The Jellinek Curve
By life-j.
E. M. Jellinek (“Bunky”) is among other things said to be the father of the “Jellinek Curve” which we saw here at AA Agnostica a while back. He was also one of the foremost researchers on alcoholism in his day. It appears that he was one of the first people in the academic world to give alcoholism the status of a disease.
On Wikipedia his credentials are impressive:
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 1941 he was managing editor of the newly established Quarterly Journal of Studies on Alcohol (now the Journal of Studies on Alcohol and Drugs). 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.
His whole life is documented there. However, a bit more research reveals that his life story is far from well documented. Even his identity in earlier parts of his life is questionable. Very well, he lived in several places around the world, and it was not uncommon in the world before electronic records that a person could bullshit their way into rather prestigious positions of employment. Things were hard to verify. I had two successful 20 year careers myself in fields I knew practically nothing about when I started. A Danish friend of mine, equipped with a fake degree from an American university where he never set foot taught English in Japan for a year. History is full of examples like these. And it appears that Jellinek is no exception from this long and glorious tradition.
According to his second wife, or as she is referred to in one biographical paper:
The CAS archives contain letters written from Thelma Pierce Anderson, Jellinek’s likely second wife, to Mark Keller at the Center of Alcohol Studies:
“I do remember Bunky coming home and saying, ‘How would you like to be married to an alcohol expert?’ I said something along the line of, ‘But you don’t know one damned thing about it’. …I said I thought he could probably learn enough to bull his way along until he needed to know more. Again, Bunky took to the books, and I swear that within ten days he had developed a number of really good and original ideas on a subject about which he (nor anyone else it turned out) had had not one reasonable notion in 50 years.” (Anderson to Keller, 1963)
We in AA would know him from his contact with Marty Mann, one of the first women to sober up within the Fellowship. (“Women Suffer Too”) She was from a wealthy family, and supported his research financially – and at least initially – and also provided the material she wanted to have researched. Again, according to Wikipedia:
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. 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”.
By this time he did indeed have a reputation to uphold, and in the resulting paper, Phases in the Drinking History of Alcoholics (1946), he does indeed in several places cautiously distance himself from his involvement with it. The 36 questions these hand picked alcoholics were asked were much like the “20 Questions” we all know well, though the questions were prefaced by “At What Age Did You First”. We all know the age is not a primary factor. Jellinek points out that such a questionnaire should instead have been prepared by a researcher in order to really do the subject justice, not by someone with a point to prove.
And now the “Jellinek Curve”. (Editor’s Note: Click here for large PDF version of the Jellinek Curve. If you click on the image at the bottom of this article you will also get the PDF. Feel free to print it, if you wish.)
According to the paper “Mystery and speculations – An introduction to E.M. Jellinek’s redemption” by William Bejarno:
Perhaps his most enduring contribution to the field is his idea of “phases” of alcohol addiction (Jellinek, 1946, 1952), later modified by Dr. Max Glatt to include a recovery element (Glatt, 1958), but still popularly referred to as the “Jellinek Curve.” This curve has been modified and applied to all sorts of addiction disorders over the years and remains highly cited to this day.
Jellinek eventually distanced himself from it. Max Glatt was sort of the British counterpart to Jellinek, but apparently much more involved in treatment of alcoholics.
Most of the elements along this curve are familiar to an alcoholic in recovery. Most of us have experienced many of them. What I will focus on here, however are those entries which relate to the realm of the spiritual because there’s something funny going on. On the Recovery side of the Curve we find, relatively early on “Spiritual needs examined”. I don’t think this was foremost on my mind when I was newly sober, though going to AA I eventually would wind up doing this exam because that’s part of what you do in AA. Farther up the curve we find things like “Rebirth of Ideals”, “Application of Real Values” and those make better sense, along with most of the others. It is a bit later. The whole recovery list I find to generally be a reasonable representation of the progress of recovery.
But what really jumped out at me was an entry on the Addiction side. Again most of them I could relate to from my own experience, but not the one called “Vague Spiritual Desires”. This supposedly happens right before the end, a while after “Moral Deterioration”, “Impaired Thinking”, “Indefinable Fears”, “Unable to Initiate Action”, “Obsession with Drinking” – all familiar, but then “Vague Spiritual Desires”?
I dabbled in spiritual things along my way toward active alcoholism. In my 20s I would occasionally go so far off on a tangent as to allow Jehovas Witnesses, or Children of God in for a cup of coffee and a discussion, later on I got vaguely interested in Eastern stuff, later on yet, as the years passed, we’d all sit at 2 AM, drunk on our asses and have deep, deep discussions about god and spirituality, and who created the world, and where he was before he created it and all that, for my own part mostly from an atheist point of view. I did a variety of psychotherapies too, some of which could be said to include spiritual elements. But all that of course fell by the wayside eventually. Later on we were only interested in beer and sex, and later on yet, only beer.
So somehow these “Vague Spiritual Desires” come into the picture at this point. Now I know there are people of a supposedly religious inclination who at this point would start bargaining with their god to see if they couldn’t somehow ease out of the corner they had painted themselves into, but even prayers on such an occasion can hardly be called spiritual desire, rather it’s just a slick attempt to get one over on whatever god there may be.
Personally I had no spiritual desires at that point, vague or otherwise, and I have not known any alcoholic in the twilight before recovery that did. So what is it doing there? I can not see any other explanation than that someone with an agenda put it in there. Time for the white light, folks!
It’s a shame, really. This sort of thing tends to call the whole thing into question about its honesty and reliability when really the rest of the curve is actually quite good. Obvious agendas such as that one do scare honest unbelievers away.
But otherwise: looking over this curve provides a 5 minute overview and reminder of my own alcoholism and recovery, better than most other things I have seen.
Thanks for the info on Jellinek. Very interesting. When it comes to talking about alcoholism as a disease, I think people will also want to study what the Hazelden people mean when they call alcoholism a primary disease. That means it is a pathological relationship between one’s body and the substance alcohol. On the practical level, people can bust their asses working on their “spiritual” health yet never lose their physical reaction to alcohol. I think lots of slippers miss this point.
Most excellent and informative article, life-j…
It doesn’t surprise me that “Bunky” was part charlatan — after all most humans are at times . . . 😉
I was impressed to learn this week that the esteemed New England Journal of Medicine published a longitudinal study strongly suggesting that the prescribed treatment for the early detection of one form of breast cancer has resulted in unnecessary radical treatments for bunches of the gentler sex. Money and the profit motive influences the most pristine of expertise, eh?
Since I worked in the field of addiction treatment for 30 years, I’ve been acutely aware of and used the Jellinek curve for over three decades. It made some considerable sense at the time and was most useful in breaking through one of the primary symptoms of addiction – utterly baffling denial in the face of disaster – of many of my clients, whom I urged to get actively involved in AA.
Nevertheless, I note with interest that Bill W., a definitely un-sainted founder of AA, was most reluctant to use the medical term disease to describe alcoholism – he mostly preferred to use the the more general terms illness and malady, so as to insure that he didn’t overstep his expertise as a layman, I suppose, and piss off the medical professionals. I’m fairly sure that term “disease” is not mentioned in the first 164 pages of the Big Book, even in the “The Doctor’s Opinion.”
Anyway, currently the issue is again receiving lots of play, both in the popular press as well as professional journals – is addiction a disease, or is it not? Same as it ever was…
Interestingly the curve itself does not use the word, but illness or addiction (“learns alcoholism is an illness”). I’m an epsilon drunkard, according to Jellinek’s taxonomy; a binge drinker, or dipsomaniac (from dipso, thirst and mania, mad love, according to the Greeks)!
What I find interesting, Laurie, as an amateur historian of AA is that Towns hospital did not make a distinction between alcohol and drug addiction – on page xxv of “The Doctor’s Opinion” the introduction to Silkworth’s letter reads”
Further on page 22 is evidence that even among our earliest members a number were “dually addicted”:
In Dr. Bob’s story on page 176 he relates this pattern of using drugs to supplement his use of alcohol:
“Singleness of purpose” devoted only to alcohol has roiled AA rooms for the last 40 or so years and was a major focus of the 2015 PRAASA panels.
Charles Towns was a fascinating character – there’s a Towns essay on this website. A goodly part of the entrepreneur’s early acclaim came from some supposed successes with opium addicts in China. As business declined Towns became more like “All Addictions Anonymous” than anything else.
He was the P.T. Barnum of healthcare.
Quite right, Thomas. Disease appears only once in the first 164 on p.64 referring to resentments being the stem of all spiritual disease. It also appears in the 12+12 p.150 tradition 5 where the metaphor is taken to the disease concept of alcoholism. Those are the only two I know of in the ‘sacred’ texts. =-)
Delightful, eye-opening article. I think the disease concept is a useful metaphor, as opposed the notions that alcoholism is a sin, moral failing, bad habit, etc.. However, I prefer to call it a physical addiction to the drug, ethyl alcohol — an addiction that is fatal unless arrested through abstinence.
The Jellinek Curve reminds me of a much older curve, an 1848 print by Nathaniel Currier: “The Drunkard’s Progress / From the First Glass to the Grave.” I have a copy of the print, which I’ve photographed and put on my website. Here it is (click on it to see it full size):
I think there’s more coherence to Currier’s curve, as well as greater artistry — although he and the rest of the temperance folk didn’t anticipate recovery.
John, thanks for sharing that illustration. I have a book about a hundred years old with similar pictures, maybe one day I will scan and post them.
As for the disease concept, or illness concept, I confess I have not distinguished much between the two. I think, like you say, it is just a good metaphor to help us get out of the moral failure concept which prevailed in the temperance and prohibition movements.
I reckon there is a difference between the two, but what they have in common, especially for our purpose is that someone with a disease or an illness we try to help and have sympathy for, someone with moral failure we (at least more readily) condemn.
And it shows that all there was room for in this illustration, or all there was knowledge to support, was condemnation.
I offer an interesting twist to the recovery part of the curve, it offers a reasonable and fair account of my 23 years dry. Some 5 years ago a series of events at work left me with PTSD and the decline into the pit is the same minus the alcohol. The part that I find difficult is that today my life is unmanageable and I am back to where I started mentally. In many regards what I am saying is that I have never been that far out of the woods. Hopefully the curve will prove true a second time. I am very grateful that throughout this testing time the desire to drink never returned otherwise it would have been the end.
Thanks life-j., for the reminder and your sense of humour. Over the years (32) I’ve been asked countless times how AA works and doesn’t work. And for many years I would try an analytical approach. Finally I said enough of the bull-shit and would say for me it was the members, their stories and those who wanted help.
Thanks for this Life and thank you everyone for all your interesting and varied comments; I feel fortunate to be part of this community where longstanding alleged axioms are questioned and often debunked.
I have never felt comfortable with the notion that alcoholism is a disease; it simply never made sense to me. I always felt a dis-ease with life, that’s why I drank to take the edge off things; drinking simply made me feel better. Our fellowship seems to me to work the same way as booze; the connectedness, the acceptance, the sharing and encouragement allowed me to feel ok in my own skin.
Whatever alcoholism is, and I’ve heard it described in many ways, I’ve got a good case of it and it has been the fellowship that has facilitated its ongoing arrest in my life, not god or any of the other malarkey I hear at conventional meetings.
There’s a new book out called “The Biology of Desire: Why Addiction is not a Disease.” (Reviewed here at The Globe and Mail.) The author, Marc Lewis presents a very compelling argument against the disease model; stay tuned!
I had a collection of great books before I came to AA they did not help because I did not know what my problem was.
When I found out in my 4th step that the character defects of fear anger and pride… rebellion and self- righteousness… laziness and irresponsibility… foolish rationalization and outright dishonesty… wrong dependencies and destructive power driving stood in the way of me being free from alcohol obsession. When I started to deal with these defects all of those books started to help. Cheers, Daniel.
Nice article, Life. It appears that “research” is a continuum, as in re-search, again and again, until a little more of the “facts” are re-vealed and re-examined.
What I glean from the ‘curve’ is another source of potential identification, and by no means in a perfect, one-size-fits-all way. In a general way we have experienced some or many of the curve’s “causes and conditions” but not all. True to the times and culture, some “spiritual” reference is included and I am grateful it is so limited.
In my own personal experience, being raised a Catholic and morphing later into the Children of God you mentioned in my young adulthood (all drinking/using years!), “spirituality” , in retrospect, is perceived in what I can identify with in the 12 +12 p.32, as: “we had wallowed in emotionalism and had mistaken it for true religious feeling”. (and who can define “true” religious feeling?!) I remember being drunk and weeping to gospel music on many occasions feeling ‘truly’ repentant and ‘emotionally’ righteous!
My perceptions today are that all religiosity is rooted in emotionalism and even more so the so-called non-religious. We can’t help being emotional beings no matter how hard we try not to be.
M. Scott Peck’s book The Road Less Traveled informed me that everyone holds a “worldview” or personal “religion”, whether formed by primary caregivers, genetics, nature and/or nurture; and that wandering both to and from “faith” is commonplace for our species and is a by-product, not a cause, of mental health. (although I’m not sure that they both don’t influence each other)
Another book and theory of interest of late is by Rene Eram, called The Addict’s Loop. It completes the “Curve” into a full circle or spiral of the revolving door so many of us experienced in our using years (and which appears to continue into emotional sobriety); detached from both internal and external reality, caused by learned toxic codependencies, and counter-conditioned by abstinence or moderation, paired with support by mutual aid in “core-integrity and root honesty” self-discovery.
Always great to ‘hear’ from your contributions.
Thanks, all, for the stimulating conversation
As noted, Dr. J. and Marty Mann, the first woman AA member worked closely together and were the founders of the National Council on Alcoholism. The goal was to educate and advocate for treatment of alcoholism as a disease, rather than viewing it as a moral failing. AA women owe alot to Marty Mann. It is alleged that when she first attempted to join AA and was rebuffed by the men, her response was “Move your asses; I’m coming in!” 🙂
It’s a great menu, “There are some of the characteristics of addiction and recovery; do you recognize any of them?” I see it more like a buffet of possibilities more than don’t proceed to stage K until you’ve completed stage J kinda deal. This is a great look at some vital history, Life-j.
The vague spiritual desires thing is very “Lucy in the sky with diamonds” – what ever is the mysterious meaning behind it kinda thing. Could nihilistic and dark imaginings be vague spiritual desire? How about delusions of grandeur? For one who’s theistic, how about doubting the grace of Yahweh? Maybe hearing or sensing things and attributing hallucinations to something cosmic? It’s more fun than to think about than sitting in unexpected traffic.
I saw the Jellinek Curve at my first AA meeting. It was in a frame standing on the piano, though in Britain it was called the Glatt Chart after Max Glatt, who ran the alcohol unit at St Bernard’s National Health Service (taxpayer funded) hospital, London. I was referred there at the end of my drinking, though by then Glatt had been succeeded by his colleague David Marjot (both those consultant psychiatrists were passionate advocates for AA and Marjot told me to keep going to AA as there was no inpatient bed available for me at that time – I’ve still got his letter). Glatt, a Jewish survivor of the Nazi death camps, recalling early AA in Britain in ‘Share’, the British AA magazine (June 1985), said: ‘AA had started 16 years earlier in far away Akron, Ohio, and at about the same time Bunty Jellinek – father of the modern scientific approach to alcoholism – had begun his research that was to put alcoholism scientifically on the map…’ Max Glatt wrote a seminal book about alcoholism in which he described how AA meetings began to be held in British hospitals in the 1950s.I heard him speak at an AA convention in, I think, 1986. I can recall only two things that stuck in my memory. He said he had met hundreds, if not thousands, of ‘recovered’ (not recovering) alcoholics; and he said he would like to be an alcoholic for ‘just half an hour, to know what it feels like’! To me the curve tells an alcoholic’s Pilgrim’s Progress and I identified with the narrative, even ‘vague spiritual desires’ at the end of my drinking. I’d been a Pentecostal churchgoer in my youth and longed wistfully for the fellowship and sense of purpose I experienced then – ‘vague spiritual desires’. But by then I was a sceptical agnostic with two university degrees and knew there was no way I could go back to that primitive religious enclave. So instead I tried to kill myself. It was in AA I found the spiritual non-religious fellowship and sense of purpose I craved.
My thought is that I certainly felt empty and alone in the world just before I got sober, and while before AA I would not have called that a spiritual need, afterward it’s a pretty accurate description for connection to people and something bigger than me…
The fact that I am a devout (born again) atheist/agnostic has nothing to do with my opinion that it is BS that alcoholism is a disease – perhaps it does cause dis – ease however i have come to believe over my 20 plus yrs sober (out of 34 yrs in AA) that alcoholism is rather a self imposed compulsion that often looks like a disease. Once again it is over educated BS that any form of addiction is a disease, including my own (mild, controllable) sexual addictions – LOL
I believe the “…over educated BS that any form of addiction is a disease..” opinion is a small minority opinion and is yours and not mine.
Being educated I bristle at the disparaging attitude that many AA’s have toward science and education. There are various forms of nomenclature but one currently acceptable might be “alcohol dependence disorder”. We who are sober know that is is treatable but chronic in most cases. How do you express a Life Threatening Bad Habit or Toxic Psycho-Emotional Alcohol Related Behavioural Disorder? The term “disease” is useful for normies to get around the fact that one does not simply stop drinking.
Thanks for your comment Dan, and I totally agree. Another excellent example is PTSD, which used to be referred to as Battle Fatigue, but by the Pattons’ as cowardice. I make this statement because after one year in Vietnam, as a Casualty Officer, and at that time a career Airman, I ended up being med-evaced to Fort Worth Texas in 1969 for what was called a “Psychoneurotic depressive reaction” which I believe was an early diagnosis of PTSD.
Later on, I chose alcohol and drugs to “cope” with it. I don’t give a crap what anyone says, I was addicted! And I fought those addictions for over 30 damn years. Beginning in 1981, the VA treated my addiction as a “disease” not a dis-ease. I was damn sick – I knew it and the VA knew it. With their help and my long term involvement in AA, the DISEASE has been arrested (like some cancers can be arrested), but it can never by cured. I will therefore continue my lifesaving treatment by doing what I’ve been taught to do – attend meetings, help other addicts, and don’t drink or use.
BTW, I still jump when I hear loud bangs, and I have some pretty terrifying dreams, but I’ve learned to deal with them, with the VA’s help – and if there’s any doubt, PTSD is in the DSM and has been for a number of years.
Hello Don B. Thanks for comment. I can completely identify with your situation having had my own visit to that vicinity a few years later when things were supposed to be being “cleaned up”. It was a mess and I was too when I got home. Multiple substance abuse issues and an insanely reckless lifestyle followed before I thought I had my ducks in a row. The stress issues remained and so did the alcohol even though I shook the others. After all that I deserved to get pissed didn’t I? When I tried to stop drinking I pretty much went right to nervous breakdown. I got into recovery and things have been good for a few years. I appreciate the validation. For a lot of us what made us drink is irrelevant when we can’t stop. An awful lot of people have died from this “bad habit”. Over educated bullshit? I don’t think so.
Thanks;
Dan L.
Edward,
I would say that disease and self imposed compulsion in the end amounts to the same thing, but then again, I’m the sort who would be inclined to think that all the ills of society which this country spends untold billions fighting with a hard fist, or ignoring, with dire social consequences, tend to fall into that same general category:
If we can’t punish our way out of it, maybe we should try to rehab our way out of it.
and in that context “disease” is just a convenient word for a problem that is so far beyond an individual’s ability to solve without outside help. A problem that properly viewed is a social problem, not an individual problem. why do alcoholism, drug addiction, crime, poor health all seem to increase during bad times? is it because everyone just happen to get the same bad idea all at the same time?
that much said – for practical purposes we do have to take responsibility each of us for whatever predicament we’re in. I recently had cancer. lots of things i had to take responsibility for there and not just leave it to god and the doctors, just like my alcoholism, but we still need to keep an eye on the big picture – one in 4 now will get cancer, and that figure is probably on the rise – and it is not an individual problem – it is a serious societal problem, and we’re just putting blinders on. Same with the war on drugs, or the prohibition.
My only exposure to the curve in my 8 years sober has been the recent posts here. For the most part, it’s consistent with my experience. My only beef would be that the slopes of the addiction and recovery curves are identical. I spent 40 years on the addiction path, and so far, less than 8 on the other side, and now it’s much flatter. Sorry, I’m an engineer and generally think anal analytical. Somewhere along the way, I did experience those ‘vague spiritual desires’, mainly brought about by watching Kung Fu or some Native American movies (e.g. Dances with Wolves or with Chief Dan George – NO John Wayne). Even went to church with my wife off and on to smooth out ruffled feathers, and if you listen just a little, you hear things that make you think just a bit. But drinking becomes a full time job with no time for such foolishness. Like you said, beer and sex, then only beer.
The Jellinek Curve was presented to me on by a brilliant doctor in rehab 42 years ago. It saved my butt. I identified with all of it immediately. I can’t remember whether “vague spiritual desire.” was on it or not. Either way, the information resonated with me so deeply, that I remember half of it today. Not surprised to learn that Bunkie might have been a bit of a con. That chart makes way too much sense to have come from conventional research. By co-incidence, an AA friend of 40 years told me last week, that he had seen the Jellinek lecture preented by the same doctor at at a union hall 40 years ago as well and it had such an impact, that today, he feels, like myself, it insulated us against the evangelical crazies in AA long enough to get a foot hold in sobriety and think for ourselves.
Thanks life-j. It was interesting to learn something about Jellinek. I had heard the name mentioned in relation to alcoholism but that was all. Another shady character! What I find most interesting is the recovery part of his curve. I have seen that before in various forms and found it very enlightening.
Thanks;
Dan L.
When I entered AA on May 1, 1970, I was desperate and tried to get the god bit. Fortunately, the benefits of sobriety kept me going in spite of my failure to get the god bit. I attend meetings and try to take something positive home with me. I always tell the newcomer with god doubts that they can stay sober. I am 81 now and have 45 years of sobriety. I really like this on line free thinkers meeting. I love my fellow alcoholics whether I agree with them or not.
The first time I saw the Jellinek Curve was in a surprise counseling session my wife had set up for us with an alcoholism counselor. The counselor had a slightly different version of the above chart. Her chart had a fork at the very bottom; a spur that turned downward and ended in the word “DEATH”. The counselor pointed to that fork and said “you are here”. My wife nodded, I shook my head – and spent the five more years trying to prove them wrong.
The phases of addiction are both similar and individual among us. As regard the ingredient of spirit it may or may not be a phase, perhaps. For me the element has been present as early as I can remember pondering the big picture, some time before adolescence, maybe 8 or 9. Quickly, the idea of God and praying seemed to lack resonance, and has remained so.
But the natural world has always been the touchstone for discovery, a huge power outside and within myself. Watching an ant pause after a frenzy of “self willed” activity. The rhythm is informative in mysterious ways, much to my benefit after five years of sobriety. The accumulation of insight has been rewarding.
Yesterday I celebrated sobriety with my home group of about twenty by beginning my share with a kind of ritual, standing up and deliberately approaching each person with eye contact, a smile and “thank you”. The fellowship and the individual contact with nature keeps me sober . . . today.