If you’ve been to rehab, you probably remember receiving piles of handouts of varying quality, from coloring exercises to relapse prevention worksheets. The one that sticks in my mind is a picture of a u-shape curve that slopes to the bottom of the page, makes a little circle around itself, like a roller coaster, and slopes back up again to the top of the page. The little graph was of course a model of alcoholism (and applied to any addiction, really). According to the chart, the alcoholic first starts with a little relief drinking, then problems start to increase, and finally the alcoholic “hits bottom”. After a ride (or four) on the roller coaster of relapse, the alcoholic starts to realize he or she needs help, seeks treatment, and finally regains his or her life. When I first came across it in rehab, the graph seemed brilliant, because it matched so well with everything I knew about alcoholism (and since I was on a solid slide down it matched my story so far.)
It wasn’t until recently I came across that image again. I am currently reading Trysh Travis’s The Language of the Heart, and in the first chapter she goes into detail about E. M. Jellinek’s work. Travis is a an academic historian and a University of Florida professor, and the book description from the publisher summarizes it as such:
In The Language of the Heart, Trysh Travis explores the rich cultural history of Alcoholics Anonymous (AA) and its offshoots and the larger “recovery movement” that has grown out of them. Moving from AA’s beginnings in the mid-1930s as a men’s fellowship that met in church basements to the thoroughly commercialized addiction treatment centers of today, Travis chronicles the development of recovery and examines its relationship to the broad American tradition of self-help, highlighting the roles that gender, mysticism, and bibliotherapy have played in that development.
(Apparently I treat writing a blog like going to grad school).
First some background: E. M. Jellinek headed the Yale Center of Alcohol Studies, the first interdisciplinary academic center devoted to the research of alcohol use. (I mentioned the Yale Center in my earlier post on the Harvard Crimson). The center evolved from various projects at the Yale University Laboratory of Applied Physiology and Biodynamics in the 1930s, and it still operates today, although it moved to Rutgers University in 1962. Travis points out that, interestingly enough, the center received funding from the alcohol industry, which was desperate to prove that alcoholism was not the fault of their products, but the inclination of a of a “mere handful of the population.”
In 1945, trying to establish a more solid foundation for the disease concept of alcoholism, Jellinek conducted a study, funded by Alcoholics Anonymous activist Marty Mann and one of her most financial famous backers, R. Brinkley Smithers, an AA convert and IBM heir with plenty of money to throw around. Jellinek’s research methods consisted of a self-reported questionnaire published in AA’s Grapevine newsletter, and researchers fielded data from only 96 respondents. From his data, published in 1946, Jellinek was able to describe 5 distinct phases of alcoholism, which I summarized above. While the graphic itself wasn’t designed by Jellinek, it was informed by his research and has since been known as the “Jellinek Curve”. A detailed summary of the Jellinek Curve can be seen here, on the website of a rehab program called The Watershed (which is not the program I attended). The Watershed’s website describes the curve as “A statistically proven pattern of behaviors exhibited by people suffering from alcohol and/or drug addiction.”
The thing is, nothing about this research can legitimately be called “statistically proven.” Jellinek’s survey, advertised in the back Grapevine, would have attracted respondents who already had a very specific frame of reference for alcoholism. Of course they would have reported back to Jellinek a narrative that has already been framed by a view shaped by Alcoholics Anonymous. And it now makes sense that the rehab worksheet seemed informative to me on first glance– it reflected a narrative of alcoholism that had been drilled into me by literature, popular culture, and now this rehab. It’s popular, it’s familiar, and it’s comforting, but it’s not scientifically sound.
Jellinek went on to do more research, and eventually even worked with the World Health Organization, and I am not trying to assert that he was a hack or a fraud. I’m less concerned with the man himself, and more concerned with how and why we are still giving patients in rehabs in 2015 the results of a small, self-reported questionnaire conducted in 1945 as if it’s “statistically proven.” When I wrote about Blackout, I questioned our adherence to one narrative of addiction, when so many other addicts paths’ don’t follow Jellinek’s; literature needs multiple representations of addiction. Science, on the other, hand is free to nail down a model of addiction, diseased or otherwise, but it needs to do so with rigorousness, and we need to take to heart what it has to say, even if takes it away from our current path.
4 thoughts on “The Jellinek Curve: When Ideology Shapes Research”
The recovery process is such messy science and there are so many variables – it doesn’t surprise me that self-reporting and untested anecdotal ‘evidence’ forms the basis of so many treatment programs. Can we just say that the open ended-ness of “the addict has to want to change” means that any scientific measuring is flawed?
It gets me everytime how anyone can objectively measure something as vague and hard to pin down as addiction/sobriety.
Keep it coming – this is great content!
I don’t think that any scientific measuring can be flawed, because then IMHO we’ve just thrown up our hands. Lots of new stuff has come out of science since this study– new medications, new therapy strategies. I think evidence based answers will never be one-fits-all (just like medicine) but it will help find workable solutions for more people.
Thanks for the feedback!
I think if you were to do some more research you might just find out that E. M. Jellinek was, in fact, a fraud.
I’ve read that, but I didn’t want to get into that here. My point wasn’t really to take him down, more to point out that that bit of research was outdated.
But definitely interesting, isn’t it?