All too seldom does a film see into the deepest fantasies of the troubled mind. These frighteningly profound insights often occur where we least expect – why did Moonlight, for example, cause me to sob uncontrollably and contemplate leaving half way through? It seemed to me impossible that a film set worlds away from my comparatively privileged upbringing could display a conflict of identity so startlingly relatable that its imagery would haunt me for days.

Never has this been truer than in viewing Pedro Almodóvar’s La piel que habito [The Skin I Live In]. Consulting the array of four-star reviews, one finds a drab uniformity amongst pretentious cis males indulging in tedious Hitchcock comparisons to make up their word counts. The horror of Antonio Banderas’s Robert Ledgard is understated, and the surgery he performs on his “human guinea pig” is dismissed flippantly as Frankensteinian immorality – a ‘modern’ Modern Prometheus. Few come close to insightful reflection on its underlying power, and the unthinkable tragedy at its heart.

Just as striking an omission is the surrealist spiral of Alberto Iglesias’s soundtrack. Having scored every Almodóvar film since La flor de mi secreto [The Flower of My Secret] in 1995, he seems to have captured the director’s exquisite texture with great vibrancy. Indeed, one need only turn to Julieta or Volver to observe the sheer colour bursting from the scene, largely due to Iglesias’s measured layering of mystery and eroticism. It can come through even in the darkest moments, or the black-and-white short film Shrinking Lover that features in Hable con ella [Talk to Her]. Almodóvar has credited Iglesias with transforming this into “a lyrical, emotive profound fantasy, despite its apparent frivolity”. It is pertinent judgement for the musical gloss embalming La piel que habito, and its self-destructive love triangle of beauty, fetishism, and torture.

A flashback reveals Ledgard has kidnapped his daughter’s rapist, Vicente, and has started surgically, hormonally, and socially morphing him into his dead wife, Vera; a premise so sadistically fucked-up one can only assume Almodóvar himself is haunted by such dreams at night. Using impossible, hideously unethical, and expensive techniques, we are forced to witness the complete transformation of a male into a female, with every aspect of a woman’s body being painstakingly perfected. It is a process that had me scouring the internet for the actuality, or even the potentiality, of such a procedure, but to no avail. A miracle is performed, but on an individual for whom it is a most contemptible curse.

The dominating visual cue here is, naturally, ‘la piel’, a symbol of imprisonment impossible to escape. The discomfort a transgender person feels in their body is thus brought to the forefront of the score, alongside the notion that one’s identity may further be expressed through the clothes they wear. In an act of violent frenzy, ‘Vera’ pounces upon his dresses and tears them to shreds before sucking them out of existence with a vacuum cleaner. Mirroring his frantic panting is an hysteric string orchestra playing rapid arpeggios as the violin screeches higher and higher through a scratching tremolo. The sense of urgency and alarm is all-consuming, clawing at the viewer’s conscience and implanting within them an empathy for unshakeable malaise. Iglesias’s music burns and rages with an inextinguishable passion that can only end with a sigh of futility.

Were this the story of a pre-surgery trans woman blossoming into the beautiful person they longed and deserved to be, this might have been a charming, albeit twisted, romantic tale – a La Belle et La Bête of sorts. Once Vicente is no longer recognisable, the parallels to de Villeneuve’s classic French tale come together and he apparently embraces Ledgard’s desire. There is a lilting piano that twinkles in and out of these moments, a sorrowful love expressed as unwilling acquiescence. Accompanied by a mournful cello, Iglesias elegantly presents musical pangs for a life that might have been. The theme returns in the credits, before being sharply diverted by a searing violin solo that reminds us of ‘La identidad inaccesible’. Had proceedings ended on this bizarrely romantic note, the film’s alleged transphobia and lack of understanding would certainly have been true.

Alas, Almodóvar has one final, yet undoubtedly essential, twist to spin into his yarn. The trans fantasy goes beyond the physical to the aesthetic: Chanel products arrive via dumbwaiter, a message of thanks to Jean-Paul Gautier flashes onscreen at the close. Freedom comes with a calming of tempo, providing sharp contrast to the earlier claustrophobia. Nevertheless, Vera’s way of thanks is to put a bullet inside both the monster and the devilish mother that created him, restoring the rapture in ‘Duelo final’. We leave with a sombre melody, faint in the offing but nonetheless distinct, titled ‘La pared-dialio’ – the daily wall. His skin has solidified, forming an impenetrable prison around him. The chilling final line confirms Almodóvar’s desperate message: “I’m Vicente”.

Give a man the ideal female body, dress it up with finery and wealth, and he will remain inherently male. Ledgard, like so much of the ignorant modern world, has made an unforgivable mistake – that one can change the gender of the brain. The fear induced by this might explain why critics branded the film a ‘horror’, assisted by the crescendoing trumpet staccati in ‘El asalto del hombre tigre’. Such blatant attacks fail to faze Vicente, mere distractions from the psychological terrors he has to endure in his disconnected anatomical shell. The end highlights this with a raw punch to the groin as we realise Vicente will now face the same biting dysphoria that transgender people endure on a daily basis. Some may deem this fitting punishment for his crimes, adding another confliction into the already unravellable moralistic web. I for one could not reconcile imposing such a fate on anyone, its sheer evil evoked by the dissonance of Iglesias’s troublingly gorgeous score.