular order. Thus there are six permutations of the set {1,2,3}, namely [1,2,3], [1,3,2], [2,1,3], [2,3,1], [3,1 of the three drug constituents, with a placebo A placebo is a sham or simulated medical intervention that can produce a placebo effect. In medical research, placebos depend on the use of controlled and measured deception. Common placebos are inert tablets, sham surgery, and other procedures based on false information. In one common placebo procedure, a patient is given an inert pill, told that as a scientific control When an experiment is conducted for the purpose of determining the effect of a single variable of interest on a particular system, a scientific control is used to minimize the unintended influence of other variables on the same system. Such extraneous variables include researcher bias, environmental changes, and biological variation. Scientific. 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".^[15]

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

• Addiction Historically, addiction has been defined with regard solely to psychoactive substances which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain
• Akrasia Akrasia (ancient Greek ἀκρασία, "lacking command "), occasionally transliterated as acrasia, is the state of acting against one's better judgment
• Alcoholics Anonymous Alcoholics Anonymous is an international mutual aid movement claiming more than 2 million members and declaring its "primary purpose is to stay sober and help other alcoholics achieve sobriety". AA was founded in 1935 by Bill Wilson and Dr. Bob Smith (Bill W. and Dr. Bob) in Akron, Ohio. Along with other early members, Wilson and Smith
• Disease model of addiction The disease model of addiction describes an addiction as a lifelong disease involving biologic and environmental sources of origin.[citation needed] The traditional medical model of disease requires only that an abnormal condition be present that causes discomfort, dysfunction, or distress to the individual afflicted. The contemporary medical
• Drug tolerance In physiology, physiological tolerance or drug tolerance is commonly encountered in pharmacology, when a subject's reaction to a drug decreases so that larger doses are required to achieve the same effect. Drug tolerance can involve both psychological drug tolerance and physiological factors. Characteristics of drug tolerance: it is reversible,
• Placebo (origins of technical term) A placebo is a sham medical intervention. In one common placebo procedure, a patient is given an inert sugar pill, told that it may improve his/her condition, but not told that it is in fact inert. Such an intervention may cause the patient to believe the treatment will change his/her condition; and this belief does indeed sometimes have a
• 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

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. ^ 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
3. ^ For more information, see 1964 obituary in The American Journal Of Psychiatry [1]
4. ^ He was physician to the Swedish kings Charles XIV Charles XIV & III John , born Jean-Baptiste Bernadotte, later renamed Jean-Baptiste Jules Bernadotte (26 January 1763 – 8 March 1844) was King of Sweden (as Karl XIV Johan) and King of Norway (as Karl III Johan) from 1818 until his death. He was also the first Sovereign Prince of Pontecorvo, Italy and Oscar I Oscar I, born Joseph François Oscar Bernadotte , was King of Sweden and Norway from 1844 to his death. When, in August 1810, his father Jean-Baptiste Bernadotte was elected Crown Prince of Sweden, Oscar and his mother moved from Paris to Stockholm (June 1811). Oscar's father was the first ruler of the current House of Bernadotte. Oscar's mother.
5. ^ 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.
6. ^ It also appears as the title of his 1960 book, The Disease Concept of Alcoholism.
7. ^ Marty Mann (1905-1980), the first female member of Alcoholics Anonymous Alcoholics Anonymous is an international mutual aid movement claiming more than 2 million members and declaring its "primary purpose is to stay sober and help other alcoholics achieve sobriety". AA was founded in 1935 by Bill Wilson and Dr. Bob Smith (Bill W. and Dr. Bob) in Akron, Ohio. Along with other early members, Wilson and Smith
8. ^ 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])
9. ^ 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.
10. ^ Valverde (1998), pp.110-111; Valverde also noted 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).
11. ^ Valverde, 1998, p.111.
12. ^ "It is characterized by binge drinking and a slow downward slide into helplessness"(Valverde, 1998, p.112).
13. ^ JLAP - Substance Abuse Issues
14. ^ William E. Swegan, 2. The Psychology of Alcoholism
15. ^ 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) A placebo is a sham medical intervention. In one common placebo procedure, a patient is given an inert sugar pill, told that it may improve his/her condition, but not told that it is in fact inert. Such an intervention may cause the patient to believe the treatment will change his/her condition; and this belief does indeed sometimes have a.

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