This chamber opera has unusual relevance for psychiatrists. It distils Elgard Johnsson's account of his own experience of hospitalisation with seemingly incurable schizophrenia during the 1960s. He was eventually helped to recover, and subsequently became a psychotherapist himself. His young therapist, Barbro Sandin, became an internationally famous researcher into psychotherapeutic aspects of the treatment of schizophrenia. She developed the Säter Model at the Säter Mental Hospital; was awarded an International Prize of Honour by ISPS (the International Symposium for Psychotherapy of Schizophrenia) in London, 1997, and in 1998 she instituted in Ludvika a Nursing Home Foundation for young people suffering from schizophrenia.

Carl Unander-Scharin is a largely selftaught Swedish composer, a professional singer who has been composing for some 20 years - on his showing, one whose name should become known outside his own country. The King of Fools (1995-1996) is his first stage opera, composed for the voices of the singers in its successful premiere and this 1998 recording.

The small instrumental ensemble has a quartet of Solo strings, six winds and percussion, with recorder, synthesizer and ‘radio-organist’, all used with economy, precision and inventiveness throughout. The singers double in different roles, sometimes as both patients and hospital staff. The psychotic protagonist is accompanied by high strings in his interaction with the outer world, with the synthesizer for his hallucinations. In the first act he loses his grip on reality and descends into total detachment. In the second act human contact from an empathic social worker leads to therapeutic help and a tenuous recovery.

This is a multi-layered and subtle work. Its brilliantly conceived libretto sharply characterises the world of mental patients in Sweden at the time, with an emphasis on mechanistic physical treatments with drugs and electroconvulsive therapy, ignoring the content and pain of the patients' inner worlds. Elgard Johnsson, writing in 1985, acknowledges changes in standard treatment methods by that time.

Pathos and poetic imagery coexist with cruel caricature. The ward doctor, Napoleon, operates according to the ‘medical model’ Bible of the medical director, God the Father, and the social worker trainee, who wants to try something different, is God the Mother. There is a drug aria, a neuroleptic chorus, an aria about ‘psychotic states of mind caused by biochemical changes in the brain…’, occupational therapy ‘all evil will be cured by hard work…’ and much else that will be familiar to all who have worked in the not-so-old mental hospitals.

The performances and recording are exemplary and the instrumental music, both original and accessible, never over-whelms the singers - music theatre, perhaps, without the elaboration and complexity of most contemporary operas. The lavishly illustrated 100 page booklet has a useful English summary of the Swedish text.

This is an unusual serious theatre work, marvellously realised for CD, absorbing throughout and moving too - once heard, never forgotten. It merits UK production and the attention of psychiatrists.