When you visit the Museum of the Mind at the Bethlem Hospital in South London, two statues greet you as you ascend the staircase – ‘Raving Madness’ and ‘Melancholy Madness’. They were created for the top of the entrance gate posts at the hospital and displayed to all who entered from 1676 to 1815. It’s a snapshot into the history of mental illness and the trauma that still lives within the mental health system, previously viewing patients as exhibits, less than human.

Journalism has played a key role in exposing the mistreatment within such institutions, and one of the first major instances of this was the work of Pennsylvanian-born Nellie Bly in 1887. The 23-year-old journalist feigned insanity to investigate reports of brutality and neglect at the Women’s Lunatic Asylum on Blackwell’s Island – now named Roosevelt Island – in New York City’s East River. What she discovered changed the face of the mental health treatment of women and her writings were published in a book, 10 Days in a Madhouse. This relatively unknown story is soon to premiere as an opera at Opera Philadelphia with music by Rene Orth and libretto by Hannah Moscovitch.

Composer Rene Orth | Photo: Andrew Bogard

‘I just happen to be scrolling social media, as one does, and a couple of people had posted an article about Nellie Bly,’ Orth told me about discovering Bly’s story. ‘I was like, “how is this not an opera?!” This is a total gold mine! I was sure there would be an opera out there already, but there wasn’t.’

This was back in 2017 when Orth was Composer in Residence at Opera Philadelphia. She brought the idea of staging Bly’s exposé to the companies Double Exposure programme, where a composer and librettist write a 20 minute scene. Paired with writer Hannah Moscovitch, together they began on a journey of bringing Nellie Bly’s experience within a mental hospital to the stage.

‘This is an opera that’s going to be directed by a woman, written by a woman and conducted by a woman,’ Hannah Moscovitch pointed out. Much of Moscovitch’s current work is centred around writing for TV, which makes returning to projects like this stand out against the advances made for gender equality in TV and film. ‘It’s weird to talk about this because in TV and in theatre – not that there isn’t sexism – but we’re way further ahead than opera. So when I go back into opera, I’m always asking “Guys, what is happening?”’

‘I don’t know that I want to point out the all-women creative team, but at the same time, I think it’s worth pointing out because it’s so rare that it happens,’ Orth explained. ‘I was really thinking a lot about strong female characters and how in opera there aren’t many. You could say that they’re strong, but they’re still somehow having their role defined by a man.’

Investigative journalist Nellie Bly

The experiences of mental illness is not new to the opera stage, but for 10 Days in a Madhouse, the depiction hopes to be sensitive to this experience of women’s mental health, both its history and the contemporary experiences of women in the medical system: ‘I think “trauma porn” is still a big thing and something that people, and especially men, don’t realise they’re still creating,’ Orth told me. ‘I was adamant about it, and Hannah was too, that we wanted a female director, because there’s potential to show sexual assault or sexual abuse on the stage. It’s very easy for someone to say “let’s have all the women be naked – let’s show rape.”

‘We wanted someone who could understand the themes of mental illness and how it’s still relevant today and who could take that to another level.’

Joanna Settle became the director in question, with Daniela Candillari making her company debut on the podium. Kiera Duffy is Nellie Bly and the production’s only man, Dr Blackwell, is performed by baritone Will Liverman.

The story itself highlights how a ‘perfectly sane’ woman was unable to convince the medical profession of her sanity. After pretending to be ‘crazy’ whilst staying at a boardinghouse, Bly was committed to the asylum. Once admitted, Bly abandoned her pretense at madness, but the hospital staff were unaware that she was no longer ‘insane’. In her exposé, Bly wrote: ‘The doctors and nurses did not care at all that I was perfectly sane. It is easy to get in, but once there, it is impossible to get out.’

How to explore this line between sanity and madness within the opera’s score is something Orth explored through her audio engineering background: ‘For the overall theme there’s the acoustic world, which is reality as most people perceive it, and then the electronics, which is when we go into madness. So as the characters become more mad, they become more electronic.

Illustration of Bly being examined by a psychiatrist, from her memoir Ten Days in a Mad-House

‘Opera is about drama,’ she continued. 'When there’s mental illness involved, and even emotions, there’s a certain amount of unpredictability that you can incorporate and surprise people. Part of the journey into madness into the electronic world is including amplification. It’s a completely different colour, timbre and sound. And then also there’s also live vocal effects.’

For Moscovitch’s process of writing the libretto, research involved entering into an understanding of the experiences of severe mental illness. ‘Something I kept coming back to as we rode the opera was that you can leave the mental institution, but it will never leave you once you’ve been. I also watched documentaries to try and get at the heart of what psychosis feels like, because we wanted to depict some version of PTSD or psychosis-induced PTSD.’

Librettist Hannah Moscovitch | Photo: Ian Brown

‘A big element to the story is that it’s still so relevant. Not much has changed in the treatment of mental illness.’ Orth’s interpretation of the contemporary mental health system involved including various musical genres. ‘This is why it also works so well to put in a trap beat or a dance beat, along with late 19th century waltz. Many of the experiences of women are the same. The same things are still happening.

‘History is whatever we want to remember it as, and if we don’t share these stories, then we forget. Artists are supposed to reflect society. Mothers, women, immigrants, people suffering, sickness and mental illness is all part of society. That should be reflected in in the art that we create.’ 

10 Days in a Madhouse is at Opera Philadelphia until 30 September | operaphiladelphia.org