The application of psychiatric diagnoses to historical figures is a tricky business. No matter how sincere one’s motivations, our ability to line up historical accounts with a modern-day understanding of mental illness is at least somewhat limited.

In the case of Ludwig van Beethoven, suspicions of mental illness date back to Dr. Paul Radestock in 1884, a little more than half a century after the great composer’s death. The Oct. 9, 1884 edition of The Nation carried an essay referencing Radestock’s work, that referred to the temperament of Beethoven (and others) as “marked by an irritability and eccentricity next door to insanity.”

Contemporary reports back some of this up. Johann Wolfgang von Goethe described Beethoven’s “untamed personality.” On the early stages of his hearing loss, Goethe wrote “He, who is of a laconic nature anyway, now becomes doubly so through this deficiency.”

At the same time Beethoven was composing multiple works simultaneously, according to reports, he was writing his brothers about his depression and suicidal thoughts.

All of this is the subject of an extraordinary operatic work composed by Elliott Sharp. Die Größte Fuge (or The Grand Fugue) is an “imagining of the terrible visions that Beethoven experienced in the last decade of his life” according to the album’s notes.

Performed by bass baritone Nicholas Isherwood and the Asasello String Quartet, the release is out as a double CD via Infrequent Seams. The quartet features Rostislav Kozhevnikov and Barbara Streil on violin, Justyna Sliwa on viola and Teemu Myöhänen on violoncello.

The performances are every bit as grand and in-your-face as the work’s subject deserves. Strap in.