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:
  • 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

Robin Williams’ death and copycat suicides

In a previous article we reported about celebrities, as Chris Cornell and Chester Bennington, who committed suicide (Click HERE to read the article). It is widely acknowledged that a celebrity suicide may influence population health, in particular suicides rate may increase in the next weeks due to copycat and Werther effect (Click HERE to know more about Werther Effect), and this may have a varying impact in different populations and cultures.

The role of media communicating the news is very important: the World Health Organization recently published an update in the guidelines “Preventing suicide: a resource for media professionals”, where there is a specific section named “Apply particular caution when reporting celebrity suicides” (Click HERE for the Guidelines).

Many articles about the topic were published after Robin Williams’ death, occurred in 2014: this is a good example in order to explain the topic. Robin Williams was a famous actor, with a 35-year career on screen, playing lead roles in different famous films (es: Dead Poets Society, Mrs. Doubtfire…). The day Williams died, the National Suicide Prevention Lifeline received the highest number phone calls ever.

A recent open access study published on PLOS One investigates suicides following the death of the actor Robin Williams: using a time-series analysis, researchers reported that suicides observed exceeded expected ones; this was observed across gender and age groups.  

LINK to articleIncrease in suicides the months after the death of Robin Williams in the US

Moreover, on Health Communication Young it was published an article about a survey on how his death influenced searches for information concerning depression, suicide, and mental health. They found, for example, that respondents who sought information about the suicide reported changes in their thoughts about suicide, most often dealing with the difficulty in spotting warning signs and the idea that “it can happen to anyone.”

LINK to the articleTweeting celebrity suicides: Users’ reaction to prominent suicide deaths on Twitter and subsequent increases in actual suicides.

Finally, the relationships between guidelines and news about suicide were assessed in a study performed at the Mental Health University Institute in Quebec by Creed and Whitley. In Canada guidelines and best practice have been recently published to help journalists writing about mental health and suicide. Creed and Whitley tried to relate these norms to the pieces written about Robin Williams’ suicide from major Canadian newspapers: they observed that articles generally followed the evidence-based guidelines when reporting about Williams’ suicide.

LINK to the article: Assessing Fidelity to Suicide Reporting Guidelines in Canadian News Media: The Death of Robin Williams

In conclusion, as described in the WHO guidelines, celebrity suicides are particularly likely to induce copycat suicides: “the effect of a report about a suicide on subsequent suicides is greater when the person described in the story is a celebrity and is held in high regard by the reader or viewer. Particular subgroups in the population (such as young people, people suffering from mental illness, persons with a history of suicidal behaviour or those bereaved by suicide) are particularly vulnerable to engaging in imitative suicidal behaviour”.

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

Image from Pixabay

Movie of the Month (April 2018)

In April 2018 we chose a movie for you:

“What Dreams May Come”

Directed by: Vincent Ward
Starring: Robin Williams, Cuba Gooding Jr, Annabella Sciorra, Max von Sydow
Year: 1998
Running time: 113 minutes

Plot: The story is based on Richard Matheson’s novel and the title is from a line in Hamlet’s soliloquy “To be, or not to be”. It describes the love story between the pediatrician Chris Nielsen and the artist Annie Collins, who have to face the difficulties of grief after their children death. Later in the story Chris also dies in a car crash: Annie attempts to cope with his loss but she is wracked with guilt for the deaths of Chris and their children, believing that she was responsible for it, and she commits suicide. After his death, Chris awakens in “Heaven”, and unfortunately he learns that those who commit suicide go to “Hell”; this is not the result of a judgment made against them, but rather their own tendency to create “nightmare” afterlife worlds based on their pain. So Chris decided to start a journey, not without dangers, to rescue his wife.  

“…They think of suicide as a quick route to oblivion, an escape. Far from it. It merely alters a person from one form to another. Nothing can destroy the spirit. Suicide only precipitates a darker continuation of the same conditions from which escape was sought. A condition under circumstances so much more painful”.

Richard Matheson, What Dreams May Come



Scientific News and Reading Suggestions #18

Recently on BMJ it has been published a free meta-analysis and systematic review about job-related stressors and suicidality (Milner et al, 2018), a very interesting topic. Job stressors are widely acknowledged as determinants of common mental health disorders, and in literature there are several works about their correlation with suicidality. The paper by Milner and coworkers offers an overview of what is known in the literature about this topic.

LINKPsychosocial job stressors and suicidality: a meta-analysis and systematic review

Regarding job stressors and suicidality, it is known that physicians have an increased risk to die by suicide; it is quite difficult to estimate with accuracy the phenomenon, but it seems that approximately 300-400 physicians die every year for suicide, a doctor a day. Medical profession is one of the occupations with the highest risk of death by suicide.

The Washington Post recently published the article “What I’ve learned from my tally of 757 doctor suicides”, written by a family physician who, in addition to her daily work, is committed in suicide prevention. She reports about  an “uncomfortable” topic for discussion, the problem of suicide among physicians, trying to summarize the main findings collected during many years of practice.

LINKWhat I’ve learned from my tally of 757 doctor suicides

Among physycians, psychiatrist have to face with people who attempt suicide nearly every day. On Jama Psychiatry has been recently published an interesting issue by N. P. Morris, a medical doctor working at the Department of Psychiatry in Stanford University; the text is a reflection on psychiatrists daily activities and feelings, in particular when they are called to face with patients who made suicide attempts or self-harm.

LINKWhen Mind Deforms Body

You can find it on Frontiers in Psychiatry: click HERE

Image From Pixabay

Looking forward to sharing with you
the next scientific news and reading suggestions!

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

Scientific News and Reading Suggestions #17 – part 2

On March our reading suggestion was about a recent article by our member Christina van der Feltz-Cornelis on “Frontiers in Psychiatry”:

“Springtime Peaks and Christmas Troughs: A National Longitudinal Population-Based Study into Suicide Incidence Time Trends in the Netherlands”
Emma Hofstra, Iman Elfeddali, Marjan Bakker, Jacobus J. de Jong, Chijs van Nieuwenhuizen and Christina M. van der Feltz-Cornelis

Here her comment about it:

“Time trends are one of the most studied phenomena in suicide research; however, evidence for time trends in the Dutch population remains understudied. Insight into time trends can contribute to the development of effective suicide prevention strategies.

Therefore, we examined time trends in national daily and monthly data of 33,224 suicide events that occurred in the Netherlands from 1995 to 2015, as well as the influence of age, gender, and province, in a longitudinal population-based design with Poisson regression analyses and Bayesian change point analyses.

We found that suicide incidence among Dutch residents increased from 2007 until 2015 by 38%. Suicide rates peak in spring, up to 8% higher than in summer (< 0.001). Suicide incidence was 42% lower at Christmas, compared to the December-average (IRR = 0.580, < 0.001). After Christmas, a substantial increase occurred on January 1, which remained high during the first weeks of the new year. We also found effects by gender, age and province of residence, however, no differential effects were found for gender, age and province of residence in both season and Christmas with regards to suicide incidence.

It is recommended to plan (mental) health care services to be available especially at high-risk moments, at spring time, and in the beginning of January. Further research is needed to explore the protective effect of Christmas in suicide incidence”.

You can find it on Frontiers in Psychiatry: click HERE

Image From Pixabay

Looking forward to sharing with you
the next scientific news and reading suggestions!

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


Thanks to Christina M. van der Feltz-Cornelis

Movie of the Month (March 2018)

In March 2018 we chose a movie for you:

“The Sea Inside”

Directed by: Alejandro Amenábar
Starring: Javier Bardem
Year: 2004
Running time: 125 minutes

Plot: The movie is based on the true story of Ramón Sampedro, a man from Galicia (Spain), who, since 28 years, is quadriplegic as a consequence of an accident, and is bedridden. The movie focuses on his campaign for the right to end his own life. However, the real focus is life, as a priceless gift, through the characters we meet around Ramón’s bed (his family, the three women, a quadriplegic priest), beautiful landscapes and music. Life and love, in its deepest meaning, represented by two opposites: Manuela and Julia.

We selected this movie because of the current debate concerning euthanasia and assisted suicide.
The topic is the object of current debates involving the whole clinical community, and it has also been the focus of two intersection symposia organized by the EPA-SSSP together with the Old Age Psychiatry Section in 2017 in Florence, and in 2018 in Nice (click HERE for more details). In our opinion it effectively represents the complexity of this thematic, and offers a wide perspective about it, without focusing on a single viewpoint.

“Out to sea. Out to sea, and in the weightlessness of the deep where dreams come true, two souls unite to fulfill a single wish. Your gaze and mine, over and over like an echo, repeating silently: “Deeper, and deeper” beyond everything that is flesh and blood. But I always awaken and I always wish for death, my lips forever entangled in your hair”.

Ramón Sampedro

Sources (image and contents):

Thanks to Raffaella Calati and Carla Gramaglia

Our experiences at the 26th EPA Congress in Nice (March 2018)

CME Course: “Management and Treatment of Suicidal Patients”

On Sunday 4th March 2018, at the 26th EPA Congress in Nice there was the CME Course “Management and Treatment of Suicidal Patients” directed by Marco Sarchiapone and Vladimir Carli. The Course, chaired by Marco Sarchiapone, was attended by 33 participants, a really high number considering also the schedule (Sunday morning, starting from…).

Participants were very interested about the topic and highly interactive. During the 3 hours of the course, participants were offered theoretical knowledge via a frontal lesson format, but also had the opportunity of working in small groups to debate about the topic discussed. In the end, we had a very engaging group discussion, which allowed sharing of experiences in different European Countries.

Intersection symposium “Suicide, assisted suicide and euthanasia in the elderly”

On Sunday 4th March 2018 it took place the Intersection symposium “Suicide, assisted suicide and euthanasia in the elderly” organized by the EPA-SSSP and by the EPA Section of Old Age Psychiatry. A joint symposium involving these two sections had already been proposed at the 25th EPA Congress in Florence, and considering its success, it was decided to continue this fruitful intersection collaboration. In Nice, the Chairs of the symposium were Gabriela Stoppe and Patrizia Zeppegno, who were also presenters together with Reinhard Lindner and Christina Van der Feltz Cornelis. Many people joined the simposium; the debate about the relationship between aging, assisted suicide and euthanasia involved experts from all over the world and was really engaging.

In the past months, the topic was discussed not only by physicians, but also by politicians. For instance, in Italy, on 22th December 2017 it was presented Law n°219, about living will. Law 219/2017 allows adults to decide their end of life medical care including the terms under which they can refuse treatment. The law permits Italian citizens to write living wills and refuse medical treatments including artificial nutrition and hydration.

To know more click HERE.

Intersection symposium: “Suicidal Behaviour in the Vulnerable Populations: Focus on Migrants”

On Tuesday 6th March 2018 it took place an important focus on one of the main EPA topic, “Suicidal Behaviour in the Vulnerable Populations: Focus on Migrants”. The symposium was held by M.Sarchiapone and M. Schouler-Ocak. The first intervention by C. Gramaglia, entitled “Migrant’s suicidals behaviours: a transcultural perspective”, brilliantly introduced us into the actual topic; then, M. Schouler-Ocak presented “Suicide Attempt Rates and Intervention Effects in women of Turkish Origin in Berlin”, providing the audience an example of effective prevention. In the end we had the pleasure to assist to D. Bhugra intervention on “Attempted suicide among South Asians in the UK”. These speeches elicitated a very participated debate and wide spreaded discussion adding enriching hints of knowledge in the audience which participated with interest.



Scientific News and Reading Suggestions #17

Our member Christina van der Feltz-Cornelis suggested us her recent article, published on February, 2018, online on “Frontiers in Psychiatry”:

“Springtime Peaks and Christmas Troughs: A National Longitudinal Population-Based Study into Suicide Incidence Time Trends in the Netherlands”
Emma Hofstra, Iman Elfeddali, Marjan Bakker, Jacobus J. de Jong, Chijs van Nieuwenhuizen and Christina M. van der Feltz-Cornelis

It talks about suicide time trends in the Dutch population: it can be useful in order to create new prevention strategies, looking at planning mental health care services especially at high-risk moments (eg at spring time or in the beginning of January).

You can find it on Frontiers in Psychiatry: click HERE

Image From Pixabay

Looking forward to sharing with you
the next scientific news and reading suggestions!

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


Thanks to Christina M. van der Feltz-Cornelis


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