In the first segment of this post, Ron Roizen explored the congenial relationship between the free and easy scientific method that prevailed at the Yale School during the late 1940s and Marty Mann’s message-driven National Council on Alcoholism. The second installment in his story brings in another character– Alcoholics Anonymous– and shows how they all held hands.
The A.A. Grapevine Survey
Arguably the most notable – and perhaps also the most unlikely – of these awkward interactions surrounded The A.A. Grapevine’s survey of alcoholism’s symptomatology in 1945. This survey in due course provided the data for E.M. Jellinek’s famous 1946 (8) and 1952 (9) articles describing an alcoholism syndrome.
If some speculative historical interpolation may be forgiven – because the exact origins of the Grapevine survey are not known: My hunch is that once Marty Mann embarked on marketing the disease concept to the American public she encountered questions about the concept she could not adequately address.
It’s likely, moreover, that when Mann called for backup at the Yale group its scientists had little help to offer. Mann may have also turned to her psychiatrist friend, Harry Tiebout, for help. Her request, in turn, may have prompted the writing of Tiebout’s 1945 article on the syndrome of alcohol addiction (10). Yet Mann was probably not entirely satisfied with Tiebout’s article, as its symptomatology took a psychiatric (rather than a physiologic) approach toward alcoholism. Thus, Mann may have soon come to the conclusion that she needed to collect her own scientific data on alcoholism’s symptomatology – in what would become the 1945 Grapevine survey.
Jellinek – slyly, I suggest — alluded to the homegrown origins of the Grapevine survey and a homegrown rationale for its undertaking in the introductory pages of his 1946 article. “Members of Alcoholics Anonymous,” wrote Jellinek,
see their own experience duplicated day in, day out by the many inebriates who come to them for help. Again and again they hear about those drinking incidents and behaviors which in their own cases seemed significant to them. The older members of that informal organization of recovered alcoholics, no doubt, would like to see some systematization of the knowledge derivable from the drinking history. It is, presumably, because of this that the Grapevine, now the official organ of Alcoholics Anonymous, published in its May 1945 issue a questionnaire designed for members of Alcoholics Anonymous (p. 3, emphasis added).
I see slyness here on Jellinek’s part because he attributed the Grapevine survey’s origins to a broadly diffuse alleged desire among “older members” of A.A. for a systematization of their collective drinking experience. That doesn’t quite ring true. A more candid description of the reasons behind the survey might have noted Mann’s campaign’s unmet need for more scientific stiffening for the disease concept.
Jellinek, also in the 1946 article, expressed diffidence about undertaking the analysis of data arguably collected in a more or less unscientific fashion. “After the questionnaires were returned,” he wrote,
the editors of the Grapevine requested me to prepare a statistical analysis of the data. I have undertaken this work with great interest but also with many misgivings. Statistical thinking should not begin after a survey or an experiment has been completed but should enter into the first plans for obtaining the data. In the questionnaire under consideration this requirement was neglected (p. 5).
It is well to step back and take in the irony attaching to the Grapevine survey’s story. Should the known part of this story and my guesswork prove more or less correct, then: First, Yale scientists hired a publicist to promote the disease concept. Then the concept turned out to lack good scientific legs. The publicist, in turn, launched her own survey study — in order to provide rudimentary data buttressing alcoholism’s disease character. Next, a Yale scientist reluctantly agreed to analyze the data. He published two papers stemming from the survey (1946 and 1952). In due course a chart showing alcoholism’s symptom progression (in the 1952 paper) became widely distributed within the alcoholism movement.
“This chart,” wrote Robin Room (8), “particularly as adapted by [Max] Glatt, is probably the most widely diffused artifact of the alcoholism movement’s disease concept.” Quite a story.
Players in all institutions engage in back-stage communications about how best to pursue their aims and the limits of appropriate actions. The correspondence I’ve made use of in this post sheds new light on Mann’s organization’s weak rhetorical position respecting the alcohol science it sought from Yale. O’Connor’s correspondence with Straus and with Bacon illuminated the limits of what Yale science could offer on issues that were important to NCA’s broader campaign. Mann’s correspondence with Haggard, on the other hand, showed how she sought to shape Yale science along lines that were useful – or at least not obstructive – to her campaign’s goals. The story of the Grapevine survey suggested how the role relationship between Mann’s group and the Yale group could become partly reversed. Mann, in all probability, designed and carried out the data-gathering for this study – a scientific task the Yale group might have undertaken. There are no one-way streets in this picture of interaction concerning science between NCA and Yale. Not-so-hard science could be finessed, massaged, or negotiated when the situations and the goals of the two institutions warranted.
(8) 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 7:1-88, 1946.
(9) Jellinek, E.M., “Phases of Alcohol Addiction,” Quarterly Journal of Studies on Alcohol 13:673-684, 1952.
(10) Tiebout, Harry M., “The Syndrome of Alcohol Addiction,” Quarterly Journal of Studies on Alcohol 5:535-546, 1945.
(11) Yet, and interestingly, Mann cited Tiebout’s 1945 article, and not Jellinek’s 1946 and 1952 articles, as authority for the disease concept claim in her 1950 book, Primer on Alcoholism.
(12) Room, Robin G. W., Governing Images of Alcohol and Drug Problems: The Structure, Sources and Sequels of Conceptualizations of Intractable Problems, Ph.D. dissertation, University of California, Berkeley, Sociology, 1978, p. 55.