The opera opens on a madwoman, Nellie, who is seen through the lens of one of the asylum’s leaders, Doctor Blackwell, as paranoiac and psychotic. She hears voices, fabricates threats, and imagines she is someone she isn’t. As we move backwards in time, we find that when Nellie’s attempts to convince the Doctor that she is a reporter only reaffirm his diagnosis. When she tries to detail the mistreatment of the women in his asylum – abuse by nurses, inadequate food, freezing temperatures – he hears her complaints as paranoiac. At the opera’s end, we see Nellie, nervous and adrenalized, pretending to be mad during a medical examination, not suspecting that within ten days she’ll be desperately trying to convince the same doctor of her sanity.
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