Although evidence suggests that that natural history of addiction is similar across people and expressions of addiction (Shaffer et al., 2004), personal stories about the development of addiction remain compelling and informative. This week’s Addiction and the Humanities presents annotated excerpts from an intensely gripping story about the gradual metamorphosis of the psychological state, thoughts, and emotions of a physician who became addicted to morphine. The fictional story,Morphine, is based on the real experiences of the author, a famous Russian writer Michael Bulgakov*, who became morphine addicted early in his life.
Jan. 20. 1917. Perpetual blizzards… I’m sick of it. Alone every
evening. <…>
Social isolation could
have protective or risk-related implications for addiction. Here, social
isolation does not appear to provide protection from exposure to potential
objects of addiction and leaves the person with no social support.
Feb. 15. Last night an interesting thing happened. I was just going to bed, when I suddenly felt pain in the region of my stomach. And what pain! Groaning, I reached the kitchen, and called Anna K., the nurse. She came to my room and had to give me a morphine injection. <…> I must give due praise to the man who first extracted morphine from poppyheads. The pain stopped seven minutes after the injection. It would be a good thing if a doctor were able to test many more drugs on himself. He would then have a completely different understanding of their effect. After the injection I slept soundly and well for the first time in months – and I forgot completely about the woman who deceived me.
The first experience
of morphine injection is extremely rewarding. It relieves not only physical
pain, but also emotional distress.
Feb 16. I am alone in my quarters. Fearing a recurrence of yesterday’s pain attack, I injected myself in the thigh with .01 gram. The pain cease almost instantaneously. A good thing Anna K. left the phial behind.
Being alone, previous
rewarding experience and availability of drug - all become factors in the
addiction progress.
Feb 18. Four injections. No harm in that.
Tolerance is evident as he increases the dose to reach the same effect previously obtained at a lower dose.
Feb 21. Anna K. is behaving very oddly – just as though I weren’t a doctor at all! 1.5 syringes = .0.015 grammas morph.? Yes. It is two weeks now since I last thought about the woman who deceived me. I am very proud of that. I am a man.
Morphine injection
“protects” against condemnation of other people. The character feels pride
rather than shame.
For the first minute there is a sensation of being touched on my neck. The touch grows warmer and spreads. In the second minute there is a sudden surge of cold in the pit of my stomach, after which I start to think with unusual clarity and experience a burst of mental energy. If I had not been spoiled by my medical training, I would say that a man can only work normally after an injection of morphine. <…> Anna K. is frightened. Calmed her, saying that since childhood I have been remarkable for having tremendous will power.
Exposure to morphine
can produce extremely rewarding psychological states that are accompanied by
misleading feelings of self-confidence. Medical training and knowledge about
consequences are not enough to protect the person from continuing morphine use.
March 2 I shall go to bed very early <…> And my sleep will be sweet.
Morphine is a central
nervous system depressant, often leading to deep relaxation and sleep.
March 19. Last night I had a quarrel with Anna K. “I’m not going to make up the solution any more. ‘ It was then that I first discovered in myself a nasty tendency to lose my temper and, worse, to shout at people when I am in the wrong. <…> And I snatched the keys out of her hand.
Personality change and
episodes of violent mood swings can be symptoms of addiction. This often leads
to deterioration of interpersonal relationship with other people (e.g., his
nurse, who also became Dr. Polyakov’s mistress at that time).
April 9. The devil is in this phial! This is its effect: on injecting one syringe of a 2% solution, you feel almost immediately a state of calm, which quickly grows into a delightful euphoria. This lasts for only a minute or two, and then it vanishes without a trace as though it had never been. Then comes pain, horror, darkness.
This is a common
description of euphoria and withdrawal effects. Increasingly shorter periods of
euphoria are followed by longer periods of physical suffering.
May 6. Two syringes of a 3% solution. My previous notes must sound somewhat hysterical. In fact there is nothing particularly unusual or alarming about my condition. It does not in the least affect my capacity to work. On the contrary….
People with addiction
often deceive themselves by suggesting that the drug injection may even improve
their work ability.
Dr. Polyakov
experiences mood swing episodes. The dysphoria and physical discomfort
associated with withdrawal are accompanied by denial; Another symptom of
addiction is irregular sleeping patterns that encourage tiredness and physical
distress.
Nov 18. <…> I may be in a state of moral decay, but I am nevertheless making an effort to arrest it. This morning, for instance, I did not have an injection.
Attempts of self-cure
are difficult and made even more difficult in almost complete social isolation.
Jan. 17. 1918. During abstinence I am terrified by the slightest sound and I find people detestable. I am afraid of them. In the euphoric phase I love everyone, although I prefer solitude.
People with opioid
addiction often experience fear and tension during the withdrawal periods. To
reduce the discomfort of sounds, lights, and people, one sign of addiction is
seeking isolation or trips to an isolated place like the bathroom or bedroom.
Feb. 13. 1918 <…> I have decided against treatment. It’s hopeless. And I don’t want to torment myself any longer. NO ONE IS TO BE BLAMED FOR MY DEATH.
Dr. Polyakov commits
suicide and leaves his notebook as a “pathological history” to “warn others.”
In 1927, Medical Worker (Medicinsky
rabotnik) journal first published this story as an impressive and sincere
description of addiction. As described in the annotations, the story contains
the initial rewarding experience associated with morphine use, the progression
of increasing doses, later self-excuses for using, additional need to increase
the dose (tolerance), a switch between self-confidence and disparity, and
finally, the agonizing suffering and complete destruction of life. This story
raises questions about the role of personality and social settting in
addiction. Which is the “devil” here: The person, the environment, or morphine
itself? The tale is based on the real experience of the author, who was a
physician in a rural area, who developed an addiction to morphine despite his
medical training and knowledge. This is a bright illustration of how knowledge
itself does not prevent or limit addiction. Unlike his character, Bulgakov
managed to overcome his addiction after coming back to
--
References cited
M. Bulgakov (1975). A country doctor’s notebook. Morphine.
pp.114 – 144.
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.
The tale is a part of a book of stories that is available on Amazon, ebay, and LibraryThing
The pictures are taken from the story-based movie
Morphia (2008) presented at
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