This is a novel about Beethoven's deafness and the history of his various love lives with different women. It is also a novel about Napoleon's march on Russia 1812, and, more importantly, about his lonely retreat, separated from his army.

But these subjects can be construed to be of psychiatric interest. As the author says in the Foreword,

"But what is psychiatry? Psychiatry is extremity. And this is a novel of extremity, the extremity of Beethoven’s “fiery, active temperament” in love and Napoleon at his military nadir of 1812. And I think it can be argued that all forms of personal extremity are forms of madness. Or rather, the mind in extremity occupies a world of madness, that is to say, of experience unreachable to most other, so-called sane people...

Napoleon on his retreat from Russia in the chapter Incognito is quite clearly mad in the sense of being deluded, and his vast schemes to be the Emperor of Europe are in fact typical of what a psychiatrist today would refer to as the grandiose thinking of a manic depressive. Further, Josephine speaks of the “unspoken malady that [still] consumes him.” Is that malady physical or mental? 

And Kay Redfield Jamison in Touched With Fire quotes psychiatric evidence that Beethoven’s famed eccentricity at least bordered, if did not cross, the line of the psychotic".

A WOMAN SCORNED

            Humiliation! Standing in the throne room whilst the Emperor read out his reasoning for the divorce. And most of the bitching dog kennel of his family were at his side, in full silk and robes, their stone faces concealing their delight that the struggle of thirteen years was ending with the triumph of their will over my own. How often silk socks conceal eczema! There stood Louis the mad King of Holland, Caroline the Queen of Naples, Jérôme the King of Westphalia, and Pauline the pretty but dim-witted Princess Borghese, together through the second born of their number the most crowned family in Europe. Madame Mère, the prize bitch that bred them stayed away, but I knew she'd be smiling in secret even as my marriage vanished before me. Coward, coward, coward! I could have scratched out her eyes and swallowed them whole, no matter the consequences.