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Baritone Will Liverman, soprano Kiera Duffy, and soprano Lauren Pearl in 10 Days in a Madhouse | Photo: Dominic M. Mercier

Madness and opera aren’t strangers. A true staple of the 19th century operas by Donizetti, Mozart and Bellini, the ‘mad scene’ has developed its own connotations of vocal virtuosity. But it’s rarer to see an opera dealing with mental illness directly, asking the past and present treatment of the ‘mad’ to come under scrutiny through the art form.

Rene Orth’s 10 Days in a Madhouse - part of the O Festival of Opera Philadelphia - takes the story of investigative journalist Nellie Bly as she uncovered the abusive practices at the Women’s Lunatic Asylum on Blackwell Island in New York in 1887. Maybe it’s a hard sell - contemporary opera can bring harrowing depictions of illness, abuse, death and betrayal. Here Orth, along with librettist Hannah Moscovitch, brought an opera full of the necessary drama, recognising the nuances of mental illness without unjustified terror or glorification.

It opens with a ‘madwoman’ stood facing us in a doorway. Most of the room is blank and curved, with just a small section illuminated to reveal a 19th century hallway. It’s Day 10 in the madhouse and the story begins with chorus echo’s of ‘what…’, opening out into the repeated litany; ‘What time’s the boat?’ It’s soon interrupted by screams of ‘let me out!’. A trap beat enters, a nurse runs around the stage’s circular structure. There’s an immediate, beguiling sense of confusion, with both plot and musical genre, increasing our dis-ease, but gripping us through Orth's ingenious scoring.

The days countdown, each day passing with an electronic ‘boom’ and a projection of ‘Day 8’. As time passes, the story becomes clearer. The doctor appears - the opera’s only male character - and asks the same questions day after day. Bly herself is played by an eerily vacant Kiera Duffy. Her arresting soprano immediate at capturing the frustration and darkness of the asylum. Doctor Blackwell is Will Liverman - somehow difficult to despise, though increasingly uneasy as the days reverse and his treatment of Nellie reveals sexual misconduct. His baritone was clear and stern, holding himself with an emotionless professionalism - frustrating and brilliantly believable.

Mezzo-soprano Raehann Bryce-Davis in her Opera Philadelphia debut as Lizzie in 10 Days in a Madhouse  | Photo: Dominic M. Mercier

The plot begins to centre around Lizzie, played by mezzo Raehann Bryce-Davis who truly commands the stage. Distressingly troubled, but tender, loving and misunderstood, her strong vocals brought immense emotion to the passionate score. Directed by Joanna Settle, depictions of mental illness were so much in the complexity of emotion, reflection through Duffy’s body language and interactions with each of the women. The women of the asylum, a chorus of seven dressed in identical plaid dresses, reflected the spectrum of illness seen in institutions - ‘you don’t look mad’ was a line from Moscovitch's libretto that struck, transcending time to reveal our potential for judgement and bias.

This blurring line between sanity and madness was reflected in Orth’s captivating score, through the merging of acoustic and electric sound worlds. The painting of the story took tremendous risk through fast-paced and complex musical change. Uneasy waltzes underpinned the doctor’s bizarre treatments, interrupted by drum beats and warping string sounds.

A sharp Opera Philadelphia Orchestra was sat above the stage, conducted by Daniela Candaillari. In her Opera Philadelphia debut leading the players inside the complex score, juggling electronics, drums and ableton alongside acoustic instruments, as well as ingeniously merging with an on-stage gramophone (used to ‘calm’ the patients) and an impressively out-of-tune asylum choir on Day 1.

The women's choir at Blackwell Asylum | Photo: Dominic M. Mercier

Day 2 provided perhaps the true climax of the opera. Orth’s sound world is now tonal as Lizzie tells her story with true vividness. She tells us about missing the last boat to return to her sick daughter before she died. Sometimes verging on a musical theatre ballad, it wasn’t immediately convincing, though grew in emotional clarity. The chorus of women are in tune, Lizzie and Nellie’s friendship is deepened and the fear of the mad disappears. I was enthralled by Settle’s ability to depict the human nature of the mentally ill in this scene - the physical contact of Nellie and Lizzie begging perhaps for more understanding between the ill and the well in today’s society.

‘After the 10 Days’ reveals Nellie speaking from up in the orchestra pit in an aria that begs for reform in the treatment of the mentally ill. Dressed in the same plaid pattern, but now 'dressed up' as she returns to the outside (costume and set designs by Andrew Lieberman), the impact of the asylum clearly hasn’t left her. We are told to ‘help them’ and with a final ‘please’ as the music becomes secondary to the power of Nellie Bly’s tremendous advocacy.

The commitment of Opera Philadelphia to stage an opera challenging the past and present experiences of mentally ill women has revealed an opera of tremendous impact and collaboration. I hope we continue to see productions of 10 Days in a Madhouse as mental health experiences past and present become a continually vital point of discussion.

10 Days in a Madhouse is at the Wilma Theater, Philadelphia until 30 September | operaphila.org