Bulgakov’s Morphine: substance use disorders and suicide

Morphine is a story written by Michail Bulgakov, published for the first time in 1927 on the magazine “The Medical Worker”.

The book, written in form of diary, is focused on the personal history of young doctor Polijakov, describing feelings and consequences of substance use disorder, until the extreme one: suicide. Polijakov has his first contact with morphine during a crisis of abdominal pain. From this moment, Polijakov’s life falls into a spiral of decadence and addiction: recruitment and research of the substance become the young doctor’s only concerns, and as a consequence he eventually neglects his work and personal relationships. Moreover, the abuse of morphine causes him physical consumption and psychiatric symptoms, with the onset of hallucinations and distress which lead the young doctor into a voluntary hospitalization in a detox clinic. This attempt fails: he escapes from the clinic and restarts abusing. Exasperated by his situation, for which he sees no way out, Polijakov writes a letter to ask for help to a university classmate, but after sending the letter, hopeless and full of remorse, he impulsively decides to take his own life; his diary is then delivered to the colleague to whom he had asked for help, who decides to publish and share Polijakov’s memories (to know more about the topic read our new reading suggestion at this link).

This tale describes drug addiction from the point of view of an addicted, depicting young doctor’s thoughts. We sew the first contact with the substance, the excuses that Polijakov gives himself to continue in the abuse of morphine, the intense craving and, when he becomes conscious of his problem and the sense of fail and hopelessness related to the awareness that he is not able to stop morphine abuse; the shame for his condition finally leads him to the extreme gesture. This book also contains many autobiographical references; the author himself has suffered from morphine addiction during his life.

We choose this book as reading suggestion for this month because substance use disorder is one of risk factors for suicide; moreover, recent review highlights the frequency of self-harm and suicide between medical doctors. Perhaps not everyone knows that Michail Bulgakov, besides being a famous writer, was a medical doctor. After graduation he worked as a physician at the Kiev Military Hospital and then, during the First World War, as a volunteer in the Red Cross to the front. Then he worked as a surgeon and was eventually appointed provincial physician.

To know more about suicide among people with substance use disorders contact us for our Flyers about the argument (to know more visit our page about Flyers).

To know more, contact EPA- SSSP e-mail address:



  • “Morphine” text by Mikhail Bulgakov
  • Wikipedia: https://en.wikipedia.org/wiki/Mikhail_Bulgakov
  • Psychosocial job stressors and suicidality: a meta-analysis and systematic review. Milner A, Witt K, LaMontagne AD, Niedhammer I, Occup Environ Med. 2018 Apr;75(4):245-253. doi: 10.1136/oemed-2017-104531. Epub 2017 Aug 29.

Image from Pixabay

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