PHILADELPHIA (AP) — Kiera Duffy is disturbed by “10 Days in a Madhouse” as much as an 1887 public was outraged by the squalid surroundings exposed by trailblazing reporter Nellie Bly.

“The idea of the hysterical woman trope really does persist today,” the soprano said ahead of Thursday night’s premiere of Rene Orth’s musical adaptation at Opera Philadelphia. “My sister at the age of 34 had a heart attack at a gym and was conscious and telling the emergency personnel, `I think I’m having a heart attack.′ She was having all of the classic signs and they dismissed it and told her you’re probably having a panic attack and gave her the wrong medication and she died.”

Siobhan Duffy Gaffney’s death in December 2018 was on Duffy's mind as she rehearsed the lead role of Bly. The complex work is based on the reporting of the New York World reporter, who feigned derangement and fooled doctors to gain admittance to the Blackwell’s Island insane asylum for women on what is now New York City’s Roosevelt Island. Bly uncovered abusive overcrowding, lack of heat, shared bath water and discrimination, leading to a grand jury investigation and reforms.

An all-woman creative team was commissioned to develop the work by Opera Philadelphia and Toronto’s Tapestry Opera. Bly disclosed that many detainees were sane and held only because they were poor, spoke little English or had run afoul of a man.

“I have a lot to say about women’s rights being taken away and how women are treated,” director Joanna Settle explained. “If Britney Spears can be put in a conservatorship performing nine shows a week in Vegas at the highest level, it’s unbelievable that someone that legibly competent can lose her freedom. So, it’s not such an old issue, which is why we all respond to the story.”

Orth composed the 80-minute work for 12 musicians plus electronics. Acoustic generally accompanies reality and harsher electronics and drums for delusion. With a compelling and unique style, the 38-year-old composer mixes in a waltz and hymn for a chorus of inmates.

“I would love it if somebody walked out of the theater and said: `I want to see that again,‘” Orth said, “or if they also feel there’s a social justice message to society: We need to do better for women.”

Librettist Hannah Moscovitch was paired with Orth in what Moscovitch calls a “blind date” by Opera Philadelphia general director David Devan after her work on “Sky on Swings,” Lembit Beecher’s 2018 chamber opera about Alzheimer’s disease. Moscovitch’s libretto reverses Bly’s story, starting on day 10 and working toward Bly’s admittance, an inverted chronology evoking Harold Pinter’s “Betrayal.”

“We were interested in what the audience would think of a woman being crazy — seem like she was crazy — and then realize that she was sane,” Moscovitch said, “how the audience would reconsider their own assumptions.”

Duffy memorably portrayed Bess in Missy Mazzoli’s 2016 Opera Philadelphia premiere of “Breaking the Waves” based on the Lars von Trier film.

“I’m not turning down Adinas and Susannas left and right to choose this work, but I’m very, very happy that this work did choose me,” she said, referring to famous Mozart and Donizetti roles. “I personally find playing these more canonic characters to be something of a straitjacket, because I think not only the listener — but also I, myself — have a sort of ideal sound in mind and ideal performance, whether it’s Judith Blegen or Kathleen Battle. And so that means it becomes for me at least kind of suffocating because I’m never quite living up to my own ideal or what I suspect as the audience’s ideal.”

Baritone Will Liverman sings Dr. Josiah Blackwell and mezzo-soprano Raehann Bryce-Davis the inmate Lizzie, both before they head to New York for the Metropolitan Opera premiere of Anthony Davis’ “X: The Life and Times of Malcolm X.” Soprano Laurel Pearl sprints circles around the simple, singular set, portraying the Nurse/Matron as a 19th century Nurse Ratched.

Daniela Candillari leads a run of five performances through Sept. 30 at Opera Philadelphia’s Festival O23 before conducting the world premiere of Jeanine Tesori’s “Grounded” at the Washington National Opera.

Liverman keeps in shape by running the Philadelphia Museum of Art steps made famous in “Rocky.”

“My brain is just full of time signatures and notes at all times, because when I’m not doing `Madhouse’ I’m in the `Malcolm X’ madhouse,” Liverman said. “With new material and different sound worlds that we’re really not accustomed to, it takes some time to let the musical language settle in.”

Candillari conducted a reworked version of Orth’s “Empty the House” in 2019. For this production in the 296-seat Wilma Theater, the orchestra is on a platform above the set, and uplights by Andrew Leiberman create an eerie atmosphere. About a half-dozen monitors are placed around the stage.

“I don’t have clear contact with singers, so I sort of resorted to learning sign language alphabet to be able to cue the singers, whether it’s the chorus, whether it’s one of the four principals,” Candillari said.

Bryce-Davis has the most compelling aria, “My daughter,” an ode to a dead child. Bryce-Davis views Roosevelt Island quite differently following her immersion in the traumatic story.

“My sister lives on Roosevelt Island and so whenever I’m in New York, that’s where I am,” she said. “When I first realized the connection, I was like, wait, what?”