Is she touched by God? Hearing voices due to mental illness? Or confused by everyone telling her who she should be?

Such is the dramatic nexus of Missy Mazzoli's Breaking the Waves. Based on the 1996 Lars von Trier film, it's the tale of a rural Scottish girl whose marital devotion becomes a road to sadistic ruin in one of the more talked-about new operas of the fall.

Following Opera Philadelphia's five premiere performances between Thursday and Oct. 1 at the Perelman Theater, Breaking the Waves is already booked in New York's prestigious Prototype Festival in January and then London's Hackney Empire. Much of the advance buzz has to do with the creative team, whose members are acknowledged as significant talents in fringier circles and ready to make their places in the mainstream.

"I feel like everything I've written ... and lived through up to this point has led to this piece," said composer Missy Mazzoli, 35, born in Lansdale and well known in the alt-music terrains of Brooklyn. "I feel like I've been able to put my full, true, authentic artistic self in this piece ...

"I'd love for this to be a turning point. But I'll feel that the opera is successful if people can come to it and feel that it's something they've never seen before ... something that comes out of operatic tradition but is definitely written in 2016 by a bunch of people in their mid-30s."

In contrast to her music for her all-female, post-rock band Victoire, Mazzoli's musical language for Breaking the Waves has been described as "Janácek, but now," for a story whose operatic potential is obvious. The spare dialogue, expansive Scottish landscapes, and edgy emotions of the von Trier film seem to cry out for music to explore all that is under the surface.

The story is also full of deeply private moments when the heroine, Bess McNeill, is talking to God and getting arrestingly specific answers. Librettist Royce Vavrek reveals early on that Bess has a history of hospitalizations, and not for physical ailments. Whether experiencing religiosity or auditory hallucinations, she musically channels her voices with a gray area between speech and song, accompanied by electric guitar.

The effect is intentionally ambiguous, says stage director James Darrah: "The piece leaves it unresolved. But it does end with a miracle. ... " And that is? Spoiler alert: Church bells that come from everywhere and nowhere.

With a degree of sex and violence that made Helena Bonham Carter walk away from the central film role (it was eventually played by Emily Watson), the plot leading up to the miracle is something that would have been unthinkable at Opera Philadelphia only 16 years ago. Back then, a stylized poster advertising the opera Salome had to be amended with a few veils.

"It's an R-rated opera. Would you go to R-rated things as a grown-up? Of course you would," said Opera Philadelphia president and general director David Devan, who shepherded the opera into being. "We're making disclaimers. We're telling people there is nudity and stylized violence. ... We did talk to the cast. ... To do the job you have to be prepared to be nude for certain portions, though, as it turns out, not as much as we thought." The Guggenheim Museum Works & Process presentation on Sept. 12 in New York was in concert form - and thus fully clothed.

Chosen for the central role of Bess on the strength of performing Pierrot Lunaire (an extravagant portrayal of madness), Philadelphia-born soprano Kiera Duffy is taking on the role of an innocent girl who takes to having sex with strangers - in what would have to be the most complex singing and acting role of her  - or maybe anybody else's  - career.  Duffy is a von Trier fan; the film, she says, is nearly "perfect."

"But I'm not going to lie. There are moments when I'm thinking, 'What is my Irish Catholic family going be thinking in certain scenes?' " she says. "I've given them fair warning."

What convinced Devan to go forward with the opera - and a $1.2 million budget that's low for grand opera but high for the Perelman Theater - was the humanity he believed Mazzoli (a composer in residence with the company 2012-15) and Vavrek (who originated the idea) would bring to the piece. Although the film has been branded misogynist in some quarters, the ultrafeminist Mazzoli connects with the story as a three-dimensional portrait of a woman whose church, family, doctor, and husband are hemming her in from all sides with their intractable ideas of how she should behave and act.

Mazzoli floats the idea that the character's supposed mental illness is in fact an expression of emotion that's not encouraged or understood in rural, Calvinist 1970s Scotland. Indeed, these are people without words for what they're feeling. "The challenge," said Vavrek, "was to create text that was simple but could carry an aria."

Traveling to the Isle of Skye, where the opera is set, Mazzoli and Vavrek recorded the local accents and dialects in a community that's still so isolated that, even on major roads, sheep have the right of way. But what seems to have impressed the composer most is the dramatic seaside vistas: "I was struck by the sharp contrast and the violence of the landscape. Rock formations jut out of the water. It's a very quiet place, but the landscape seemed to be screaming at me."

Mazzoli has written a more loosely plotted opera, Song from the Uproar, but Breaking is her first foray into more traditional narrative, a direction she's been headed all along. Even with her band Victoire - which she says is actually a modern chamber ensemble that happens to be plugged in - she treated melodies, chords, and harmonies as characters. Her decision to use electric guitar in Breaking to suggest the voice of God isn't some act of youthful irreverence: "It has a ambiguity and strangeness." Interestingly, her Victoire albums have religion-tinged titles such as Cathedral City and Vespers for a New Dark Age.

How Philadelphia audiences receive Breaking the Waves may say as much about the city as it does the opera. "It's a very different city than the one I knew growing up," Duffy says. "We're in the midst of a renaissance. There's palpable youthful creative energy permeating the city. It's an exciting time to be here. And there's a vibe that this town is really going to get this piece."